Performance assessment of FCHVs on acute respiratory infection (ARI) case management after two months of CB-IMCI training for the partial fulfillment of bachelor degree in public health.

Thesis Report.

SUMMARY: Performance assessment is a measure of assessment based on authentic tasks such as activities; exercises or problems that require workers to show what they can do. Some performance tasks are designed to have workers demonstrate their understanding by applying their knowledge to a particular situation. Performance assessment is a tool to ensure workers' capability in their work and make corrective measures, if any lacking in their working competency and environment. In this context, the study was carried out with the objective to assess the performance of FCHVs on ARI case management in community level. A descriptive post-test only study was conducted in 35 FCHVs from 10 VDCs of Parbat district. The study site was selected purposively. Primary data were collected through interview, performance summery and observation. The study showed that the mean age of FCHVs was 36 years; most of them were form age group 30-40 years (40%) and among those, more were from lower secondary level (43%) education. The overall performance of FCHVs on ARI case management was good (table 1, 2). Regarding the knowledge and skills; 94 percent defined ARI correctly, 69 percent had complete knowledge on signs of ARI, 99 percent had correct knowledge on age of sleep and sitting child, 93 percent had correct knowledge on respiratory rate cut-off point of sleep and sitting child. Only 46 percent had knowledge of danger signs of sleep child while 94 percent had knowledge of danger signs of sitting child, 74 percent were able to classify pneumonia child for treatment, 99 percent had correct knowledge on cotrin dosage of child for pneumonia treatment, 54 percent had knowledge on what is to be done at the 3rd day follow up, 80 percent had correct knowledge on management of ARI child with cold/cough while 91 percent had correct knowledge on management of ARI child with pneumonia (table 4.3- 4.6, fig 4.1 -4.5). Regarding case management of sick child with ARI, two months records from registers of FCHVs were summarized from performance summery sheet. The findings from records showed information on the basis of educational level of FCHVs. There were altogether 329 cases registered, of which FCHVs from lower secondary level registered the highest ARI cases (39%) followed by SLC and above (28%). Regarding the treatment of children aged 2-12 months and 1 -5 years were found higher with pneumonia in Lower secondary level FCHVs(i.e. 39% and 62% respectively) followed by SLC and above. Similarly 85 percent of treatment cases and 92 percent of referral cases were followed up at third day which was high in Lower secondary level FCHVs (i.e. 47.7% and 72.8 respectively) followed by SLC and above. Likewise, 12 cases of children aged 2 months to 5 years were referred, of which most of the cases (8 cases) were from lower secondary level FCHVs. In ARI classification, 66 percent were classified as cold and cough (No pneumonia), 32 percent were in pneumonia (fast breathing) and 2 percent were in very severe disease/ severe pneumonia (Having one or more danger signs). And age-cotrim dosage consistency for pneumonia cases treatment was 98 percent. Only 2 percent of the pneumonia cases were treated with high dosage of cotrim (fig. 4.6- 4.9). Observation checklist was used for assessing FCHVs performance on ARI case management. All the FCHVs were exposed to case management and the overall performance of FCHVs on ARI case management was satisfactory. Regarding the case management, 57 percent FCHVs had good preparation for the case management while 43 percent had satisfactory performance. Before handling the cases, all the FCHVs (100%) asked mother about the child age and the condition of the child, 879 percent FCHVs checked child for danger signs, 80 percent of them used laminated charts properly during assessment of ARI in child, 82 percent of the FCHVs used the timer properly for respiratory rate (R/R) count, 77 percent of FCHVs counted respiratory rate accurately, only 29 percent of the FCHVs gave correct dosage of cotrim accoding to age of child, 80 percent of FCHVs gave proper advice at the 3rd day follow up visit and, 83 percent of the FCHVs were able to give proper advice to caretaker of child for home treatment (table 4.7 -4.9, fig. 10). In brief, the overall performance of FCHVs on ARI case management was found satisfactory; it was due to CB-IMCI training through Integrated Rural Health Development Training Center (IRHDTC/Nepal). Some indicators were found slightly weak due to training duration gap, which suggests that refresher training is needed for better results on ARI case management. Performance of FCHCs was high in high education level which suggests education to FCHVs needs to be strengthened.

Eng.