Health worker performance in the management of children with acute respiratory infections (ARI) was assessed in two local government areas (LGAs) in Nigeria. The data derived were utilized to identify training needs. Survey instruments included an inventory list for ARI-related equipment and supplies, observation checklists for children presenting to the health worker with ARI symptoms, a questionnaire for exist interviews with mothers, and a supervisor performance checklist. One hundred and twenty-three health workers in Ife Central LGA and 50 in Ojo were observed at selected public health facilities. Most health workers took a good general history, but specific ARI-related history and physical examination were frequently omitted. Symptomatic diagnosis and treatment were common. Drugs most commonly prescribed for treatment of ARI were chloroquine, paracetamol and antibiotics. Essential drugs and supplies for ARI management were not available in some facilities. Communication with mothers was generally unsatisfactory and instruction on home management incomplete. Many of the health workers had not attended a continuing education programme in the previous two years and supervision which could have provided on-the-spot training was irregular. Improvements in ARI case management will require attention to policy, logistics, training (including in-service education) and supervision. The possible role of an integrated approach to the management of the sick child in improving the quality of health worker performance is discussed.
PIP: The authors assessed the performance of 123 health workers in Ife Central local government area (LGA) and 50 in Ojo LGA in managing children with acute respiratory infections (ARI) with the goal of deriving information useful in the development of a national ARI control program. Health workers were observed at nineteen public health facilities in Ife Central LGA and in fourteen in Ojo LGA. Most health workers took good general histories, but specific ARI-related history and physical examination were frequently omitted. ARI was commonly treated on the basis of symptomatic diagnosis. Chloroquine, paracetamol, and antibiotics were most commonly prescribed to treat ARI, although essential drugs and supplies for ARI management were unavailable in some facilities. Communication with mothers was generally unsatisfactory and instruction on home management incomplete. Many of the health workers had not attended a continuing education program in the previous two years, while supervision was irregular. Attention to policy, logistics, training, and supervision will be required to improve ARI case management in Nigeria. The authors discuss the potential role of an integrated approach to managing sick children.