Can community health workers identify umbilical cord infection?

4 August, 2018

We are used to reading paper after paper saying that CHWs can do this and they can do that, so many that I wonder about the potential burden being placed on them. I was expecting this paper to have the same result. But no, in fact 'Despite extensive training, [CHWs] could not consistently identify signs and symptoms associated with omphalitis in the sub‐Saharan African setting'. Citation and abstract below. (fulltext is restricted-access)

CITATION: Can community health workers identify omphalitis? A validation study from Southern Province, Zambia

Julie M. Herlihy Sara Gille Caroline Grogan Lauren Bobay Kelvin Simpamba Bashagaluke Akonkwa Tina Chisenga Davidson H. Hamer Katherine Semrau

Tropical Medicine and International Health, Volume 23, Issue7 July 2018 Pages 806-813

First published: 12 May 2018


Objective: Omphalitis, or umbilical cord infection, is an important cause of newborn morbidity and mortality in low‐resource settings. We tested an algorithm that task‐shifts omphalitis diagnosis to community‐level workers in sub-Saharan Africa.

Methods: Community-based field monitors and Zambian paediatricians independently evaluated newborns presenting to health facilities in Southern Zambia using a signs and symptoms checklist. Responses were compared against the paediatrician's gold standard clinical diagnosis.

Results: Of 1009 newborns enrolled, 6.2% presented with omphalitis per the gold standard clinical diagnosis. Paediatricians' signs and symptoms with the highest sensitivity were presence of pus (79.4%), redness at the base (50.8%) and newborn flinching when cord was palpated (33.3%). The field monitor's signs and symptoms answers had low correlation with paediatrician's answers; all signs and symptoms assessed had sensitivity <16%.

Conclusion: Despite extensive training, field monitors could not consistently identify signs and symptoms associated with omphalitis in the sub‐Saharan African setting.

Comment: Of course, these findings are as likely to reflect the training as much as the CHWs themselves.

Best wishes, Neil

Joint Coordinator, CHIFA Project on Newborn Care

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CHIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All) and assistant moderator of the CHIFA forum. He is current chair of the Dgroups Foundation (, which supports 700 communities of practice for international development, social justice and global health. Twitter: @hifa_org FB: