BACKGROUND In the context of task shifting, a promoted approach to healthcare delivery in resource-poor settings, trained community health workers (CHWs) have been shown to be effective in delivering quality care of malaria for febrile under-5 children. While their effectiveness has been documented, the fidelity of implementation (FOI) has not been adequately studied. By understanding and measuring whether an intervention has been performed with fidelity, researchers and practitioners gain a better understanding of how and why an intervention works, and the extent to which outcomes can be improved. The objective of this study was to assess the FOI of a recommended protocol for malaria care by CHWs in a resource-poor setting in Nigeria. METHODS Thirty-five female CHWs who participated in a 3-day training on home management of malaria among under-5 children were studied. They managed 1,646 children over the implementation period and then underwent evaluation via a one-time hospital-based observation by the trainers. During the evaluation, a pre-tested standard checklist was used to compute performance scores for CHWs; doctors and nurses were selected to serve as the gold standard for comparison. Performance scores (PS) recorded during the evaluation were used to assess adherence and compliance with the recommended treatment protocol. RESULTS Of the 4 skill domains assessed, adherence was greatest for compliance with malaria treatment recommendations (94%) and lowest for post-treatment initiation counseling of home-based caregivers (69%). The average overall adherence of 83% was comparable to adherence by gold standard comparators. Mean PS was not found to be significantly associated with CHW demographics. Scores for clinical evaluation among those whose occupation was not healthcare-related were significantly lowered by 0.52 [95% CI (1.05-0.01), p = 0.05]. Compliance with the treatment protocol increased by 23% for every unit increase in total PS (p = 0.07) and doubled for every unit increase in scores for post-treatment initiation counseling of caregivers (p = 0.002). CONCLUSIONS Studying intervention fidelity stands to identify the shortcomings of implementation and specific areas to target for improvement in future adoption or implementation. This study concludes that future trainings should emphasize clinical evaluation and post-treatment counseling of caregivers by CHWs to ensure the best outcome for children.

中文翻译：

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尼日利亚社区卫生工作者对患有疟疾的儿童实施推荐护理的忠实度。

背景 在任务转移的背景下，在资源匮乏的环境中推广医疗保健提供方法，训练有素的社区卫生工作者 (CHW) 已被证明可以有效地为发热的 5 岁以下儿童提供高质量的疟疾护理。虽然它们的有效性已被记录在案，但尚未对实施保真度 (FOI) 进行充分研究。通过了解和衡量干预是否忠实执行，研究人员和从业者可以更好地了解干预如何和为什么起作用，以及可以在多大程度上改善结果。本研究的目的是评估尼日利亚资源匮乏环境中 CHW 疟疾护理推荐方案的 FOI。方法 研究了参加为期 3 天的 5 岁以下儿童疟疾家庭管理培训的 35 名女性 CHW。他们在实施期间管理了 1,646 名儿童，然后通过培训师在医院的一次性观察进行了评估。在评估过程中，使用预先测试的标准清单来计算 CHW 的性能分数；医生和护士被选为比较的黄金标准。评估期间记录的表现评分 (PS) 用于评估对推荐治疗方案的依从性和依从性。结果 在评估的 4 个技能领域中，遵守疟疾治疗建议的依从性最高 (94%)，最低的是家庭护理人员的治疗后初始咨询 (69%)。83% 的平均总体依从性与黄金标准比较器的依从性相当。未发现平均 PS 与 CHW 人口统计学显着相关。职业与医疗保健无关的人的临床评估分数显着降低了 0.52 [95% CI (1.05-0.01), p = 0.05]。治疗方案的依从性随着总 PS 的每增加一个单位而增加 23% (p = 0.07)，并且每增加一个单位，护理人员的治疗后初始咨询分数就会增加一倍 (p = 0.002)。结论 研究干预保真度有助于确定实施的缺点和特定领域，以在未来采用或实施中加以改进。