Assessing and improving data quality from community health workers: a successful intervention in Neno, Malawi.

SETTING: A community health worker (CHW) program was established in Neno District, Malawi, in 2007 by Partners In Health in support of Ministry of Health activities. Routinely generated CHW data provide critical information for program monitoring and evaluation. Informal assessments of the CHW reports indicated poor quality, limiting the usefulness of the data. OBJECTIVES: 1) To establish the quality of aggregated measures contained in CHW reports; 2) to develop interventions to address poor data quality; and 3) to evaluate changes in data quality following the intervention. DESIGN: We developed a lot quality assurance sampling-based data quality assessment tool to identify sites with high or low reporting quality. Following the first assessment, we identified challenges and best practices and followed the interventions with two subsequent assessments. RESULTS: At baseline, four of five areas were classified as low data quality. After 8 months, all five areas had achieved high data quality, and the reports generated from our electronic database became consistent and plausible. CONCLUSION: Program changes included improving the usability of the reporting forms, shifting aggregation responsibility to designated assistants and providing aggregation support tools. Local quality assessments and targeted interventions resulted in immediate improvements in data quality.

Gender differences in enrolment in an HIV-treatment programme in rural Lesotho, 2006-2008: a brief report.

The southern African nation of Lesotho has an HIV seroprevalence of approximately 25%. To address the need for HIV care in rural Lesotho, a project called the Rural Health Initative (RHI) was launched in seven clinics in 2006. Data on enrolment were collected retrospectively and analysed for trends in gender enrolment over time. Of 6001 enrolled, 3904 were women (65.1%) and 2097 (34.9%) were men. When analysed by month of enrolment, there was a higher percentage of men enrolled in December compared with the other months of the year (χ(2) = 15.98, P < 0.001). This may be due to the migratory work of the men in the mines of South Africa and suggests a need for targeted interventions to increase male enrolments over the entire calendar year.

Distribution of adult respiratory illnesses at a primary health centre in Lesotho.

SETTING: Primary health centre in the highlands of Lesotho. BACKGROUND: There is limited information about the relative frequencies of common respiratory illnesses in resource-limited settings, particularly in sub-Saharan Africa. OBJECTIVE: To examine whether the distribution of respiratory illnesses in this region is unique due to the high prevalence of human immunodeficiency virus infection. DESIGN: In a prospective, cross-sectional study of adults and adolescents with cough or difficulty breathing recruited from the waiting areas of the health centre, the primary outcome was the respiratory diagnosis for each participant, which was based on history, physical examination, response to antibiotics and the results of chest radiography (CXR) and sputum examinations. RESULTS: Acute respiratory infections accounted for 65% of all diagnoses among 696 patients who were evaluated by a clinician and CXR. Pneumonia accounted for 10% of all diagnoses, and confirmed or probable tuberculosis (TB) accounted for 13%. Chronic respiratory conditions, including asthma, chronic obstructive pulmonary disease, silicosis and old TB, accounted for 14% of all diagnoses. Excluding 61 patients with an uninterpretable CXR, 36% (228) of the participants had significant pathology on CXR. CONCLUSION: A high proportion of patients presenting to a primary health centre in Lesotho with routine respiratory complaints have serious respiratory illnesses.

Improved case detection of active tuberculosis associated with an antiretroviral treatment program in Lesotho.

Tuberculosis (TB) remains the leading infectious killer of adults with human immunodeficiency virus (HIV) globally. Lesotho has the third highest prevalence of HIV and the fourth highest prevalence of TB worldwide, and the majority of TB patients are co-infected with HIV. This paper describes an antiretroviral treatment (ART) program instituted in a health center in a mountain region of Lesotho. Although the main goal of the program was to increase HIV detection and initiate ART for patients, the program also resulted in a ten-fold increase in the detection of TB among patients with and without HIV.