The authors declare that they have no competing interests.
DM, JKT, SP, GP, JK, PW, FB, RB, GO, FP and KK took part in designing the study, in tools development, in data analysis and in manuscript writing. SK participated in data analysis and manuscript writing. DM, RB, and GO participated in data collection. All authors approved the final manuscript.
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.
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.
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.
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.
Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C, Child Health Epidemiology Reference Group of WHO and UNICEF: Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2008, 375: 1969-1987. CrossRef
Kinney MV, Kerber KJ, Black RE, Cohen B, Nkrumah F, Coovadia H, Nampala PM, Lawn JE, Axelson H, Bergh AM, Chopra M, Diab R, Friberg I, Odubanjo O, Walker N, Weissman E: Sub-Saharan Africa’s mothers, newborns, and children: where and why do they die?. PLoS Med. 2010, 7: e1000294-10.1371/journal.pmed.1000294. PubMedCentralCrossRefPubMed
Rutebemberwa E, Kallander K, Tomson G, Peterson S, Pariyo G: Determinants of delay in care-seeking for febrile children in eastern Uganda. Trop Med Int Health. 2009, 14: 1-8. CrossRef
WHO: Evidence base for community management of pneumonia. 2002, WHO, Stockholm
WHO: Scaling up home management of malaria. 2002, TDR News, Geneva, Switzerland, 1-2. 67
WHO/UNICEF: Joint statement: Management of pneumonia in community settings. 2004, WHO/UNICEF, Geneva/New York
MOH Uganda: Implementation guidelines for the Home Based Management of fever strategy. 2002, MoH Uganda, Kampala
MOH Uganda: Integrated community case management of childhood malaria, pneumonia and diarrhoea. Implementation guidelines. 2010, Kampala, 50-
WHO: Guidelines for the treatment of malaria -- 2nd edition. 2010, World Health Organization, Geneva
Young M: Effective management of childhood malaria at the community level: program experience to guide the research agenda. 2003
WHO: Global Strategic Plan: Roll Back Malaria 2005–2015. 2005, WHO, Geneva
Msellem MI, Martensson A, Rotllant G, Bhattarai A, Stromberg J, Kahigwa E, Garcia M, Petzold M, Olumese P, Ali A, Björkman A: Influence of rapid malaria diagnostic tests on treatment and health outcome in fever patients, Zanzibar: a crossover validation study. PLoS Med. 2009, 6: e1000070-10.1371/journal.pmed.1000070. PubMedCentralCrossRefPubMed
Mubi M, Janson A, Warsame M, Martensson A, Kallander K, Petzold MG, Ngasala B, Maganga G, Gustafsson LL, Massele A, Tomson G, Premji Z, Björkman A: Malaria rapid testing by community health workers is effective and safe for targeting malaria treatment: randomised cross-over trial in Tanzania. PLoS One. 2011, 6: e19753-10.1371/journal.pone.0019753. PubMedCentralCrossRefPubMed
Yeboah-Antwi K, Pilingana P, Macleod WB, Semrau K, Siazeele K, Kalesha P, Hamainza B, Seidenberg P, Mazimba A, Sabin L, Kamholz K, Thea DM, Hamer DH: Community case management of fever due to malaria and pneumonia in children under five in Zambia: a cluster randomized controlled trial. PLos Med. 2010, 7: e1000340-10.1371/journal.pmed.1000340. PubMedCentralCrossRefPubMed
WHO: Product Information Sheets 2000 Edition. 2000, World Health Organization, Geneva
Mukanga D, Babirye R, Peterson S, Pariyo GW, Ojiambo G, Tibenderana JK, Nsubuga P, Kallander K: Can lay community health workers be trained to use diagnostics to distinguish and treat malaria and pneumonia in children? Lessons from rural Uganda. Trop Med Int Health. 2011, 16: 1234-1242. 10.1111/j.1365-3156.2011.02831.x. CrossRefPubMed
Mukanga D: Community Case Management of Malaria and Pneumonia in Children – exploring use of diagnostics by community health workers in Uganda. 2012, Karolinska Institutet, Department of Public Health Sciences
Mukanga D, Tibenderana JK, Kiguli J, Pariyo GW, Waiswa P, Bajunirwe F, Mutamba B, Counihan H, Ojiambo G, Kallander K: Community acceptability of use of rapid diagnostic tests for malaria by community health workers in Uganda. Malar J. 2010, 9: 203-10.1186/1475-2875-9-203. PubMedCentralCrossRefPubMed
Iganga District: Five year Orphans and other Vulnerable Children Strategic Plan 2008/2009 - 2012/2013. 2008, Iganga District Local Government, Iganga, Uganda
MARA Maps: Duration of the malaria transmission season. [ http://www.mara.org.za/pdfmaps/UgaSeasonality.PDF]
Kish L: Survey sampling. 1965, John Wiley and Sons, Inc, New York
Levy PS, Lemeshow S: Sampling of populations, 4th Edition edn. 2008, John Wiley and Sons, New York CrossRef
Elmardi KA, Malik EM, Abdelgadir T, Ali SH, Elsyed AH, Mudather MA, Elhassan AH, Adam I: Feasibility and acceptability of home-based management of malaria strategy adapted to Sudan’s conditions using artemisinin-based combination therapy and rapid diagnostic test. Malar J. 2009, 8: 39-10.1186/1475-2875-8-39. PubMedCentralCrossRefPubMed
Ajayi IO, Browne EN, Garshong B, Bateganya F, Yusuf B, Agyei-Baffour P, Doamekpor L, Balyeku A, Munguti K, Cousens S, Pagnoni F: Feasibility and acceptability of artemisinin-based combination therapy for the home management of malaria in four African sites. Malar J. 2008, 7: 6-10.1186/1475-2875-7-6. PubMedCentralCrossRefPubMed
Alba S, Dillip A, Hetzel MW, Mayumana I, Mshana C, Makemba A, Alexander M, Obrist B, Schulze A, Kessy F, Mshinda H, Lengeler C: Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions – a user perspective. Malar J. 2010, 9: 163-10.1186/1475-2875-9-163. PubMedCentralCrossRefPubMed
Alba S, Hetzel MW, Goodman C, Dillip A, Liana J, Mshinda H, Lengeler C: Improvements in access to malaria treatment in Tanzania after switch to artemisinin combination therapy and the introduction of accredited drug dispensing outlets - a provider perspective. Malar J. 2010, 9: 164-10.1186/1475-2875-9-164. PubMedCentralCrossRefPubMed
Sabot OJ, Mwita A, Cohen JM, Ipuge Y, Gordon M, Bishop D, Odhiambo M, Ward L, Goodman C: Piloting the global subsidy: the impact of subsidized artemisinin-based combination therapies distributed through private drug shops in rural Tanzania. PLoS One. 2009, 4: e6857-10.1371/journal.pone.0006857. PubMedCentralCrossRefPubMed
Cohen JM, Sabot O, Sabot K, Gordon M, Gross I, Bishop D, Odhiambo M, Ipuge Y, Ward L, Mwita A, Goodman C: A pharmacy too far? Equity and spatial distribution of outcomes in the delivery of subsidized artemisinin-based combination therapies through private drug shops. BMC Health Serv Res. 2010, 10 (Suppl 1): S6-10.1186/1472-6963-10-S1-S6. PubMedCentralCrossRefPubMed
Goodman C, Brieger W, Unwin A, Mills A, Meek S, Greer G: Medicine sellers and malaria treatment in sub-Saharan Africa: what do they do and how can their practice be improved?. AmJTrop Med Hyg. 2007, 77 (6 Suppl): 203-218.
Lehmann U, Friedman I, Sanders D: Review of the utilisation and effectiveness of community-based health workers in Africa. 2012, [ http://hrh.uwc.ac.za/index.php?module=hrhlibrary&action=downloadfile&fileid=111930420852115]
World Bank: Reaching the Poor with Health, Nutrition, and Population Services. What Works, What Doesn’t and Why. 2005, The World Bank, Washington
Uganda Bureau of Statistics: Uganda Demographic and Health Survey 2006. 2006, UBOS and ORC Macro, Calverton
Filmer D, Pritchett LH: Estimating wealth effects without expenditure data–or tears: an application to educational enrollments in states of India. Demography. 2001, 38: 115-132. PubMed
- Access, acceptability and utilization of community health workers using diagnostics for case management of fever in Ugandan children: a cross-sectional study
James K Tibenderana
George W Pariyo
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