Evaluation of Community Health Workers’ Knowledge and Performance in Delivering Integrated Community Case Management in Borno State

Integrated community case management deploys community health workers to manage malaria, pneumonia, and diarrhoea at the community level, and the knowledge and performance of CHWs is central to the strategy's effectiveness in conflict-affected northern Nigerian states. This study evaluated community health worker knowledge and performance in delivering iCCM in Borno State, North East Nigeria. A descriptive cross-sectional study was conducted among 120 CHWs from 24 communities across Maiduguri Metropolitan, Jere, and Konduga LGAs. A structured knowledge assessment questionnaire and direct observation of case management practice using WHO IMCI observation checklists were applied. Rapid diagnostic testing and treatment practices for malaria were specifically assessed. Results showed adequate iCCM knowledge in 63.3 percent of CHWs. Correct malaria case assessment was demonstrated in only 52.5 percent of observed encounters. Appropriate pneumonia treatment referral was correctly applied in 58.3 percent of severe cases. ORS preparation and counselling were correctly performed in 67.5 percent of diarrhoea case observations. Performance was significantly associated with recency of iCCM training (p < 0.001) and supervisory visit frequency in the preceding six months (p < 0.01). Supply stockouts affected performance in 41.7 percent of CHWs for at least one commodity in the preceding month. The study recommends quarterly iCCM refresher training, monthly supervisory visits, improved commodity supply chains, and digital performance support tools for CHWs in Borno State. Keywords: community health workers, integrated community case management, iCCM, Borno State, North East Nigeria