{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T23:55:32Z","timestamp":1783468532505,"version":"3.55.0"},"reference-count":21,"publisher":"American Public Health Association","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[2001,10]]},"abstract":"<jats:p> Objectives. To characterize community health worker (CHW) performance using an algorithm for managing common childhood illnesses in Siaya District, Kenya, we conducted CHW evaluations in 1998, 1999, and 2001. <\/jats:p><jats:p> Methods. Randomly selected CHWs were observed managing sick outpatient and inpatient children at a hospital, and their management was compared with that of an expert clinician who used the algorithm. <\/jats:p><jats:p> Results. One hundred, 108, and 114 CHWs participated in the evaluations in 1998, 1999, and 2001, respectively. The proportions of children treated \u201cadequately\u201d (with an antibiotic, antimalarial, oral rehydration solution, or referral, depending on the child's disease classifications) were 57.8%, 35.5%, and 38.9%, respectively, for children with a severe classification and 27.7%, 77.3%, and 74.3%, respectively, for children with a moderate (but not severe) classification. CHWs adequately treated 90.5% of malaria cases (the most commonly encountered classification). CHWs often made mistakes assessing symptoms, classifying illnesses, and prescribing correct doses of medications. <\/jats:p><jats:p> Conclusions. Deficiencies were found in the management of sick children by CHWs, although care was not consistently poor. Key reasons for the deficiencies appear to be guideline complexity and inadequate clinical supervision; other possible causes are discussed. <\/jats:p>","DOI":"10.2105\/ajph.91.10.1617","type":"journal-article","created":{"date-parts":[[2008,11,29]],"date-time":"2008-11-29T13:33:29Z","timestamp":1227965609000},"page":"1617-1624","source":"Crossref","is-referenced-by-count":81,"title":["Community Health Worker Performance in the Management of Multiple Childhood Illnesses: Siaya District, Kenya, 1997\u20132001"],"prefix":"10.2105","volume":"91","author":[{"given":"Jane M.","family":"Kelly","sequence":"first","affiliation":[{"name":"Jane M. Kelly, Renu M. Garg, Mary J. Hamel, Samantha Y. Rowe, Alexander K. Rowe, and Michael S. Deming are with the Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. Jane M. Kelly is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga. Benta Osamba is with CARE Kenya, Siaya, Kenya. At the time of the study, Jennifer J. Lewis was with the Department of International Health and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benta","family":"Osamba","sequence":"additional","affiliation":[{"name":"Jane M. Kelly, Renu M. Garg, Mary J. Hamel, Samantha Y. Rowe, Alexander K. Rowe, and Michael S. Deming are with the Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. Jane M. Kelly is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga. Benta Osamba is with CARE Kenya, Siaya, Kenya. At the time of the study, Jennifer J. Lewis was with the Department of International Health and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renu M.","family":"Garg","sequence":"additional","affiliation":[{"name":"Jane M. Kelly, Renu M. Garg, Mary J. Hamel, Samantha Y. Rowe, Alexander K. Rowe, and Michael S. Deming are with the Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. Jane M. Kelly is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga. Benta Osamba is with CARE Kenya, Siaya, Kenya. At the time of the study, Jennifer J. Lewis was with the Department of International Health and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary J.","family":"Hamel","sequence":"additional","affiliation":[{"name":"Jane M. Kelly, Renu M. Garg, Mary J. Hamel, Samantha Y. Rowe, Alexander K. Rowe, and Michael S. Deming are with the Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. Jane M. Kelly is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga. Benta Osamba is with CARE Kenya, Siaya, Kenya. At the time of the study, Jennifer J. Lewis was with the Department of International Health and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer J.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Jane M. Kelly, Renu M. Garg, Mary J. Hamel, Samantha Y. Rowe, Alexander K. Rowe, and Michael S. Deming are with the Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. Jane M. Kelly is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga. Benta Osamba is with CARE Kenya, Siaya, Kenya. At the time of the study, Jennifer J. Lewis was with the Department of International Health and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha Y.","family":"Rowe","sequence":"additional","affiliation":[{"name":"Jane M. Kelly, Renu M. Garg, Mary J. Hamel, Samantha Y. Rowe, Alexander K. Rowe, and Michael S. Deming are with the Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. Jane M. Kelly is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga. Benta Osamba is with CARE Kenya, Siaya, Kenya. At the time of the study, Jennifer J. Lewis was with the Department of International Health and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander K.","family":"Rowe","sequence":"additional","affiliation":[{"name":"Jane M. Kelly, Renu M. Garg, Mary J. Hamel, Samantha Y. Rowe, Alexander K. Rowe, and Michael S. Deming are with the Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. Jane M. Kelly is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga. Benta Osamba is with CARE Kenya, Siaya, Kenya. At the time of the study, Jennifer J. Lewis was with the Department of International Health and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Deming","sequence":"additional","affiliation":[{"name":"Jane M. Kelly, Renu M. Garg, Mary J. Hamel, Samantha Y. Rowe, Alexander K. Rowe, and Michael S. Deming are with the Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. Jane M. Kelly is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga. Benta Osamba is with CARE Kenya, Siaya, Kenya. At the time of the study, Jennifer J. Lewis was with the Department of International Health and..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"844","reference":[{"key":"R1","unstructured":"Deming MS, Gayibor A, Murphy K, Jones TS, Karsa T. Home treatment of febrile children with antimalarial drugs in Togo. Bull World Health Organ.1989;67:695\u2013700."},{"key":"R2","unstructured":"Ruebush TK, Kern MK, Campbell CC, Oloo AJ. Self-treatment of malaria in a rural area of western Kenya. Bull World Health Organ.1995;73:229\u2013236."},{"key":"R3","unstructured":"Foster S. Treatment of malaria outside the formal health services. J Trop Med Hyg.1995;98:29\u201334."},{"key":"R5","unstructured":"Shann F, Hart K, Thomas D. Acute lower respiratory tract infection in children: possible criteria for selection of patients for antibiotic therapy and hospital admissions. Bull World Health Organ.1984;62:749\u2013753."},{"key":"R6","unstructured":"Zeitz PS, Harrison LH, L\u00f3pez M, Cornale G. Community health worker competency in managing acute respiratory infections of childhood in Bolivia. Bull Pan Am Health Organ.1993;27:109\u2013119."},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1093\/tropej\/40.5.279"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(92)91720-S"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02580-0"},{"key":"R10","unstructured":"Kumar V, Kumar R, Khurana JL. Assessment of the effect of training on management of acute diarrhoea in a primary health care setting. J Diarrhoeal Dis Res.1989;7:70\u201376."},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)91847-N"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1080\/02724936.1989.11748635"},{"key":"R13","unstructured":"Delacollette C, Van der Stuyft P, Molima K. Using community health workers for malaria control: experience in Zaire. Bull World Health Organ.1996;74:423\u2013430."},{"key":"R14","unstructured":"Fagbule D, Kalu A. Case management by community health workers of children with acute respiratory infections: implications for national ARI control programme. J Trop Med Hyg.1995;98:241\u2013246."},{"key":"R15","unstructured":"Ashwell HES, Freeman P. The clinical competency of community health workers in the Eastern Highlands Province of Papua New Guinea. Papua New Guinea Med J.1995;38:198\u2013207."},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(94)00172-P"},{"key":"R18","unstructured":"Gove S. Integrated Management of Childhood Illness by outpatient health workers: technical basis and overview. WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bull World Health Organ.1997;75(suppl 1):7\u201324."},{"key":"R22","unstructured":"Mehnaz A, Billoo AG, Yasmeen T, Nankani K. Detection and management of pneumonia by community health workers\u2014a community intervention study in Rehri village, Pakistan. J Pak Med Assoc.1997;47:42\u201345."},{"key":"R23","unstructured":"Khan AH, Khan JA, Akbar M, Addiss DG. Acute respiratory infections in children: a case management intervention in Abbottabad District, Pakistan. Bull World Health Organ.1990;68:577\u2013585."},{"key":"R25","unstructured":"Centers for Disease Control and Prevention. Health worker performance after training in Integrated Management of Childhood Illness, Western Province, Kenya, 1996\u20131997. MMWR Morb Mortal Wkly Rep.1998;47:998\u20131001."},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03520430045037"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.11.1411"}],"container-title":["American Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ajph.aphapublications.org\/doi\/pdf\/10.2105\/AJPH.91.10.1617","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T22:34:09Z","timestamp":1652135649000},"score":1,"resource":{"primary":{"URL":"https:\/\/ajph.aphapublications.org\/doi\/full\/10.2105\/AJPH.91.10.1617"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2001,10]]},"references-count":21,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2001,10]]}},"alternative-id":["10.2105\/AJPH.91.10.1617"],"URL":"https:\/\/doi.org\/10.2105\/ajph.91.10.1617","relation":{},"ISSN":["0090-0036","1541-0048"],"issn-type":[{"value":"0090-0036","type":"print"},{"value":"1541-0048","type":"electronic"}],"subject":[],"published":{"date-parts":[[2001,10]]}}}