Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan.

Objective: To assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community. Design: Cross-sectional quality-of-care study. Setting: The feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model. Subjects: LHW implementing treatment for uncomplicated SAM in the community. Results: Oedema was diagnosed conducted correctly for 87.5% of children; weight and mid upper-arm circumference were measured correctly for 60.0% and 57.4% of children, respectively. The appetite test was conducted correctly for 42.0% of cases. Of all cases of SAM without complications assessed during the study, 68.0% received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4.0%. Conclusions: This quaiity-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impart of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.