Frequent changes in policy risk confusion among health workers

BMJ 1999;319:58 ( 3 July )

Letters

Frequent changes in policy risk confusion among health workers

EDITOR $---$ The study by Usen et al¹ adds weight to their previous work,² with a larger sample and better blinding of investigatorsconsidering a wide range of clinical predictors of hypoxaemia.We question the practical importance of this work in terms ofthe World Health Organisation's current guidelines for communityhealth workers.³ Their simple algorithm improves specificity,which would allow more efficient use of resources, albeit at theexpense of sensitivity, the importance of which isdebatable.

If the authors are suggesting that their chosen predictors should be incorporated into, or even replace, the World HealthOrganisation's guidelines for community health workers then wewould question whether a change in these guidelines is justified.Retraining has substantial financial and practical costs. Furthermore,frequent changes in policy carry risks of confusion and disagreementamong community health workers and may decrease their credibilityin thecommunity.

P Brettle, Medical student.
L Guinness, Medical student.
L Lim, Medical student.
S Robb, Medical student.
Department of Epidemiology and Public Health, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH Elizabeth.lim{at}ncl.ac.uk

1.	Usen S, Weber MW, Mulholland EK, Jaffar S, Oparaugo A, Omosigho C, et al. Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: prospective cohort study. BMJ 1999; 318: 86-91[Abstract/Free Full Text]. (9 January.)
2.	Weber MW, Usen S, Palmer A, Jaffar S, Mulholland EK. Predictors of hypoxaemia in hospital admissions with acute lower respiratory tract infection in a developing country. Arch Dis Child 1997; 76: 1-5[Free Full Text].
3.	World Health Organisation Programme for the Control of Acute Respiratory Tract Infections. In: Acute respiratory tract infection in children: case management in small hospitals in developing countries. Geneva: WHO , 1990(WHO/ARI/ 90.5.)

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Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: prospective cohort study: Stanley Usen, Martin Weber, Kim Mulholland, Shabbar Jaffar, Anslem Oparaugo, Charles Omosigho, Richard Adegbola, and Brian Greenwood
BMJ 1999 318: 86-91. [Abstract] [Full Text] [PDF]