Coaching Community Health Volunteers in Integrated Community Case Management Improves the Care of Sick Children Under-5: Experience from Bondo, Kenya

Background: Shortages of healthcare workers is detrimental to the health of communities, especially children. This paper describes the process of capacity building Community Health Volunteers (CHVs) to deliver integrated preventive and curative package of care of services to manage common childhood illness in hard-to-reach communities in Bondo Subcounty, Kenya. Methods: A pre-test/post-test single-group design was used to assess changes in knowledge and skills related to integrated community case management (iCCM) among 58 Community Health Volunteers who received a six-day iCCM clinical training and an additional 3-week clinical coaching at health facilities. Thereafter, community health extension workers and health managers provided supportive supervision over a six-month period. Skills were assessed before the six-day training, during coaching, and after six months of iCCM implementation. Results: CHVs knowledge assessment scores improved from 54.5% to 72.9% after the six-day training (p < 0.001). All 58 CHVs could assess and classify fever and diarrhoea correctly after 3–6 weeks of facility-based clinical coaching; 97% could correctly identify malnutrition and 80%, suspected pneumonia. The majority correctly performed four of the six steps in malaria rapid diagnostic testing. However, only 58% could draw blood correctly and 67% dispose of waste correctly after the testing. The proportion of CHV exhibiting appropriate skills to examine for signs of illness improved from 4% at baseline to 74% after 6 months of iCCM implementation, p < 0.05. The proportion of caregivers in intervention community units who first sought treatment from a CHV increased from 2 to 31 percent (p < 0.001). Conclusions: Training and clinical coaching built CHV’s skills to manage common childhood illnesses. The CHVs demonstrated ability to follow the Kenya iCCM algorithm for decision-making on whether to treat or refer a sick child. The communities’ confidence in CHVs’ ability to deliver integrated case management resulted in modification of care-seeking behaviour

Clinicopathological discrepancies in the diagnoses of childhood causes of death in the CHAMPS network: An analysis of antemortem diagnostic inaccuracies

Introduction Determining aetiology of severe illness can be difficult, especially in settings with limited diagnostic resources, yet critical for providing life-saving care. Our objective was to describe the accuracy of antemortem clinical diagnoses in young children in high-mortality settings, compared with results of specific postmortem diagnoses obtained from Child Health and Mortality Prevention Surveillance (CHAMPS).Methods We analysed data collected during 2016–2022 from seven sites in Africa and South Asia. We compared antemortem clinical diagnoses from clinical records to a reference standard of postmortem diagnoses determined by expert panels at each site who reviewed the results of histopathological and microbiological testing of tissue, blood, and cerebrospinal fluid. We calculated test characteristics and 95% CIs of antemortem clinical diagnostic accuracy for the 10 most common causes of death. We classified diagnostic discrepancies as major and minor, per Goldman criteria later modified by Battle.Results CHAMPS enrolled 1454 deceased young children aged 1–59 months during the study period; 881 had available clinical records and were analysed. The median age at death was 11 months (IQR 4–21 months) and 47.3% (n=417) were female. We identified a clinicopathological discrepancy in 39.5% (n=348) of deaths; 82.3% of diagnostic errors were major. The sensitivity of clinician antemortem diagnosis ranged from 26% (95% CI 14.6% to 40.3%) for non-infectious respiratory diseases (eg, aspiration pneumonia, interstitial lung disease, etc) to 82.2% (95% CI 72.7% to 89.5%) for diarrhoeal diseases. Antemortem clinical diagnostic specificity ranged from 75.2% (95% CI 72.1% to 78.2%) for diarrhoeal diseases to 99.0% (95% CI 98.1% to 99.6%) for HIV.Conclusions Antemortem clinical diagnostic errors were common for young children who died in areas with high childhood mortality rates. To further reduce childhood mortality in resource-limited settings, there is an urgent need to improve antemortem diagnostic capability through advances in the availability of diagnostic testing and clinical skills