Assessment of the impact of quality improvement interventions on the quality of sick child care provided by Health Extension Workers in Ethiopia.
BACKGROUND
Ethiopia has scaled up integrated community case management of childhood illness (iCCM), including several interventions to improve the performance of Health Extension Workers (HEWs). We assessed associations between interventions to improve iCCM quality of care and the observed quality of care among HEWs.


METHODS
We assessed iCCM implementation strength and quality of care provided by HEWs in Ethiopia. Multivariate logistic regression analyses were performed to assess associations between interventions to improve iCCM quality of care and correct management of iCCM illnesses.


RESULTS
Children who were managed by an HEW who had attended a performance review and clinical mentoring meeting (PRCMM) had 8.3 (95% confidence interval (CI) 2.34-29.51) times the odds of being correctly managed, compared to children managed by an HEW who did not attend a PRCMM. Management by an HEW who received follow-up training also significantly increased the odds of correct management (odds ratio (OR) = 2.09, 95% CI 1.05-4.18). Supervision on iCCM (OR = 0.63, 95% CI 0.23-1.72) did not significantly affect the odds of receiving correct care.


CONCLUSIONS
These results suggest PRCMM and follow-up training were effective interventions, while implementation of supportive supervision needs to be reviewed to improve impact.
Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Nathan P
NP
Miller
Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Agbessi
A
Amouzou
Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Elizabeth
E
Hazel
United Nations Children's Fund (UNICEF) Ethiopia Country Office, Addis Ababa, Ethiopia.
Hailemariam
H
Legesse
United Nations Children's Fund (UNICEF) Ethiopia Country Office, Addis Ababa, Ethiopia.
Tedbabe
T
Degefie
ABH Services, PLC, Addis Ababa, Ethiopia.
Mengistu
M
Tafesse
Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Robert E
RE
Black
Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Jennifer
J
Bryce
D019090:Case Management / Q000592:standards*; D000067576:Child Health; D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D002983:Clinical Competence; D003150:Community Health Workers / Q000193:education / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards; D005002:Ethiopia; D006801:Humans; D007223:Infant; D016015:Logistic Models; D000071252:Mentoring; D016017:Odds Ratio; D058996:Quality Improvement; D011787:Quality of Health Care