Validation of community health workers' assessment of neonatal illness in rural Bangladesh
Validation of community health workers' assessment of neonatal illness in rural Bangladesh
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DOI：
10.2471/blt.07.050666
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发表时间：
2009-01-01
期刊：
影响因子：
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通讯作者：
El Arifeen, Shams
中科院分区：
文献类型：
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作者：
Darmstadt, Gary L;Baqui, Abdullah H;El Arifeen, Shams
目的评价量表的效度（灵敏度，特异性，阳性和阴性预测值）的临床算法，用于社区卫生工作者（CHW）在孟加拉国农村地区的常规家访期间检测和分类新生儿疾病。5和8。被归类为非常严重的疾病（VSD）的新生儿被转诊到社区医院。在CHW评估的12小时内，医生独立评估了从36个项目CHW中随机选择的一名CHW在给定日期看到的所有新生儿。医生记录了疾病的症状和体征，对疾病进行了分类，并确定新生儿是否需要在医院接受家庭护理。结果CHW对VSD的诊断敏感性为73%，特异性为98%，阳性预测值为57%，阴性预测值为99%。母亲报告的任何喂养问题，确定由医生询问显着相关（P <0.001）与“不吸在所有”和“不重视在所有”或“不重视”临床上确定的CHWs在喂养assessment.Conclusion CHWs确定与高效度的新生儿重症需要产妇级别的护理。在家中进行疾病识别和管理，包括由社区卫生工作者转诊患有严重疾病的新生儿，是在资源匮乏的发展中国家环境中改善新生儿健康和存活率的一项有希望的战略。
Objective To estimate the validity (sensitivity, specificity, and positive and negative predictive values) of a clinical algorithm as used by community health workers (CHWs) to detect and classify neonatal illness during routine household visits in rural Bangladesh.Methods CHWs evaluated breastfeeding and symptoms and signs of illness in 395 neonates selected randomly from neonatal illness surveillance during household visits on postnatal days 0, 2, 5 and 8. Neonates classified with very severe disease (VSD) were referred to a community-based hospital. Within 12 hours of CHW assessments, physicians independently evaluated all neonates seen in a given day by one CHW, randomly chosen from among 36 project CHWs. Physicians recorded symptoms and signs of illness, classified the illness, and determined whether the newborn needed referral-level care at the hospital. Physicians' identification and classification were used as the gold standard in determining the validity of CHWs' identification of symptoms and signs of illness and its classification.Findings CHWs' classification of VSD showed a sensitivity of 73%, a specificity of 98%, a positive predictive value of 57% and a negative predictive value of 99%. A maternal report of any feeding problem as ascertained by physician questioning was significantly associated (P < 0,001) with "not sucking at all" and "not attached at all" or "not well attached" as determined clinically by CHWs during feeding assessment.Conclusion CHWs identified with high validity the neonates with severe illness needing referral-level care. Home-based illness recognition and management, including referral of neonates with severe illness by CHWs, is a promising strategy for improving neonatal health and survival in low-resource developing country settings.