Can community health workers identify umbilical cord infection?

25 February, 2019

Dear CHIFA and HIFA-Zambia colleagues,

We consistently hear on HIFA and CHIFA that community health workers can be trained to be at least as good as professional staff for an ever-increasing range of tasks. So I was interested to read the conclusion of this abstract: 'Despite extensive training, field monitors could not consistently identify signs and symptoms associated with omphalitis in the sub‐Saharan African setting.'

Unfortunately the full text is restricted-access so many/most of us are unable to learn from it.

CITATION: Herlihy, J. M., Gille, S. , Grogan, C. , Bobay, L. , Simpamba, K. , Akonkwa, B. , Chisenga, T. , Hamer, D. H. and Semrau, K. (2018), Can community health workers identify omphalitis? A validation study from Southern Province, Zambia. Trop Med Int Health, 23: 806-813. doi:10.1111/tmi.13074

https://onlinelibrary.wiley.com/doi/abs/10.1111/tmi.13074

ABSTRACT

Objective

Omphalitis, or umbilical cord infection, is an important cause of newborn morbidity and mortality in low‐resource settings. We tested an algorithm that task‐shifts omphalitis diagnosis to community‐level workers in sub‐Saharan Africa.

Methods

Community‐based field monitors and Zambian paediatricians independently evaluated newborns presenting to health facilities in Southern Zambia using a signs and symptoms checklist. Responses were compared against the paediatrician's gold standard clinical diagnosis.

Results

Of 1009 newborns enrolled, 6.2% presented with omphalitis per the gold standard clinical diagnosis. Paediatricians' signs and symptoms with the highest sensitivity were presence of pus (79.4%), redness at the base (50.8%) and newborn flinching when cord was palpated (33.3%). The field monitor's signs and symptoms answers had low correlation with paediatrician's answers; all signs and symptoms assessed had sensitivity <16%.

Conclusion

Despite extensive training, field monitors could not consistently identify signs and symptoms associated with omphalitis in the sub‐Saharan African setting.

Best wishes, Neil

Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org

Coordinator, HIFA Project on Community Health Workers

http://www.hifa.org/projects/community-health-workers

Joint Coordinator, CHIFA Project on Newborn Care

http://www.hifa.org/projects/newborn-care

HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org