Determinants of community health workers' adherence to clinical guidelines for the management of ill children in Siaya, Kenya

• Main Author: Rowe, Samantha Y
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2005
• Subjects: Guidelines; Medical treatment; Pediatrics; Public health; Studies
• ISBN: 054215398X; 9780542153983

This dissertation describes 4 studies of determinants of community health workers' (CHW) adherence to clinical guidelines for the management of ill children in Siaya, Kenya. Study I. To assess the effect of several quality improvement interventions and other factors on CHW practices, we analyzed a sample of ill-child consultations performed in a hospital from February–March 2001. Refresher training, supervision, community women's involvement in CHW selection, adequacy of medicine supplies, and use of a guideline flipchart during consultations were not significantly associated with adherence to overall or treatment-specific guidelines for the integrated management of all illnesses in a child. Several patient characteristics were significantly associated with adherence. Study II. To identify which interventions were related specifically to malaria treatment quality, we analyzed a sample of children with malaria treated during Study I. An adequate medicine supply in the past year and use of a flipchart during the consultation were significantly associated with correct malaria treatment. Refresher training, supervision, and community women's involvement in CHW selection were not related to correct malaria treatment. Several patient characteristics were significantly associated with correct malaria treatment. Study III. To assess the effect of refresher training on adherence, we analyzed a sample of ill-child consultations performed in communities from March 1997–May 2002. The first refresher training's effect on adherence differed by several patient characteristics, including severity of illness and symptoms. The second refresher training was associated with a decline in adherence. Study IV. To assess whether results from an evaluation where CHWs were observed reflected normal everyday CHW practices, we compared the proportion of ill-child consultations with treatment errors when CHWs were observed and not observed. CHWs made fewer treatment errors when they were observed. Conclusions. This dissertation found that several quality improvement interventions were generally ineffective for a CHW program in a real life setting, and several “non-intervention” factors influenced adherence. We recommend that the CHW program revise its strategies to improve and maintain CHWs' adherence to guidelines, particularly its refresher training strategy.