Table 2.

Components and criteria of the quality of care score

Component	Description	Score Criteria	Score
Assessment
Health screening	RCom are expected to complete a full health screen which consists of 10 questions; one point was awarded for each question asked. The health screen addresses respiratory, gastro-intestinal, neurological, and systemic conditions including fever, swelling, cough, vomiting, etc.	1 point for every question asked	10
Identification of danger signs and other serious conditions/symptoms	Based on the response to health screening questions, RCom are expected to further assess, looking for four danger signs for immediate referral and seven other serious health conditions including red MUAC. One point was awarded for each of the 11 possible signs that were correctly confirmed by the clinician; the point was awarded whether the flag was correctly identified as positive (being present) or negative (not present).	1 point for every sign correctly identified	11
Treatment
Referral	RCom are expected to refer sick children to a health centre when a child presented with at least one major danger sign (convulsions, lethargy/unconsciousness, feeding/drinking incapacity and vomiting).	3 points were awarded when a correct referral or non-referral occurred.	3
Medication administration	RCom are expected to administer four types of medications when appropriate. RCom are able to administer: ORS/Zinc for gastrointestinal /, ACT for malarial symptoms, Paracetemol for fever, and Amoxicillin for respiratory illness/pneumonia.	One point was awarded for each of the 4 medications that were administered or not administered correctly.	4
	The criteria for administering a medication were based on positive symptoms, rather than positive danger signs. Children presenting with diarrhea required ORS/zinc; with fever, they required Paracetemol; with vomiting or diarrhea combined with a fever, they required ACT; and with cough combined with a fever, they required Amoxicillin. Children that were referred to a health clinic were considered to have been treated appropriately regardless of whether medication had been administered or not.
Advice given	RCom are expected to advise caregivers regarding the need for referral. If a referral occurs, for those returning home, one point was awarded for advice when it was given in each of the following three topics: home care, immunizations, and follow up.	3 points awarded if reason for referral was made; or,	3
		1 point awarded for each of the following: advice on home care, immunizations, and follow-up
Total score			31

ACT – artemisinin-based combination therapy, ORS – oral rehydration solution, RCom – Relais Communautaire