SEARCHCROSS-SECTIONALpublic health, epidemiology

cross-sectional·public health, epidemiology, pediatrics, infectious disease, family medicine·PMC10450039

Know-do gap for sick child care and drivers of knowledge and practice among health extension workers in four regions of Ethiopia: a cross-sectional study

BMJ Open · 3 authors, 2 centres

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TL;DR

A facility-based cross-sectional study was conducted in 52 districts across 4 regions of Ethiopia from December 2018 to February 2019.

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A facility-based cross-sectional study was conducted in 52 districts across 4 regions of Ethiopia from December 2018 to February 2019. Knowledge of pneumonia signs and symptoms ranged from 27.8% to 76.0%, while actual practices ranged from 15.1% to 47.3%. Significant know-do gaps were found in assessment (16.7%, p=0.002) and management (68.5%, p<0.0001). Mentorships through PRCMM were associated with providers' knowledge, while medicines availability was associated with actual practice. Limitations include potential Hawthorne effect from observation and a small sample size. Findings suggest knowledge-based training alone is insufficient and that continuous mentoring, performance reviews, and commodity supply are needed.

STUDY TYPE

cross-sectional

SPECIALTY

public health

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ORIGINAL PAPER

PMC10450039

Know-do gap for sick child care and drivers of knowledge and practice among health extension workers in four regions of Ethiopia: a cross-sectional study

BMJ Open

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ABSTRACT

Abstract Objective Though efforts were made to expand community-based sick child healthcare in Ethiopia, the quality of care provided remained low. Improving quality of care requires understanding providers’ knowledge of appropriate care and their actual execution of tasks. This study examined gap between what health extension workers (HEWs) knew and did during the management of sick children in Ethiopia. Design Facility-based cross-sectional study was conducted. Setting The study was carried out in 52 districts across 4 regions in Ethiopia. Participants We interviewed 274 HEWs and performed observations of consultations done by 150 HEWs supplemented with facility assessment from December 2018 to February 2019. Outcome We compared providers’ knowledge and performance in the management of childhood pneumonia and diarrhoea. Know-do gap implies the difference in proportion between knowledge and actual practice of HEWs. Logistic regression was used to identify predictors of knowledge and actual practice. Results Providers’ correct knowledge ranged from 27.8% to 76.0% for signs and symptoms of pneumonia, and 32.0% to 84% for dehydration signs. Their actual practices ranged from 15.1% to 47.3% for pneumonia and 27.0% to 42.6% for dehydration. The correct knowledge and actual practices for pneumonia and dehydration management were 88.3% vs 15.6% and 93.9% vs 51.3%, respectively. There was significant know-do gap in assessments (16.7%, p=0.002) and management of childhood conditions (68.5%, p<0.0001). Mentorships were associated with providers’ knowledge of clinical management, while medicines availability was associated with their actual management practice. Conclusions While knowledge and actual practice for assessment and management of pneumonia and dehydration ranged from very low to high, what is more concerning is the huge know-do gap among HEWs. Our findings suggest that knowledge-based training is necessary but not sufficient for ensuring correct assessment and management of sick children by HEWs. Continuous support through mentorships and the supply of commodities are critically needed. Keywords: Community child health, Quality in health care, INFECTIOUS DISEASES, Public health

CITATION EXPORT

Dawit Wolde Daka, Muluemebet Abera Wordofa, Mirkuzie Woldie. Know-do gap for sick child care and drivers of knowledge and practice among health extension workers in four regions of Ethiopia: a cross-sectional study. BMJ Open. (2023). https://doi.org/10.1136/bmjopen-2022-069698

AUTHORS

3 · 2 CENTRES

Dawit Wolde Daka, Muluemebet Abera Wordofa, Mirkuzie Woldie

1Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
2Department of Population & Family Health, Jimma University, Jimma, Ethiopia