HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Data Supplement All Versions of this Article: AJPH.2008.134411v1 99/5/837    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rowe, A. K. Articles by Deming, M. S. Search for Related Content PubMed PubMed Citation Articles by Rowe, A. K. Articles by Deming, M. S. Related Collections Quality of Care Other Health Service Delivery Public Health Workers Other Child and Adolescent Health Surveys Other Statistics/Evaluation/Research

Alexander K. Rowe, MD, MPH, Faustin Onikpo, MD, MPH, Marcel Lama, MD, MPH, Dawn M. Osterholt, MD, MSPH, Samantha Y. Rowe, PhD, MPH and Michael S. Deming, MD, MPH

Alexander K. Rowe is with the Malaria Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Faustin Onikpo is with the Direction Départementale de la Santé Publique de l'Ouémé et Plateau [Departmental Direction of Public Health of Ouémé and Plateau], Ministry of Health, Porto-Novo, Benin. At the time of the study, Marcel Lama was with Africare-Benin, Porto-Novo. Dawn M. Osterholt is with the Division of General and Community Pediatric Research, Cincinnati Children's Hospital, Cincinnati, OH. Samantha Y. Rowe is with the Data Management Activity, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta. Michael S. Deming is with the Parasitic Diseases Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA.

Correspondence: Requests for reprints should be sent to Alexander K. Rowe, Centers for Disease Control and Prevention, Mailstop F22, 4770 Buford Highway, Atlanta, GA 30341-3724 (e-mail: axr9{at}cdc.gov).

Objectives. We evaluated an intervention to support health workers after training in Integrated Management of Childhood Illness (IMCI), a strategy that can improve outcomes for children in developing countries by encouraging workers' use of evidence-based guidelines for managing the leading causes of child mortality.

Methods. We conducted a randomized trial in Benin. We administered a survey in 1999 to assess health care quality before IMCI training. Health workers then received training plus either study supports (job aids, nonfinancial incentives, and supervision of workers and supervisors) or usual supports. Follow-up surveys conducted in 2001 to 2004 assessed recommended treatment, recommended or adequate treatment, and an index of overall guideline adherence.

Results. We analyzed 1244 consultations. Performance improved in both intervention and control groups, with no significant differences between groups. However, training proceeded slowly, and low-quality care from health workers without IMCI training diluted intervention effects. Per-protocol analyses revealed that workers with IMCI training plus study supports provided better care than did those with training plus usual supports (27.3 percentage-point difference for recommended treatment; P < .05), and both groups outperformed untrained workers.

Conclusions. IMCI training was useful but insufficient. Relatively inexpensive supports can lead to additional improvements.