Background
Methods
Setting
Study population, Study and data collection
Qualitative approach
Nbr | Discussion topics for FGD with households |
---|---|
1 | General knowledge of the community-based under-five children health services |
2 | Community practices regarding the seeking behavior for health services for under-five children |
3 | Community’s attitude towards the use of mobile phone and collection of data |
4 | Community’s participation in mobile phone data analysis and use of corrective actions |
5 | Community’s expectations regarding data collection on MNCH at the household level |
Quantitative approach: Structured interview (using questionnaire)
Nbr | Items |
---|---|
1 | What are the health issues of under-five children in your village? |
2 | What are health services for under-five children in your village? |
3 | What is the current community-based surveillance for under-five children health services? |
4 | Do you know how to use mobile phone applications? |
5 | If you receive a mobile phone for MNCH surveillance-related services, what other needs will you use it for? |
6 | Would you want to participate in the MNCH surveillance using mobile phones? |
7 | Can you use a mobile phone to collect data at households? Yes/No |
8 | Can you analyze MNCH data collected with a mobile phone application? Yes/No |
9 | What type of incentives can you receive to undertake MNCH surveillance? |
10 | How many households can you visit per day? |
11 | Who is the appropriate respondent for MNHC collection at the household? |
12 | What is the best time to collect MNCH data at the household? |
13 | Do you usually receive support for MNCH surveillance from local health center nurses? |
14 | Do you usually receive support for MNCH surveillance from Health Zone authorities? |
# | Items |
---|---|
1 | The willingness of village leaders, village volunteers, and households to participate in the MNCH surveillance, their capacity and competencies, and the level of accountability of the village committees towards the MNCH community surveillance |
2 | The appropriate workload to undertake these efforts, the appropriate respondent at the household level, and the best time to collect data at household |
3 | The appropriate incentives (financial, in-kind, award, and recognition) at the individual or community levels. |
4 | The coverage of mobile phone services in the villages and the usage of mobile phones in terms of personal and MNCH surveillance-related services |
5 | Support of provincial and national stakeholders |
Data analysis
Results
Focus group discussions
General knowledge of the community-based under-five children health services
“Lately, the children suffered from diarrhea, high fever, and loss of blood and water. Very often, I saw and learned about an increasing number of children receiving blood and water at the hospital. People do not understand. There are many children and mothers who die in our community.”
“We talk about the epidemic of malaria, which requires infusion and transfusion. In the case of malaria, nurses consult our children and give quinine. However, after two weeks, we observed again high fever in children.”
“We have mosquito nets in our homes, but our children die. We do not have the peace and desire to have children. Last time, the epidemic of fever for children lasted two months and we knew nothing. Health workers must do something to detect this disease. The future of our children is in jeopardy.”
“We use long acting insecticide bed nets and take treatments at health centers, but our children were still suffering from the fever. You see, there are people who practice witchcraft in this area.”
“Mothers wash vegetables with dirty water. All this causes disease. We are not used to boiling water before consuming it. We drink it as it is. Maybe this causes diarrhea to our children.”
“Women breastfeed without washing the breasts. When they come from the farm, children suck breasts that contain sweat. When women use the toilet, they put their hands directly in the food without washing them.”
“Poor hygiene and lack of toilets in the villages make children sick. They have worms. All children wash in the same water basin in turn, you will see even 5 children wash their hands in one place and distribute microbes. Regarding the use of latrines or cabinets, we see a village of 50 households with only 10 toilets. Other people go to the forest for defecation, saying that pigs will eat it. When children go to play, they walk on feces that contain hookworms, and even if they have received mebendazole during the campaign, hookworms will remain in their bodies. Children cannot be healthy. This problem is due to the negligence and lack of toilets.”
“Children are not in good health. They refuse to eat; the tummy becomes big and they do not play with others. I see that this situation happens when mothers are pregnant and they do not have energy to give children good food.”
Community practices regarding the seeking behavior for health services for under-five children
“When a child falls ill, it is brought to the HC for treatment and blood tests. Nurses give medications and parents go back home.”
“We need to take better care of our children from birth until they are 5 years old. Experts tell us that prevention is better than cure. We also follow the advice on the radio about bringing our children to health centers for vaccinations, vitamins, and mebendazole.”
“Children are dying due to neglect. They can have high fever for 2-3 days, but if the mother has no money to bring him to the hospital, she will stay at home and only give aspirin and vitamin. And when the child's condition worsens, it is then taken to the hospital for transfusion and infusion, and this situation can sometimes result in death.”
“Many mothers trust traditional healthcare providers, who are not nurses. If you have no money, you can give them chicken, cassava, beans, or corns that you have in the house and they provide the treatment. But, these people are charlatans in my view. In a few cases, they can treat well the child, but in most of time, parents are obliged to take the sick child to the hospital after wasting their time and belongings on these charlatans.”
“CHWs began to treat children and when the disease gets complicated, and it is often too late.”
“CHWs do not always treat the children well. They must study to become nurses. I know a case of my neighbor’s child. This child was treated at home by a CHW until the disease complicated so that he could be referred to the HC. But it was too late because the child died.”
“I am in the community health group accompanying nurses for vaccination since 2012. The black church believers do not agree to have their children vaccinated. Some of them call it “delayed poison” because when children receive the vaccine, they get sick with fever. However, we all know that if the child gets a fever after vaccination, we must give paracetamol. But the people do not want this. They say that they grew up without taking vaccines.”
“There is the presence of several illnesses in children lacking food before 6 months. Children suffered from diarrhea, high fever, loss of blood and water.”
Community’s attitude towards the use of the mobile phone use and collection of data
“The phone has the advantage of making emergency calls in case of sickness and ask for medications and materials instead of going to the hospital, which might be too late if you do not have money. The device is faster to send messages and data.”
“This phone made other people rich. They can receive money and get assistance when needed from other people. It is pity for those who do not have them.”
“I like the mobile phone application so much. One day, my neighbor just called his daughter from Kinshasa. The following day, he received money from a number in the mobile phone. He took this number to a shop in our village and they gave him money. This was good and easy.”
“You must buy call credits every time and pay for changing them. Even if you do not call, the charge of the phone decreases. Instead of buying food, people buy phone credits and there are fights in the house.”
Community’s participation in mobile phone data collection, analysis, and use activities
“We saw some people from Kinshasa using the phone to ask questions about usage of toilet.”
“We always listen to the questions and give answers. The person who asks the questions just presses the button in the mobile phone.”
“We see the people with these phones. Instead of calling and talking, they just ask questions and press the button. It is cool. There is no paper and writing involved.”
“These people do not give us anything. We saw them having a mobile phone and buying nice foods whilst we, who answered their questions, have nothing. This is not fair to us.”
“We will always participate in answering questions even if these people do not give us anything.”
“If, these activities help us in protecting our children from getting sick and our wives dying of pregnancy, we will participate in answering questions and discuss on how to improve our health.”
“For example, women breastfeed without washing the breasts. When they come from the field, children suck breasts that contain sweat and dirt. This situation can be studied and discussed among us so that all women stop doing it.”
Community’s expectations regarding data collection on MNCH at the household level
“We do not receive anything from these people who visit our houses, except medications against worms, vitamins, and vaccines for our children. We do not get anything.”
“They do not explain to us why they are asking questions. They just tell us to answer to the questions. We know that receive money but nothing is given to us.”
“They are just asking questions, but do not bring anything for the children like foods or toys.”
“We would like to know what they are doing with the data they are collecting. One day, I asked one data collector this question: why are you always asking us questions about the health of our children. He told me that the doctor has asked for it. You see, maybe the doctor wants this information so that he sends it to Kinshasa and receive more money from Kinshasa for himself.”
“We assume that the information we give to the VHV is sent to the doctor and authority. Then, they provide vaccines, vitamins, and medications against worms to our children. That it is why I always say that it is good to give them the information about the health of our children.”
Structured interviews
Village health volunteers
Variables | Nbr (n = 190) | % |
---|---|---|
Willingness to participate in the MNCH surveillance | 173 | 91,1 |
Having the capacity and competencies to use mobile phone for surveillance | ||
Able to use mobile phones | 137 | 72,1 |
Need to be trained more | 34 | 17,9 |
Need additional assistance to become familiar with the technology | 19 | 10,0 |
Estimates for daily workload in collecting data (in households) | ||
≤ 5 | 122 | 64,2 |
6–10 | 56 | 29,5 |
11–15 | 12 | 6,3 |
Willingness to undertake MNCH activities using mobile phones | ||
Willingness to do the work | 137 | 72,1 |
Recognizing that this is their job | 33 | 17,4 |
Recognizing that this is an optional work | 20 | 10,5 |
Expected incentives | ||
Financial | 92 | 48,4 |
Gift of the mobile phone | 34 | 17,9 |
An award | 27 | 14,2 |
Free healthcare for the family | 23 | 12,1 |
Public recognition | 8 | 4,2 |
In-kind gift for the community | 6 | 3,2 |
Appropriate responders at household | ||
Mothers | 140 | 73,7 |
Fathers | 16 | 8,4 |
Grand-parents | 15 | 7,9 |
Aunts | 11 | 5,8 |
Uncles | 8 | 4,2 |
Timing for collecting data | ||
Noon time during the weekdays | 120 | 63,2 |
Evening | 65 | 34,2 |
Afternoon | 4 | 2,1 |
Morning | 1 | 0,5 |