Effectiveness of a Community Health Worker(CHW) training in monitoring and care of patients with Chronic Obstructive Pulmonary Disease(COPD) in rural Gujarat, India.

Background- COPD is the second leading contributor to the disease burden of India. The current COPD burden cannot be managed effectively just through a physician based approach. Community Health Workers(CHWs) can play an effective role in making COPD care accessible and effective. Findings of an assessment of a training program for CHWs on COPD are reported here.Methods- 90 CHWs were exposed to a series of 5 training sessions designed and administered jointly by a team of public health experts and physiotherapists in the year 2017-18. Topics covered were basic clinical aspects of COPD, monitoring a patient with COPD and basic aspects of pulmonary rehabilitation. The assessment comprised 12 MCQs and short questions, 7 video exercises, 2 case vignettes and 5 skill assessments through Objectively Structured Clinical Examination(OSCE). Mean percentage scores were calculated for each domain of assessment to make it comparable.Results 70 CHWs with a mean age of 42.2 years completed all the trainings and underwent the assessment. Mean percentage score(SD) for knowledge was 62%(16.3). In OSCE assessment, scores were best in sputum clearance technique demonstration(92.1%) and the least in dyspnoea relieving positions(59.2%). The CHWs had difficulties in identifying signs of respiratory distress(score – 55.1%). No statistically significant association was observed between performance scores and their sociodemographic profile.Conclusion The results were encouraging and the program may be pilot tested in a Government setting.