Are primary health workers skilled enough to assess the severity of illness among young infants?

ABSTRACT

OBJECTIVE: To evaluate the skills of health workers in assessing the severity of illness among young infants. DESIGN: Cross sectional. SETTING: Five different health institutions viz, subcenter, primary health center, community health center, sub-divisional hospital, district hospital. METHODS: 110 young infants aged <2 months who attended the selected health institutions on specific week days were assessed by a physician. Subsequently 10 female health workers assessed these babies. Physician and health workers used same symptom and sign based guidelines for classification of the illness. Level of agreement between the physician and the health workers were assessed using kappa statistics. RESULTS: Physician classified 37.3% infants as not sick or mildly sick, 42.7% as moderately sick and 20% as severely sick. In comparison to the physician, the sensitivity and specificity of the health workers' assessment of severe illness was 77% and 76% respectively. Of 22 babies classified as severely sick by the physician, female health workers classified 5 as not sick or mildly sick, 8 as moderately sick and 9 as severely sick. On the other hand health workers classified one not sick or mildly sick and 9 moderately sick infants as severely sick. Level of agreement between the physician and health workers was poor (Kappa value = 0.39, 95% CI = 0.26, 0.52). Health workers misclassified illness mainly due to 'not counting the respiratory rate and 'not looking for chest retractions, purulent discharge and jaundice'. CONCLUSION: Trained health workers' skills were not satisfactory for assessment of illness severity among young infants. During training, importance of these signs needs to be emphasized.