Mailman School of Public Health, Columbia University, New York City, NY, USA.
Ifakara Health Institute, Dar es Salaam, Tanzania.
Int J Health Policy Manag. 2018 Dec 1;7(12):1097-1109. doi: 10.15171/ijhpm.2018.63.
Community health worker (CHW) interventions to manage childhood illness is a strategy promoted by the global health community which involves training and supporting CHW to assess, classify and treat sick children at home, using an algorithm adapted from the Integrated Management of Childhood Illness (IMCI). To inform CHW policy, the Government of Tanzania launched a program in 2011 to determine if community case management (CCM) of malaria, pneumonia and diarrhea could be implemented by CHW in that country.
This paper reports the results of an observational study on the CCM service delivery quality of a trial cohort of CHW in Tanzania, called WAJA. In 2014, teams of data collectors, employees of the Ministry of Health and Social Welfare trained in IMCI, assessed the IMCI skills rendered by a sample of WAJA on sick children who presented to WAJA with illness signs and symptoms in their communities. The assessment included direct observations of WAJA IMCI episodes and expert re-assessment of the same children seen by WAJA to assess the congruence between the assessment, classification and treatment outcomes of WAJA cases and those from cases conducted by expert re-assessors.
In the majority of cases, WAJA correctly assess sick children for CCM-treatable illnesses (malaria, pneumonia, and diarrhea) and general danger signs (90% and 89%, respectively), but too few correctly assess for physical danger signs (39%); on classification in the majority of cases (73%) WAJA correctly classified illness, though more for CCM-treatable illnesses (83%). In majority of cases (78%) WAJA treated children correctly (84% of malaria, 74% pneumonia, and 71% diarrhea cases). Errors were often associated with lapses in health systems support, mainly supervision and logistics.
CCM is a feasible strategy for CHW in Tanzania, who, in the majority of cases, implemented the approach as well as IMCI expert re-assessors. Nevertheless, for CCM to be effective, in Tanzania, a strategy to implement it must be coordinated with efforts to strengthen local health systems.
社区卫生工作者（CHW）干预儿童疾病管理是全球卫生界推广的一项策略，涉及培训和支持 CHW 使用改编自儿童疾病综合管理（IMCI）的算法在家中评估、分类和治疗患病儿童。为了为 CHW 政策提供信息，坦桑尼亚政府于 2011 年启动了一个项目，以确定该国的 CHW 是否可以实施社区病例管理（CCM）治疗疟疾、肺炎和腹泻。
本文报告了坦桑尼亚 WAJA 试验队列的 CHW 社区病例管理服务提供质量的观察性研究结果。2014 年，由卫生部和社会福利部的数据收集员团队进行培训，使用 IMCI 对 WAJA 的一个样本进行评估，以评估在社区中出现疾病症状和体征的生病儿童的 IMCI 技能。评估包括对 WAJA 的 IMCI 发作的直接观察和对由 WAJA 看到的相同儿童的专家重新评估，以评估 WAJA 病例的评估、分类和治疗结果与专家重新评估者的评估、分类和治疗结果之间的一致性。
在大多数情况下，WAJA 正确评估了可进行 CCM 治疗的疾病（疟疾、肺炎和腹泻）和一般危险体征（分别为 90%和 89%），但太少的病例正确评估了身体危险体征（39%）；在大多数情况下（73%）WAJA 正确分类了疾病，但 CCM 可治疗的疾病更多（83%）。在大多数情况下（78%）WAJA 正确治疗了儿童（疟疾 84%，肺炎 74%，腹泻 71%）。错误通常与卫生系统支持的失误有关，主要是监督和后勤。
CCM 是坦桑尼亚 CHW 的可行策略，他们在大多数情况下实施了这一方法以及 IMCI 专家重新评估。然而，为了使 CCM 有效，在坦桑尼亚，实施这一策略的策略必须与加强当地卫生系统的努力相协调。
