Siribié Mohamadou, Ajayi IkeOluwapo O, Nsungwa-Sabiiti Jesca, Afonne Chinenye, Balyeku Andrew, Falade Catherine O, Gansane Zakaria, Jegede Ayodele S, Ojanduru Lillian, Oshiname Frederick O, Kabarungi Vanessa, Kyaligonza Josephine, Sanou Armande K, Sermé Luc, Castellani Joëlle, Singlovic Jan, Gomes Melba
Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
Department of Epidemiology and Medical Statistics.
Clin Infect Dis. 2016 Dec 15;63(suppl 5):S264-S269. doi: 10.1093/cid/ciw624.
Use of community health workers (CHWs) to increase access to diagnosis and treatment of malaria is recommended by the World Health Organization. The present article reports on training and performance of CHWs in applying these recommendations.
Two hundred seventy-nine CHWs were trained for 3-5 days in Burkina Faso, Nigeria, and Uganda, and 19 were certified to diagnose and treat only uncomplicated malaria and 235 to diagnose and treat both uncomplicated and severe malaria. Almost 1 year after training, 220 CHWs were assessed using standard checklists using facility staff responses as the reference standard.
Training models were slightly different in the 3 countries, but the same topics were covered. The main challenges noticed were the low level of education in rural areas and the involvement of health staff in the supervision process. Overall performance was 98% (with 99% in taking history, 95% in measuring temperature, 85% for measuring respiratory rates, 98% for diagnosis, 98% for classification, and 99% for prescribing treatment). Young, single, new CHWs performed better than their older, married, more experienced counterparts.
Training CHWs for community-based diagnosis and treatment of uncomplicated and severe malaria is possible with basic and refresher training and close supervision of CHWs' performance.
ISRCTRS13858170.
世界卫生组织建议利用社区卫生工作者（CHW）来增加疟疾诊断和治疗的可及性。本文报告了社区卫生工作者在应用这些建议方面的培训和表现。
在布基纳法索、尼日利亚和乌干达，279名社区卫生工作者接受了3至5天的培训，其中19人获得仅诊断和治疗非复杂性疟疾的认证，235人获得诊断和治疗非复杂性及重症疟疾的认证。培训后近1年，使用标准检查表对220名社区卫生工作者进行评估，以医疗机构工作人员的回答作为参考标准。
3个国家的培训模式略有不同，但涵盖的主题相同。注意到的主要挑战是农村地区教育水平较低以及卫生工作人员参与监督过程。总体表现为98%（问诊为99%，测量体温为95%，测量呼吸频率为85%，诊断为98%，分类为98%，开处方治疗为99%）。年轻、单身、新入职的社区卫生工作者比年长、已婚、经验更丰富的同行表现更好。
通过基础培训和进修培训以及对社区卫生工作者表现的密切监督，对其进行基于社区的非复杂性和重症疟疾诊断与治疗的培训是可行的。
ISRCTRS13858170。
