TY - JOUR
T1 - Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan
AU - Rogers, Eleanor
AU - Ali, Muhammad
AU - Fazal, Shahid
AU - Kumar, Deepak
AU - Guerrero, Saul
AU - Hussain, Imtiaz
AU - Soofi, Sajid
AU - Alvarez Morán, Jose Luis
N1 - Funding Information:
Acknowledgements: Sincere thanks go to the Department of Health and the National Programme of Lady Health Workers in the Government of Pakistan for collaboration on this project; to Aga Khan University for its support in the development, implementation, monitoring and evaluation of the project; and to Jennifer Ankrom, Muhammad Asif, Maureen Gallagher and Chloe Puett at Action Against Hunger for their support. Financial support: This study was funded by innocent foundation. innocent foundation had no role in the design, analysis or writing of this article. Conflict of interest: None. Authorship: S.G., J.L.A.M. and S.F. formulated the research question and designed the study; M.A. collected the data; M.A., S.K., E.R. and J.L.A.M. analysed and interpreted the data; E.R. drafted the manuscript with input from all authors; all authors have approved the final version of the manuscript for publication. Ethics of human subject participation: This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects/patients were approved by the National Bioethics Committee and the Aga Khan University Ethics Review Committee in Pakistan. Verbal or written informed consent was obtained from all subjects and carers of patients. Verbal consent was witnessed and formally recorded.
Publisher Copyright:
Copyright © The Authors 2017 This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Objective To assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community. Design Cross-sectional quality-of-care study. Setting The feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model. Subjects LHW implementing treatment for uncomplicated SAM in the community. Results Oedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for 60·0 % and 57·4 % of children, respectively. The appetite test was conducted correctly for 42·0 % of cases. Of all cases of SAM without complications assessed during the study, 68·0 % received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4·0 %. Conclusions This quality-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impact of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.
AB - Objective To assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community. Design Cross-sectional quality-of-care study. Setting The feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model. Subjects LHW implementing treatment for uncomplicated SAM in the community. Results Oedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for 60·0 % and 57·4 % of children, respectively. The appetite test was conducted correctly for 42·0 % of cases. Of all cases of SAM without complications assessed during the study, 68·0 % received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4·0 %. Conclusions This quality-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impact of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.
KW - Community health workers
KW - Community-based management of acute malnutrition
KW - Severe acute malnutrition
UR - http://www.scopus.com/inward/record.url?scp=85033386744&partnerID=8YFLogxK
U2 - 10.1017/S1368980017002610
DO - 10.1017/S1368980017002610
M3 - Article
C2 - 29076801
AN - SCOPUS:85033386744
SN - 1368-9800
VL - 21
SP - 385
EP - 390
JO - Public Health Nutrition
JF - Public Health Nutrition
IS - 2
ER -
