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Can community health workers identify omphalitis? A validation study from Southern Province, Zambia
Author(s) -
Herlihy Julie M.,
Gille Sara,
Grogan Caroline,
Bobay Lauren,
Simpamba Kelvin,
Akonkwa Bashagaluke,
Chisenga Tina,
Hamer Davidson H.,
Semrau Katherine
Publication year - 2018
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13074
Subject(s) - medicine , gold standard (test) , checklist , pediatrics , signs and symptoms , vital signs , surgery , psychology , cognitive psychology
Abstract Objective Omphalitis, or umbilical cord infection, is an important cause of newborn morbidity and mortality in low‐resource settings. We tested an algorithm that task‐shifts omphalitis diagnosis to community‐level workers in sub‐Saharan Africa. Methods Community‐based field monitors and Zambian paediatricians independently evaluated newborns presenting to health facilities in Southern Zambia using a signs and symptoms checklist. Responses were compared against the paediatrician's gold standard clinical diagnosis. Results Of 1009 newborns enrolled, 6.2% presented with omphalitis per the gold standard clinical diagnosis. Paediatricians' signs and symptoms with the highest sensitivity were presence of pus (79.4%), redness at the base (50.8%) and newborn flinching when cord was palpated (33.3%). The field monitor's signs and symptoms answers had low correlation with paediatrician's answers; all signs and symptoms assessed had sensitivity <16%. Conclusion Despite extensive training, field monitors could not consistently identify signs and symptoms associated with omphalitis in the sub‐Saharan African setting.