ArticleHealth policy and planning2013
Quality of sick child care delivered by Health Surveillance Assistants in Malawi.
Article in Health policy and planning, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 3 of them syntheses that pooled it.
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60 citing papers in PubMed, 3 syntheses or guidelines pooled it, 80 citations in OpenAlex.
- Pooled it
- Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences.Human resources for health · 2022Pooled it
- Community health workers and stand-alone or integrated case management of malaria: a systematic literature review.The American journal of tropical medicine and hygiene · 2014Pooled it
- Introducing post-discharge malaria chemoprevention (PMC) for management of severe anemia in Malawian children: a qualitative study of community health workers' perceptions and motivation.BMC health services research · 2018Trial
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- Effects of the integrated Community Case Management of Childhood Illness Strategy on Child Mortality in Ethiopia: A Cluster Randomized Trial.The American journal of tropical medicine and hygiene · 2016Trial
- Exploring reference standards for the measurement of respiratory rate in children under 5 years of age: a scoping review.BMJ paediatrics open · 2026Article
- Evaluating the performance of a video expert panel in assessing respiratory rate from recorded videos for the diagnosis of non-severe paediatric pneumonia.BMJ open respiratory research · 2025Article
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- Community Health Worker programmes' integration into national health systems: Scoping review.African journal of primary health care & family medicine · 2023Article
- Improving health and social systems for all children in LMICs: structural innovations to deliver high-quality services.Lancet (London, England) · 2022Review
- Observational
- A mixed-methods study exploring adherence to the referral of severely sick children in primary health care in Southern Ethiopia.Archives of public health = Archives belges de sante publique · 2021Article
- Measuring Knowledge of Community Health Workers at the Last Mile in Liberia: Feasibility and Results of Clinical Vignette Assessments.Global health, science and practice · 2021Article
- Implementing integrated community case management during conflict in Yemen.Journal of global health · 2020Review
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- Testing a simplified tool and training package to improve integrated Community Case Management in Tanganyika Province, Democratic Republic of Congo: a quasi-experimental study.Journal of global health · 2019Article
- Unpacking healthcare waste management at rural village health clinics in the Ntcheu District (Malawi).Environmental monitoring and assessment · 2019Article
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the quality of care provided by Health Surveillance Assistants (HSAs)-a cadre of community-based health workers-as part of a national scale-up of community case management of childhood illness (CCM) in Malawi.
methodsTrained research teams visited a random sample of HSAs (n = 131) trained in CCM and provided with initial essential drug stocks in six districts, and observed the provision of sick child care. Trained clinicians conducted 'gold-standard' reassessments of the child. Members of the survey team also interviewed caregivers and HSAs and inspected drug stocks and patient registers.
findingsHSAs provided correct treatment with antimalarials to 79% of the 241 children presenting with uncomplicated fever, with oral rehydration salts to 69% of the 93 children presenting with uncomplicated diarrhoea and with antibiotics to 52% of 58 children presenting with suspected pneumonia (cough with fast breathing). About one in five children (18%) presented with danger signs. HSAs correctly assessed 37% of children for four danger signs by conducting a physical exam, and correctly referred 55% of children with danger signs.
conclusionMalawi's CCM programme is a promising strategy for increasing coverage of sick child treatment, although there is much room for improvement, especially in the correct assessment and treatment of suspected pneumonia and the identification and referral of sick children with danger signs. However, HSAs provided sick child care at levels of quality similar to those provided in first-level health facilities in Malawi, and quality should improve if the Ministry of Health and partners act on the results of this assessment.
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