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Table 3 Comparison of simulated client and conspicuous observation methods for health facility surveys in Benin

From: Evaluating health worker performance in Benin using the simulated client method with real children

Indicator (all indicators measured as percentages, unless otherwise stated) Simulated client survey Conspicuous observation survey Difference between methods (conspicuous observation – simulated client) Difference for HWs with IMCI – difference for HWs without IMCI (column 8 – column 9) [Column 10]
All HWs [Column 1] HWs with IMCI [Column 2] HW without IMCI [Column 3] All HWs [Column 4] HWs with IMCI [Column 5] HW without IMCI [Column 6] All HWs (column 4 – column 1) [Column 7] HWs with IMCI (column 5 – column 2) [Column 8] HW without IMCI (column 6 – column 3) [Column 9]
Median consultation duration, in minutes 16 19 15 21 29 15 5 (relative difference = 31.3%) 10 (relative difference = 52.6%)** 0 (relative difference = 0%) 10 (difference of relative differences = 52.6%)**
 HW offered greeting 55.6 56.5 54.8 92.4 96.6 88.8 36.8*** 40.1*** 34.0** 6.1
 Consultation performed by IMCI-trained HW 42.6 NA NA 47.0 NA NA 4.4 NA NA NA
 For children seen by IMCI-trained HW…           
 The IMCI chart booklet  was used NA 43.5 NA NA 92.0 NA NA 48.5** NA NA
 An IMCI patient recording  form was useda NA 56.5 NA NA 85.1 NA NA 28.6* NA NA
 HW determinedb if child…           
 Was unable to drink or  breastfeed 22.2 34.8 12.9 37.8 69.0 10.2 15.6 34.2* –2.7 36.9
 Was vomiting everything 46.3 65.2 32.3 48.6 71.3 28.6 2.3 6.1 –3.7 9.8
 Had convulsions 20.4 39.1 6.5 38.9 78.2 4.1 18.5* 39.1*** –2.4 41.5*
 Had cough or difficult  breathing 64.8 82.6 51.6 89.7 95.4 84.7 24.9*** 12.8 33.1*** –20.3
 Had diarrhea 33.3 56.5 16.1 67.0 93.1 43.9 33.7*** 36.6** 27.8* 8.8
 Had ear problem 27.8 60.9 3.2 40.5 72.4 12.2 12.7 11.5 9.0 2.5
 Child was weighed 90.7 95.7 87.1 96.2 96.6 95.9 5.5 0.9 8.8 –7.9
 Temperature taken 100.0 100.0 100.0 100.0 100.0 100.0 0 0 0 0
 HW checked for palmar  pallor 44.4 82.6 16.1 50.8 90.8 15.3 6.4 8.2 –0.8 9.0
 For children with fever…           
 Child checked for neck  stiffness 11.1 21.7 3.2 32.0 57.6 11.1 20.9* 35.9* 7.9 28.0
 Child checked for  measles history  in past 3 months 14.8 34.8 0 27.9 62.2 0 13.1 27.4 0 27.4
 The illness is correctly  classifiedc 62.3 77.3 51.6 78.2 84.6 72.7 15.9* 7.3 21.1 –13.8
 The illness is correctly  treatedc 47.2 90.9 16.1 45.5 70.7 22.2 –1.7 –20.2 6.1 –26.3
For children with diarrhea…           
 HW asks for duration 31.5 52.2 16.1 74.1 84.2 50.0 42.6** 32.0 33.9* –1.9
 HW asks if bloody stools 3.7 8.7 0 55.6 63.2 37.5 51.9*** 54.5*** 37.5 17.0
 HW offers drink to  assess thirst 1.9 4.4 0 48.1 68.4 0 46.2*** 64.0*** 0 64.0***
 HW does skin pinch 5.6 8.7 3.2 44.4 63.2 0 38.8*** 54.5** –3.2 57.7**
 The illness is correctly  classifiedc 3.7 8.7 0 44.4 63.2 0 40.7*** 54.5** 0 54.5**
 The diarrhea is correctly  treatedc 9.3 8.7 9.7 70.4 79.0 50.0 61.1*** 70.3*** 40.3* 30.0
HW tells at least one diagnosis to the caretaker 20.4 26.1 16.1 25.7 41.8 12.4 5.3 15.7 –3.7 19.4
HW advises caretaker to bring the child back immediately if the child…           
 Is unable to drink 14.8 34.8 0 25.0 55.2 0 10.2 20.4 0 20.4
 Becomes sicker 16.7 39.1 0 33.1 65.7 6.2 16.4* 26.6 6.2 20.4
  1. HW = health worker; IMCI = Integrated Management of Childhood Illness; NA = not applicable.
  2. a An IMCI patient recording form could either be the standard form developed by the World Health Organization or the IMCI patient register, which was a job aid specific to Benin that was being evaluated in a study (Rowe et al., 2009a).
  3. b ‘Determined’ means the health worker was exposed to the information, either because the health worker specifically asked, the caretaker spontaneously offered the information (e.g., as part of the chief complaint), or the child obviously had the sign (e.g., a child actively coughing).
  4. c ‘Correct’ means the health worker’s diagnosis or treatment exactly matched IMCI recommendations, according to the gold standard of the simulated client history (for the simulated client survey) or surveyor re-examiner (for the conspicuous observation survey).
  5. * P-value <0.05.
  6. ** P-value <0.01.
  7. *** P-value <0.001.