{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:46:13Z","timestamp":1791931573944,"version":"4.3.4"},"reference-count":20,"publisher":"Wiley","issue":"S471","license":[{"start":{"date-parts":[[2018,12,20]],"date-time":"2018-12-20T00:00:00Z","timestamp":1545264000000},"content-version":"vor","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/legalcode"}],"funder":[{"DOI":"10.13039\/100007855","name":"Alliance for Health Policy and Systems Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007855","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004441","name":"Styrelsen f\u00f6r Internationellt Utvecklingssamarbete","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004441","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000278","name":"Department for International Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000278","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Paediatrica"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess the effect of enhanced supportive supervision of lady health workers (<jats:styled-content style=\"fixed-case\">LHW<\/jats:styled-content>s) by lady health supervisors on integrated community case management of childhood pneumonia and diarrhoea.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of thirty\u2010four supervisors were randomly assigned to intervention and comparison arms. The intervention included enhanced training of supervisors on supervisory skills and written feedback to <jats:styled-content style=\"fixed-case\">LHW<\/jats:styled-content>s by supervisors. The performance of both cadres was assessed three times. Household surveys judged caregiver practices.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Intervention arm <jats:styled-content style=\"fixed-case\">LHW<\/jats:styled-content>s performed better than those in the comparison arm in assessing dehydration (92% [n\u00a0=\u00a025] vs 64% [n\u00a0=\u00a025]) and in classifying diarrhoea correctly (68% [n\u00a0=\u00a025] vs 40% [n\u00a0=\u00a025]). The two arms differed little in correct disease classification for pneumonia (44% [n\u00a0=\u00a025] vs 40% [n\u00a0=\u00a025]). Supervisory performance of intervention arm supervisors was better than that in the comparison arm in correcting the workers\u2019 clinical examination skills (64% [n\u00a0=\u00a025] vs 40% [n\u00a0=\u00a025]) and more frequent feedback. In the household survey, only 18% (n\u00a0=\u00a02182) intervention and 23% (n\u00a0=\u00a02197) comparison arm caregivers considered <jats:styled-content style=\"fixed-case\">LHW<\/jats:styled-content>s capable of providing diarrhoea and pneumonia care. Commodities for integrated community case management were not regularly available to workers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Supportive supervision can improve community case management performance. Support through refresher training, logistics and commodities is essential.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apa.14282","type":"journal-article","created":{"date-parts":[[2018,12,20]],"date-time":"2018-12-20T15:52:28Z","timestamp":1545321148000},"page":"63-71","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Improving community health worker performance through supportive supervision: a randomised controlled implementation trial in Pakistan"],"prefix":"10.1111","volume":"107","author":[{"given":"Wafa","family":"Aftab","sequence":"first","affiliation":[{"name":"Department of Community Health Sciences Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6913-7564","authenticated-orcid":false,"given":"Fauziah","family":"Rabbani","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kashif","family":"Sangrasi","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shagufta","family":"Perveen","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aysha","family":"Zahidie","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamim Ahmed","family":"Qazi","sequence":"additional","affiliation":[{"name":"Department of Maternal, Newborn, Child and Adolescent Health World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,20]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Pneumonia and Diarrhea Progress Report 2015: Sustainable Progress in the Post\u20102015 Era International Vaccine Access Center (IVAC) Johns Hopkins Bloomberg School of Public Health;2015."},{"key":"e_1_2_12_3_1","unstructured":"WHO\/UNICEF Joint Statement integrated community case management (iCCM).WHO\/UNICEF;2012."},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61376-2"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0065160"},{"key":"e_1_2_12_6_1","unstructured":"Pakistan Demographic and Health Survey 1990\/91. National Institute of Population Studies Islamabad Pakistan; IRD\/Macro International Inc. Columbia Maryland USA"},{"key":"e_1_2_12_7_1","unstructured":"Pakistan Demographic and Health Survey 2012\u201013. National Institute of Population Studies Islamabad Pakistan; MEASURE DHS ICF International Calverton Maryland USA"},{"key":"e_1_2_12_8_1","unstructured":"Lady Health Worker Programme: External Evaluation of the National Programme for Family Planning and Primary Health Care \u2010 summary of findings. Oxford Policy Management; 2009."},{"key":"e_1_2_12_9_1","volume-title":"What do we Know about them? The state of the evidence on programs, costs and impact on health outcomes of using community health workers","author":"Community Health Workers","year":"2007"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67028-6"},{"key":"e_1_2_12_11_1","unstructured":"Integrated Community Case Management (iCCM): Evidence Review Symposium. Meeting report. 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