Rowe Samantha Y, Kelly Jane M, Olewe Monica A, Kleinbaum David G, McGowan John E, McFarland Deborah A, Rochat Roger, Deming Michael S
Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, 4th Floor, Atlanta, GA 30322, USA.
Trans R Soc Trop Med Hyg. 2007 Feb;101(2):188-202. doi: 10.1016/j.trstmh.2006.02.023. Epub 2006 Oct 24.
Evaluation of a community health worker (CHW) programme in Siaya district, Kenya, showed CHWs commonly made errors in managing childhood illness. We assessed the effect of multiple interventions on CHW healthcare practices. A sample of 192 ill-child consultations performed by 114 CHWs in a hospital outpatient department between February and March 2001 were analysed. The mean percentage of assessment, classification and treatment procedures performed correctly for each child was 79.8% (range 13.3-100%). Of the 187 children who required at least one treatment or referral to a health facility, only 38.8% were prescribed all treatments (including referral) recommended by the guidelines. Multivariate analyses found no evidence that the intervention-related factors studied (refresher training, supervision, involvement of community women in the CHW selection process, adequacy of medicine supplies, and use of a guideline flipchart during consultations) were significantly associated with overall or treatment-specific guideline adherence. A multivariate linear regression analysis revealed that several non-intervention-related factors, such as patient characteristics, were significantly associated with overall guideline adherence. Given that our study was cross-sectional and our measurement of exposure to several interventions was based on CHW recall, the estimated effects of the interventions should be interpreted with caution. Despite these limitations, however, our results raise questions about the effectiveness, in the setting of Siaya district, of several interventions commonly used to improve the quality of care given by CHWs.
对肯尼亚锡亚区一项社区卫生工作者（CHW）项目的评估显示，社区卫生工作者在管理儿童疾病时普遍会犯错误。我们评估了多种干预措施对社区卫生工作者医疗保健实践的影响。对2001年2月至3月期间114名社区卫生工作者在医院门诊部进行的192例患病儿童会诊样本进行了分析。每个儿童正确进行评估、分类和治疗程序的平均百分比为79.8%（范围为13.3 - 100%）。在187名需要至少一种治疗或转诊至医疗机构的儿童中，只有38.8%的儿童按照指南建议接受了所有治疗（包括转诊）。多变量分析未发现证据表明所研究的干预相关因素（进修培训、监督、社区女性参与社区卫生工作者选拔过程、药品供应充足以及会诊期间使用指南活页图表）与总体或特定治疗的指南依从性显著相关。多变量线性回归分析显示，一些与干预无关的因素，如患者特征，与总体指南依从性显著相关。鉴于我们的研究是横断面研究，且我们对几种干预措施暴露情况的测量基于社区卫生工作者的回忆，因此对干预措施的估计效果应谨慎解读。然而，尽管存在这些局限性，我们的结果仍对锡亚区常用的几种旨在提高社区卫生工作者所提供护理质量的干预措施的有效性提出了质疑。
