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Access, acceptability and utilization of community health workers using diagnostics for case management of fever in
David Mukanga1, James K Tibenderana, Stefan Peterson
1Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda. dmukanga@afenet.net
Insights
Integrated community case management (iCCM) with diagnostics improves access to care for febrile children. Community health workers (CHWs) providing these services are highly utilized and accepted by caregivers.
Area of Science:
- Global Health
- Pediatric Care
- Diagnostic Technologies
Background:
- Integrated community case management (iCCM) is crucial for rational drug use and quality care for febrile under-five children.
- This study evaluated household access, acceptability, and utilization of community health workers (CHWs) providing iCCM with diagnostics.
Purpose of the Study:
- To assess the accessibility and utilization of CHWs trained in iCCM using malaria rapid diagnostic tests (RDTs) and respiratory rate timers (RRTs).
- To understand caregiver preferences and choices for seeking care for febrile children.
Main Methods:
- A study involving 423 households with under-five children in Iganga district, Uganda.
- Households were selected using probability proportionate to size sampling.
- Data collected via semi-structured questionnaires administered to caregivers; analyzed using statistical software.
Main Results:
- Most households (86%) were within 1 km of a CHW, significantly closer than health facilities (26%).
- CHWs were the primary choice for care (40%), followed by drug shops (33%); 57% of caregivers utilized CHW services within three months.
- Caregivers preferred CHW services with RDTs (79%) and approved their continued use (89%); RRTs were also found useful (86%).
Conclusions:
- iCCM with diagnostics is acceptable and increases access, becoming the preferred choice for febrile children's care.
- Over half of caregivers utilized CHW services, demonstrating significant uptake.
- A notable proportion of caregivers still opted for drug shops despite CHW availability, indicating a need for further intervention.
Background:
Use of diagnostics in integrated community case management (iCCM) of fever is recognized as an important step in improving rational use of drugs and quality of care for febrile under-five children. This study assessed household access, acceptability and utilization of community health workers (CHWs) trained and provided with malaria rapid diagnostic tests (RDTs) and respiratory rate timers (RRTs) to practice iCCM.
Methods:
A total of 423 households with under-five children were enrolled into the study in Iganga district, Uganda. Households were selected from seven villages in Namungalwe sub-county using probability proportionate to size sampling. A semi-structured questionnaire was administered to caregivers in selected households. Data were entered into Epidata statistical software, and analysed using SPSS Statistics 17.0, and STATA version 10.
Results:
Most (86%, 365/423) households resided within a kilometre of a CHW's home, compared to 26% (111/423) residing within 1 km of a health facility (p < 0.001). The median walking time by caregivers to a CHW was 10 minutes (IQR 5-20). The first option for care for febrile children in the month preceding the survey was CHWs (40%, 242/601), followed by drug shops (33%, 196/601).Fifty-seven percent (243/423) of caregivers took their febrile children to a CHW at least once in the three month period preceding the survey. Households located 1-3 km from a health facility were 72% (AOR 1.72; 95% CI 1.11-2.68) more likely to utilize CHW services compared to households within 1 km of a health facility. Households located 1-3 km from a CHW were 81% (AOR 0.19; 95% CI 0.10-0.36) less likely to utilize CHW services compared to those households residing within 1 km of a CHW.A majority (79%, 336/423) of respondents thought CHWs services were better with RDTs, and 89% (375/423) approved CHWs' continued use of RDTs. Eighty-six percent (209/243) of respondents who visited a CHW thought RRTs were useful.
Conclusion:
ICCM with diagnostics is acceptable, increases access, and is the first choice for caregivers of febrile children. More than half of caregivers of febrile children utilized CHW services over a three-month period. However, one-third of caregivers used drug shops in spite of the presence of CHWs.
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