Predictors of health worker performance after Integrated Management of Childhood Illness training in Benin: a cohort study

Laura C. Steinhardt; Faustin Onikpo; Julien Kouamé; Emily Piercefield; Marcel Lama; Michael S. Deming; Alexander K. Rowe

doi:10.1186/s12913-015-0910-4

Table 1 Descriptions and levels of health worker performance for various measures of case management quality

From: Predictors of health worker performance after Integrated Management of Childhood Illness training in Benin: a cohort study

Indicators of case management quality	Description	N	Mean (%)
Primary outcomes
1. Recommended treatment for all potentially life-threatening illnesses (PLTIs)	Essential treatment of all PLTIs a child had (including malaria, very severe febrile illness, pneumonia, severe pneumonia, diarrhea, anemia, and severe anemia) that exactly matched IMCI guidelines†	8,277	63.6
2. Adequate treatment for all PLTIs	Essential treatment of all PLTIs considered effective^a even if it did not exactly match IMCI guidelines	8,277	77.8
3. Percentage of all needed tasks performed per child (index of overall guideline adherence)	Percentage of total IMCI-recommended assessment tasks (maximum of 39), disease classification tasks (maximum of six), and treatment tasks (maximum of four) done (see Box 1 for details)	9,330	96.5
Secondary outcomes
4. Recommended treatment for febrile illnesses	First- or second-line antimalarial (chloroquine, sulfadoxine-pyrimethamine, respectively) for malaria or injectable quinine plus referral for very severe febrile illness, with dosages that exactly match IMCI guidelines	6,872	80.1
5. Adequate treatment for febrile illnesses	Antimalarial and dose considered effective even if it did not exactly match IMCI guidelines	6,872	87.5
6. Recommended treatment for anemia	Antimalarial, iron, and folate all given for anemia (with dosages that exactly match IMCI guidelines) or referral for severe anemia	3,133	47.1
7. Adequate treatment for anemia	Anemia treatments all given with doses considered effective even if they did not exactly match IMCI guidelines	3,133	75.6
8. Recommended treatment for pneumonia	First- or second-line antibiotics (cotrimoxazole, amoxicillin, respectively) for pneumonia or injectable ampicillin plus referral for severe pneumonia, with dosages that exactly match IMCI guidelines	2,787	76.0
9. Adequate treatment for pneumonia	Antibiotic and dose considered effective even if it did not exactly match IMCI guidelines	2,787	82.7
10. Recommended treatment for diarrhea	Oral rehydration solution given, plus antibiotic for bloody diarrhea, with antibiotic dosages that exactly match IMCI guidelines	1,680	81.6

Note: Analysis excludes consultations that took place on the day of the IMCI follow-up visit, as these may not be representative of typical health worker performance
† Includes referral for hospitalization for severe illness
^aThat is, life-saving, based on standard clinical textbooks (Gilbert et al. 2004; Robertson & Shilkofski 20015). Adequate treatment could have included errors such as small, clinically insignificant overdoses

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