Quality of Care in Integrated Community Case Management Services in Bugoye, Uganda

Background: Village health workers (VHWs) in 5 villages in Bugoye subcounty (Kasese District, Uganda) provide integrated community case management (iCCM) services, in which VHWs evaluate and treat malaria, pneumonia, and diarrhea in children under 5 years of age. VHWs use a “Sick Child Job Aid” that guides them through the evaluation and treatment of these illnesses. Malaria is diagnosed by rapid diagnostic test, pneumonia by age-based respiratory rate cutoffs, and diarrhea by symptoms as described by the caregiver. Objectives: Measure the quality of iCCM services over time using routinely collected iCCM program data. Methods: We used existing aggregate program data to: 1) summarize the patient population and services provided, and 2) measure quality of care based on concordance between matching categories or actions in the treatment algorithm. We then employed lot quality assurance sampling to create a patient-level dataset, and created a secondary patient-level dataset of all patients with “danger signs” (evidence of severe illness). Using patient-level records, we: 1) describe adherence to the iCCM algorithm; 2) measure VHW-level quality using lot quality assurance sampling deci