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

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

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)806-813
Number of pages8
JournalTropical Medicine and International Health
Issue number7
StatePublished - Jul 1 2018


  • community health workers
  • newborn health
  • omphalitis
  • umbilical cord infection
  • validation
  • Zambia

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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