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Perceived quality of care for common childhood illnesses: facility versus community based providers in Uganda
Agnes Nanyonjo1, Fredrick Makumbi, Patrick Etou
1Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden ; Malaria Consortium, Kampala, Uganda.
Insights
Community health workers (CHWs) provide higher perceived quality of care (PQC) for childhood illnesses than primary health facility workers (PHFWs). This suggests CHWs are vital for universal health coverage and improving intervention use.
Area of Science:
- Global Health
- Health Services Research
- Pediatrics
Background:
- Childhood illnesses like malaria, pneumonia, and diarrhea remain significant health challenges in resource-constrained settings.
- Effective healthcare delivery models are crucial for improving child survival rates and overall health outcomes.
Purpose of the Study:
- To compare perceived quality of care (PQC) provided by community health workers (CHWs) versus primary health facility workers (PHFWs) for under-five children treated for malaria, pneumonia, and diarrhea.
Main Methods:
- A cross-sectional study compared caretaker-rated PQC across seven domains for children (2-59 months) treated by CHWs or PHFWs.
- Factor analysis determined overall PQC scores, with comparisons using Wilcoxon rank-sum test.
- Modified Poisson and multinomial logistic regression models assessed associations between PQC and service providers.
Main Results:
- Overall PQC was significantly higher for CHWs (mean 0.58) compared to PHFWs (mean -0.58) (p<0.0001).
- The proportion of caretakers reporting high PQC was 3.1 times greater for CHWs (95% CI: 2.5-3.8).
- CHWs outperformed PHFWs in all PQC domains except continuity.
Conclusions:
- Community health workers offer superior perceived quality of care compared to primary health facility workers in resource-limited environments.
- Leveraging CHWs is essential for achieving universal health coverage and enhancing the utilization of child health interventions.
Objective:
To compare caretakers' perceived quality of care (PQC) for under-fives treated for malaria, pneumonia and diarrhoea by community health workers (CHWs) and primary health facility workers (PHFWs).
Methods:
Caretaker rated PQC for children aged (2-59) months treated by either CHWs or PHFWs for a bought of malaria, pneumonia or diarrhoea was cross-sectionally compared in quality domains of accessibility, continuity, comprehensiveness, integration, clinical interaction, interpersonal treatment and trust. Child samples were randomly drawn from CHW (419) and clinic (399) records from eight Midwestern Uganda districts. An overall PQC score was predicted through factor analysis. PQC scores were compared for CHWs and PHFWs using Wilcoxon rank-sum test. Multinomial logistic regression models were used to specify the association between categorized PQC and service providers for each quality domain. Finally, overall PQC was dichotomized into "high" and "low" based on median score and relative risks (RR) for PQC-service provider association were modeled in a "modified" Poisson regression model.
Results:
Mean (SD) overall PQC was significantly higher for CHWs 0.58 (0 .66) compared to PHFWs -0.58 (0.94), p<0.0001. In "modified" Poisson regression, the proportion of caretakers reporting high PQC was higher for CHWS compared to PHFWs, RR=3.1, 95%CI(2.5-3.8). In multinomial models PQC was significantly higher for CHWs compared to PHFWs in all domains except for continuity.
Conclusion:
PQC was significantly higher for CHWs compared to PHFWs in this resource constrained setting. CHWs should be tapped human resources for universal health coverage while scaling up basic child intervention as PQC might improve intervention utilization.
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