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

doi:10.9745/GHSP-D-20-00380

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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

Vignette	Case Description	Indicators
Vignette	Case Description	Correct Diagnosis	Correct Lifesaving Treatment	Fully Correct Treatment
Pneumonia with danger sign	Male, aged 4 years, presents with cough for 2 weeks	Pneumonia + 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 sign	Female, aged 8 months, presents with running stomach and malnutrition	Diarrhea + danger sign (red MUAC)	Refer to facility; ORS given regardless of dose	Refer to facility; ORS given (must be correct dose)
Uncomplicated malaria	Female, aged 2 years, presents with weakness and fever	Malaria	ACT 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 Activity	Activity Type	Percentage of Vignettes in Which CHWs Recommended Activity, % (95% CI) (N=155)
Pneumonia with danger sign
Treatment with amoxicillin	Lifesaving	62 (54, 69)
Correct amoxicillin dose	Lifesaving	39 (32, 47)
Referral to the facility	Lifesaving	63 (55, 70)
Overall correct lifesaving treatment	Lifesaving	23 (17, 31)
Overall fully correct treatment	Fully correct	23 (17, 31)
Diarrhea with danger sign
Treatment with ORS	Lifesaving	78 (71, 84)
Correct ORS dose	Fully correct	46 (39, 54)
Referral to the facility	Lifesaving	63 (55, 70)
Overall correct lifesaving treatment	Lifesaving	50 (42, 58)
Overall fully correct treatment	Fully correct	21 (15, 29)
Uncomplicated malaria
Treatment with ACT	Lifesaving	74 (67, 81)
Correct ACT dose	Lifesaving	65 (57, 72)
Treatment with paracetamol	Fully correct	73 (65, 79)
Correct paracetamol dose	Fully correct	39 (32, 47)
Overall correct lifesaving treatment	Lifesaving	65 (57, 72)
Overall fully correct treatment	Fully correct	28 (21, 35)