title: Improving the quality of care of children in community clinics: an intervention and evaluation in Bangladesh.
abstract: METHODS
  Community health care providers (CHCPs) in 40 rural community clinics of Comilla district, Bangladesh, were trained using a newly developed case-management job aid based on the World Health Organization Integrated Management of Childhood Illness and a communication guide.
  
  
  OBJECTIVE
  To assess 1) the change in knowledge of the CHCPs after training; 2) the absolute quality of care provided by the CHCPs (determined as the proportion of children aged <5 years [under-fives] correctly diagnosed, treated and referred); and 3) the consultation behaviour of the CHCPs.
  
  
  METHODS
  Change in knowledge was assessed by tests pre-and post-training. The quality of care was determined by reassessments at the clinic exit by a medical officer, without a baseline comparison. Consultation behaviour was assessed through direct observation. The study was performed during 2014-2015.
  
  
  RESULTS
  The mean standard knowledge score of the CH-CPs increased from 19 to 25 (P < 0.001). Of 1490 under-fives examined, 91% were correctly diagnosed, 86% were correctly treated and 99.5% received a correct referral decision. The CHCPs performed well on most of the measures of good communication, although one third did not explain the diagnosis and treatment to patients.
  
  
  CONCLUSIONS
  The training was effective in changing knowledge. The CHCPs applied the knowledge gained and provided good quality care. Following these results, the Bangladesh Ministry of Health and Family Welfare has scaled up the training nationwide. The lessons learnt should be useful for other countries.
authors.affiliation: ARK Foundation, Dhaka, Bangladesh ; Department of Economics, University of Dhaka, Dhaka, Bangladesh.
authors.forename: R
authors.initials: R
authors.lastname: Huque
authors.affiliation: ARK Foundation, Dhaka, Bangladesh.
authors.forename: F
authors.initials: F
authors.lastname: Ahmed
authors.affiliation: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
authors.forename: R
authors.initials: R
authors.lastname: King
authors.affiliation: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
authors.forename: J
authors.initials: J
authors.lastname: Walley
authors.affiliation: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Hicks
authors.affiliation: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
authors.forename: H
authors.initials: H
authors.lastname: Elsey
authors.affiliation: ARK Foundation, Dhaka, Bangladesh.
authors.forename: S
authors.initials: S
authors.lastname: Nasreen
authors.affiliation: International Union Against Tuberculosis and Lung Disease South-East Asia Office, New Delhi, India.
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
authors.forename: J N
authors.initials: JN
authors.lastname: Newell
keywords: antibiotic reduction; childhood pneumonia; primary care