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© 1996 Oxford University Press

research-article

Using Lot Quality Assurance Sampling to Assess Measurements for Growth Monitoring in a Developing Country's Primary Health Care System

JOSEPH J VALADEZ{dagger},, LORI DIPRETE BROWN{ddagger}, WILLIAM VARGAS VARGAS§ and DAVID MORLEY||

{dagger} Department of International Health, Johns Hopkins University School of Hygiene and Public Health Baltimore, MD, USA.
{ddagger} QA Project, University Research Corporation Bethesda, MD, USA.
§ Departemento de Control de Calidad, Ministerio de Salud de Costa Rica San Jose, Costa Rica.
|| Centre for International Child Health, Institute of Child Health University of London, UK.

Reprint requests to: Dr Joseph J Valadez, JHPIEGO, 1615 Thames Street, Suite 200, Baltimore, MD 21231, USA

BACKGROUND: Local supervisors used lot quality assurance sampling (LQAS) during routine household visits to assess the technical quality of Costa Rican community-based health workers (CHW): measuring and recording weights of children, interpreting their growth trend, and providing nutrition education to mothers.

METHOD: Supervisors sampled 10 households in each of 12 Health Areas (4–8 hours per area). No more than two performance errors were allowed for each CHW. This LQAS decision rule resulted in judgements with a sensitivity and specificity of about 95%.

RESULTS: Three categories of results are reported: (1) CHW adequately weighed children, calculated ages, ldentified children requiring nutritional servlces, and used the growth chart. (2) They needed to improve referral, education, and documentation skills. (3) The lack of system support to regularly provide growth cards, supplementary feeding to identlfled malnourished children, and other essential materials may have discouraged some CHW resulting in them not applying their skills.

CONCLUSIONS: Supervisors regularly using LQAS should, by the sixth round of supervision, identify at least 90% of inadequately performing CHW. This paper demonstrates the strength of LQAS, namely, to be used easily by low level local health workers to identify poorly functioning components of growth monitoring and promotion.

Keywords growth monitoring, primary health care, quality assurance, LQAS, nutrition, child survival, International health, community health, Latin America

Revised 1 September 1995


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