Introduction: The Ethiopian primary healthcare of sick children is provided within the integrated Community Case Management of childhood illnesses provided by the Health Extension Workers. There is limited knowledge whether this cadre correctly asses and classify common diseases. The aim was to study their ability to correctly classify common childhood illnesses.

Method: A survey was conducted from December 2016 to February 2017 in four regions of Ethiopia. Observations of the health extension workers’ assessment and classification of sick children were followed by a re-examination by a trained health officer.

Results: The classification by the HEWs of 620 sick children as compared to the re-examiner had a sensitivity of 89% and specificity of 94% for diarrhoea, sensitivity 52% and specificity 91% for fever, and acute respiratory tract infection had a sensitivity of 59% and specificity of 94%. Malnutrition had a sensitivity of 39% and specificity of 99%, and ear infection had a sensitivity of 61% and specificity of 99%.

Conclusion: The Ethiopian Health Extension Workers’ assessment and classification of sick children 2-59 months of age was validated by re-examination performed by trained health officers. Most cases of diarrhoea were correctly classified, while fever and respiratory infections frequently were not identified. The identification of malnutrition was especially missed. This suggests that a significant number of sick children were undiagnosed that could lead to absent or incorrect management and treatment. Efforts are needed to improve the quality of the diagnosis and classification of childhood illnesses done by the Health Extension Workers. Emphasis should be given to improve the ability of HEWs to adhere to the iCCM guidelines.

Key words: Quality, HEWs, Ethiopia