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Jane M. Kelly, MD, Benta Osamba, CHNFP, Renu M. Garg, MD, Mary J. Hamel, MD, Jennifer J. Lewis, MPH, Samantha Y. Rowe, MPH, Alexander K. Rowe, MD, MPH and Michael S. Deming, MD, MPH

Jane M. Kelly, Renu M. Garg, Mary J. Hamel, Samantha Y. Rowe, Alexander K. Rowe, and Michael S. Deming are with the Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. Jane M. Kelly is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga. Benta Osamba is with CARE Kenya, Siaya, Kenya. At the time of the study, Jennifer J. Lewis was with the Department of International Health and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham.

Correspondence: Requests for reprints should be sent to Jane M. Kelly, MD, Centers for Disease Control and Prevention, Mail Stop F22, 4770 Buford Hwy, Atlanta, GA 30341-3724 (e-mail: azk9{at}cdc.gov.

Objectives. To characterize community health worker (CHW) performance using an algorithm for managing common childhood illnesses in Siaya District, Kenya, we conducted CHW evaluations in 1998, 1999, and 2001.

Methods. Randomly selected CHWs were observed managing sick outpatient and inpatient children at a hospital, and their management was compared with that of an expert clinician who used the algorithm.

Results. One hundred, 108, and 114 CHWs participated in the evaluations in 1998, 1999, and 2001, respectively. The proportions of children treated "adequately" (with an antibiotic, antimalarial, oral rehydration solution, or referral, depending on the child's disease classifications) were 57.8%, 35.5%, and 38.9%, respectively, for children with a severe classification and 27.7%, 77.3%, and 74.3%, respectively, for children with a moderate (but not severe) classification. CHWs adequately treated 90.5% of malaria cases (the most commonly encountered classification). CHWs often made mistakes assessing symptoms, classifying illnesses, and prescribing correct doses of medications.

Conclusions. Deficiencies were found in the management of sick children by CHWs, although care was not consistently poor. Key reasons for the deficiencies appear to be guideline complexity and inadequate clinical supervision; other possible causes are discussed.

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