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ORIGINAL ARTICLE
Open Access

Measuring Knowledge of Community Health Workers at the Last Mile in Liberia: Feasibility and Results of Clinical Vignette Assessments

Jordan Downey, Anne H. McKenna, Savior Flomo Mendin, Ami Waters, Nelson Dunbar, Lekilay G. Tehmeh, Emily E. White, Mark J. Siedner, Raj Panjabi, John D. Kraemer, Avi Kenny, E. John Ly, Jennifer Bass, Kuang-Ning Huang, M. Shoaib Khan, Nathan Uchtmann, Anup Agarwal and Lisa R. Hirschhorn
Global Health: Science and Practice March 2021, 9(Supplement 1):S111-S121; https://doi.org/10.9745/GHSP-D-20-00380
Jordan Downey
aLast Mile Health, Boston, MA, USA.
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  • For correspondence: jmdowney@alum.mit.edu
Anne H. McKenna
aLast Mile Health, Boston, MA, USA.
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Savior Flomo Mendin
aLast Mile Health, Boston, MA, USA.
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Ami Waters
aLast Mile Health, Boston, MA, USA.
bUniversity of Texas Southwestern, Division of Combined Medicine and Pediatrics, Dallas, TX, USA.
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Nelson Dunbar
cLiberia Ministry of Health & Social Welfare, Monrovia, Liberia.
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Lekilay G. Tehmeh
cLiberia Ministry of Health & Social Welfare, Monrovia, Liberia.
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Emily E. White
aLast Mile Health, Boston, MA, USA.
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Mark J. Siedner
dMassachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Raj Panjabi
aLast Mile Health, Boston, MA, USA.
eBrigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
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John D. Kraemer
fGeorgetown University, Department of Health Systems Administration, Washington, DC, USA.
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Avi Kenny
aLast Mile Health, Boston, MA, USA.
gUniversity of Washington, Department of Biostatistics, Seattle, WA, USA.
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E. John Ly
aLast Mile Health, Boston, MA, USA.
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Jennifer Bass
aLast Mile Health, Boston, MA, USA.
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Kuang-Ning Huang
aLast Mile Health, Boston, MA, USA.
hUniversity of Washington, Department of Family Medicine, Seattle, WA, USA.
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M. Shoaib Khan
aLast Mile Health, Boston, MA, USA.
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Nathan Uchtmann
aLast Mile Health, Boston, MA, USA.
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Anup Agarwal
aLast Mile Health, Boston, MA, USA.
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Lisa R. Hirschhorn
aLast Mile Health, Boston, MA, USA.
iNorthwestern University Feinberg School of Medicine, Chicago, IL, USA.
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    FIGURE

    Correct Diagnoses Provided by CHWs During Clinical Vignettes to Assess Case Management of Sick Children Under 5 in 3 Rural Counties, Liberia

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    TABLE 1.

    Clinical Vignettes and Indicators Used to Assess CHW Knowledge of Community-Based Management of Sick Children Under Age 5 in 3 Rural Counties, Liberia

    VignetteCase DescriptionIndicators
    Correct DiagnosisCorrect Lifesaving TreatmentFully Correct Treatment
    Pneumonia with danger signMale, aged 4 years, presents with cough for 2 weeksPneumonia + danger sign (cough 2+ weeks)Refer to facility; amoxicillin given (must be correct dose)Refer to facility; amoxicillin given (must be correct dose)
    Diarrhea with danger signFemale, aged 8 months, presents with running stomach and malnutritionDiarrhea + danger sign (red MUAC)Refer to facility; ORS given regardless of doseRefer to facility; ORS given (must be correct dose)
    Uncomplicated malariaFemale, aged 2 years, presents with weakness and feverMalariaACT given (must be correct dose)ACT given (must be correct dose); paracetamol given (must be correct dose)
    • Abbreviations: ACT, artemisinin-combined treatment; CHW, community health worker; MUAC, mid-upper arm circumference; ORS, oral rehydration solution.

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    TABLE 2.

    Treatment Recommended by CHWs During Clinical Vignettes Assessing the Correct Management of Sick Children Under 5 in 3 Rural Counties, Liberia

    Vignette and Correct Treatment ActivityActivity TypePercentage of Vignettes in Which CHWs Recommended Activity, % (95% CI) (N=155)
    Pneumonia with danger sign
        Treatment with amoxicillinLifesaving62 (54, 69)
        Correct amoxicillin doseLifesaving39 (32, 47)
        Referral to the facilityLifesaving63 (55, 70)
        Overall correct lifesaving treatmentLifesaving23 (17, 31)
        Overall fully correct treatmentFully correct23 (17, 31)
    Diarrhea with danger sign
        Treatment with ORSLifesaving78 (71, 84)
        Correct ORS doseFully correct46 (39, 54)
        Referral to the facilityLifesaving63 (55, 70)
        Overall correct lifesaving treatmentLifesaving50 (42, 58)
        Overall fully correct treatmentFully correct21 (15, 29)
    Uncomplicated malaria
        Treatment with ACTLifesaving74 (67, 81)
        Correct ACT doseLifesaving65 (57, 72)
        Treatment with paracetamolFully correct73 (65, 79)
        Correct paracetamol doseFully correct39 (32, 47)
        Overall correct lifesaving treatmentLifesaving65 (57, 72)
        Overall fully correct treatmentFully correct28 (21, 35)
    • Abbreviations: ACT, artemisinin-combined treatment; CHW, community health worker; ORS, oral rehydration solution.

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Global Health: Science and Practice: 9 (Supplement 1)
Global Health: Science and Practice
Vol. 9, No. Supplement 1
March 15, 2021
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Measuring Knowledge of Community Health Workers at the Last Mile in Liberia: Feasibility and Results of Clinical Vignette Assessments
Jordan Downey, Anne H. McKenna, Savior Flomo Mendin, Ami Waters, Nelson Dunbar, Lekilay G. Tehmeh, Emily E. White, Mark J. Siedner, Raj Panjabi, John D. Kraemer, Avi Kenny, E. John Ly, Jennifer Bass, Kuang-Ning Huang, M. Shoaib Khan, Nathan Uchtmann, Anup Agarwal, Lisa R. Hirschhorn
Global Health: Science and Practice Mar 2021, 9 (Supplement 1) S111-S121; DOI: 10.9745/GHSP-D-20-00380

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Measuring Knowledge of Community Health Workers at the Last Mile in Liberia: Feasibility and Results of Clinical Vignette Assessments
Jordan Downey, Anne H. McKenna, Savior Flomo Mendin, Ami Waters, Nelson Dunbar, Lekilay G. Tehmeh, Emily E. White, Mark J. Siedner, Raj Panjabi, John D. Kraemer, Avi Kenny, E. John Ly, Jennifer Bass, Kuang-Ning Huang, M. Shoaib Khan, Nathan Uchtmann, Anup Agarwal, Lisa R. Hirschhorn
Global Health: Science and Practice Mar 2021, 9 (Supplement 1) S111-S121; DOI: 10.9745/GHSP-D-20-00380
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