1
|
Arntson L, McLaughlin KR, Smit E. Factors influencing fever care-seeking for children under five years of age in The Gambia: a secondary analysis of 2019-20 DHS data. Malar J 2024; 23:124. [PMID: 38678245 PMCID: PMC11056064 DOI: 10.1186/s12936-024-04951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Malaria contributes to excess child mortality in The Gambia. Children under five are at risk of severe malaria and death if not treated promptly and appropriately. It is crucial that a child with fever receive appropriate care from a trained provider. The aim was to identify influences on child fever care-seeking in The Gambia to inform malaria control strategies. METHODS This cross-sectional analysis of The Gambia 2019-20 Demographic and Health Survey used logistic regression analysis to identify associations between source of care for a child with fever (public or private healthcare provider, other, or no treatment) and mother, child, and household characteristics. RESULTS Only 52.0% of mothers sought care from a trained healthcare provider for a child with fever-45.1% from a public facility and 7.0% from the private sector. 35.2% of mothers did not seek treatment. Mothers in urban households were 2.67 times as likely (aOR, 95% CI 1.504-4.736) as mothers in rural households to seek care from an informal source (e.g., pharmacy) versus not seeking treatment, and 0.29 times as likely (aOR, 95% CI 0.165-0.515) as mothers in rural households to seek care from a public provider versus informal source. Mothers in wealthier households were 2.30 times as likely (aOR, 95% CI 1.274-4.164) as mothers in poorer households to seek care from an informal source versus no treatment and half as likely as mothers in poorer households to seek care from a public provider versus informal source (aOR 0.53, 95% CI 0.291-0.959). CONCLUSIONS Maintaining The Gambia's malaria control achievements will require the active engagement and oversight of private pharmacies along with continued integrated community case management to reach mothers who do not seek care for a child with fever, and remove challenges to seeking appropriate care from trained providers. Whether influenced by convenience, costs, perceived urgency, or other factors, given the likelihood of urban mothers and mothers in wealthier households to seek care from private pharmacies, it will be necessary to incorporate private pharmacies into malaria control strategies while building public sector capacity and workforce, and initiating more effective attitude and behavioural change among mothers and households.
Collapse
Affiliation(s)
- Laura Arntson
- Oregon State University College of Health, 160 SW 26th St, Corvallis, OR, 97331, USA.
| | - Katherine R McLaughlin
- Department of Statistics, Oregon State University, 239 Weniger Hall, Corvallis, OR, 97331, USA
| | - Ellen Smit
- Oregon State University College of Health, 160 SW 26th St, Corvallis, OR, 97331, USA
| |
Collapse
|
2
|
Kassa EA, Handiso TB, Admassu B, Nigussie A. Utilization of integrated community case management service of childhood illness (ICCM) and associated factors among under-five children in Shashogo district, Hadiya zone, south Ethiopia. SAGE Open Med 2022; 10:20503121221097643. [PMID: 35646355 PMCID: PMC9130811 DOI: 10.1177/20503121221097643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background Integrated community case management (ICCM) service is provision of concurrent clinical and preventive care by trained community health workers for common childhood illnesses in the community. In Ethiopia, integrated community case management (ICCM) service utilization is low and its magnitude is unknown as well as no adequate evidence on its associated factors. This study aimed to investigate use of integrated community case management service of childhood illness and factors associated with it. Methods A community-based cross-sectional study was conducted in Shashogo district. A total of 422 mothers who have under-five children were selected using simple random sampling method. Structured interviewer administered pre-tested in 5% of the sample; questionnaire was used to collect data. Descriptive statistics, binary and multivariable logistic regression analyses were used. Results The proportion of integrated community case management (ICCM) service utilization among sick under-five children in past six months at Shashogo district was found was 199(47.2%, with 95%CI:(43.2, 51.2)). Receiving training on health extension packages as model family AOR = 2.07(1.05, 4.08), experiencing frequent childhood illness AOR = 1.92(1.11, 3.33), having information about ICCM service AOR = 3.73(1.42, 9.76), and having a postnatal care visit in recent child AOR = 13(7.37, 23.06) were associated with utilization of integrated community case management service. Conclusion ICCM service was not used as planned though there is offer of free of charge service nearby. ICCM service is affected by maternal and child health utilization. Hence, collaborative activities of information, education, and communication activities are needed.
Collapse
Affiliation(s)
| | - Tilahun Beyene Handiso
- School of Public Health, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Bittiya Admassu
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Aderajew Nigussie
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
3
|
Koch MR, Kanneh L, Wise PH, Kurina LM, Alhasan F, Garry RF, Schieffelin JS, Shaffer JG, Grant DS. Health seeking behavior after the 2013-16 Ebola epidemic: Lassa fever as a metric of persistent changes in Kenema District, Sierra Leone. PLoS Negl Trop Dis 2021; 15:e0009576. [PMID: 34260615 PMCID: PMC8312964 DOI: 10.1371/journal.pntd.0009576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/26/2021] [Accepted: 06/19/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The West African Ebola epidemic of 2013-2016 killed nearly 4,000 Sierra Leoneans and devastated health infrastructure across West Africa. Changes in health seeking behavior (HSB) during the outbreak resulted in dramatic underreporting and substantial declines in hospital presentations to public health facilities, resulting in an estimated tens of thousands of additional maternal, infant, and adult deaths per year. Sierra Leone's Kenema District, a major Ebola hotspot, is also endemic for Lassa fever (LF), another often-fatal hemorrhagic disease. Here we assess the impact of the West African Ebola epidemic on health seeking behaviors with respect to presentations to the Kenema Government Hospital (KGH) Lassa Ward, which serves as the primary health care referral center for suspected Lassa fever cases in the Eastern Province of Sierra Leone. METHODOLOGY/PRINCIPAL FINDINGS Presentation frequencies for suspected Lassa fever presenting to KGH or one of its referral centers from 2011-2019 were analyzed to consider the potential impact of the West African Ebola epidemic on presentation patterns. There was a significant decline in suspected LF cases presenting to KGH following the epidemic, and a lower percentage of subjects were admitted to the KGH Lassa Ward following the epidemic. To assess general HSB, a questionnaire was developed and administered to 200 residents from 8 villages in Kenema District. Among 194 completed interviews, 151 (78%) of respondents stated they felt hospitals were safer post-epidemic with no significant differences noted among subjects according to religious background, age, gender, or education. However, 37 (19%) subjects reported decreased attendance at hospitals since the epidemic, which suggests that trust in the healthcare system has not fully rebounded. Cost was identified as a major deterrent to seeking healthcare. CONCLUSIONS/SIGNIFICANCE Analysis of patient demographic data suggests that fewer individuals sought care for Lassa fever and other febrile illnesses in Kenema District after the West African Ebola epidemic. Re-establishing trust in health care services will require efforts beyond rebuilding infrastructure and require concerted efforts to rebuild the trust of local residents who may be wary of seeking healthcare post epidemic.
Collapse
Affiliation(s)
- Mikaela R. Koch
- Program in Human Biology, Stanford University, Stanford, California, United States of America
- * E-mail: (MRK); (JGS); (DSG)
| | - Lansana Kanneh
- Pediatrics–Neonatal and Developmental Medicine, Stanford University, Stanford, California, United States of America
| | - Paul H. Wise
- Pediatrics–Neonatal and Developmental Medicine, Stanford University, Stanford, California, United States of America
| | - Lianne M. Kurina
- Program in Human Biology, Stanford University, Stanford, California, United States of America
| | - Foday Alhasan
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
| | - Robert F. Garry
- Tulane University, School of Medicine, Department of Microbiology and Immunology, New Orleans, Louisiana, United States of America
- Zalgen Labs, LCC, Germantown, MD, United States of America
| | - John S. Schieffelin
- Sections of Infectious Disease, Department of Pediatrics, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Jeffrey G. Shaffer
- Department of Biostatistics and Bioinformatics, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- * E-mail: (MRK); (JGS); (DSG)
| | - Donald S. Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- * E-mail: (MRK); (JGS); (DSG)
| |
Collapse
|
4
|
Miller NP, Bagheri Ardestani F, Wong H, Stokes S, Mengistu B, Paulos M, Agonafir N, Sylla M, Ameha A, Birhanu BG, Khan S, Lemango ET. Barriers to the utilization of community-based child and newborn health services in Ethiopia: a scoping review. Health Policy Plan 2021; 36:1187-1196. [PMID: 33885143 PMCID: PMC8496769 DOI: 10.1093/heapol/czab047] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/22/2021] [Accepted: 04/01/2021] [Indexed: 12/24/2022] Open
Abstract
The Ethiopian Federal Ministry of Health and partners have scaled up integrated
community case management (iCCM) and community-based newborn care (CBNC),
allowing health extension workers (HEWs) to manage the major causes of child and
newborn death at the community level. However, low service uptake remains a key
challenge. We conducted a scoping review of peer-reviewed and grey literature to
assess barriers to the utilization of HEW services and to explore potential
solutions. The review, which was conducted to inform the Optimizing the Health
Extension Program project, which aimed to increase the utilization of iCCM and
CBNC services, included 24 peer-reviewed articles and 18 grey literature
documents. Demand-side barriers to utilization included lack of knowledge about
the signs and symptoms of childhood illnesses and danger signs; low awareness of
curative services offered by HEWs; preference for home-based care, traditional
care, or religious intervention; distance, lack of transportation and cost of
care seeking; the need to obtain husband’s permission to seek care and
opposition of traditional or religious leaders. Supply-side barriers included
health post closures, drug stockouts, disrespectful care and limited skill and
confidence of HEWs, particularly with regard to the management of newborn
illnesses. Potential solutions included community education and demand
generation activities, finding ways to facilitate and subsidize transportation
to health facilities, engaging family members and traditional and religious
leaders, ensuring consistent availability of services at health posts and
strengthening supervision and supply chain management. Both demand generation
and improvement of service delivery are necessary to achieve the expected impact
of iCCM and CBNC. Key steps for improving utilization would be carrying out
multifaceted demand generation activities, ensuring availability of HEWs in
health posts and ensuring consistent supplies of essential commodities. The
Women’s Development Army has the potential to improving linkages between
HEWs and communities, but this strategy needs to be strengthened to be
effective.
Collapse
Affiliation(s)
- Nathan P Miller
- Health Section, UNICEF, 3 UN Plaza, New York, NY 10017, USA.,Department of Population and Family Health, Mailman School of Public Health, Columbia University, 722 West 168th St., New York, NY 10032, USA
| | | | - Hayes Wong
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, 722 West 168th St., New York, NY 10032, USA
| | - Sonya Stokes
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, 722 West 168th St., New York, NY 10032, USA
| | - Birkety Mengistu
- PATH Ethiopia, Bole Medhaniyalem Street #03, Bole, Addis Ababa, Ethiopia
| | - Meron Paulos
- PATH Ethiopia, Bole Medhaniyalem Street #03, Bole, Addis Ababa, Ethiopia
| | - Nesibu Agonafir
- PATH Ethiopia, Bole Medhaniyalem Street #03, Bole, Addis Ababa, Ethiopia
| | - Mariame Sylla
- Health Section, UNICEF Ethiopia, UNECA Compound, Zambezi Building, Addis Ababa, Ethiopia
| | - Agazi Ameha
- Health Section, UNICEF Ethiopia, UNECA Compound, Zambezi Building, Addis Ababa, Ethiopia
| | - Bizuhan Gelaw Birhanu
- Health Section, UNICEF Ethiopia, UNECA Compound, Zambezi Building, Addis Ababa, Ethiopia
| | - Sadaf Khan
- Maternal Newborn Child Health and Nutrition, PATH, 2201 Westlake Ave. Ste 200, Seattle, WA 98121, USA
| | - Ephrem Tekle Lemango
- Programs Section, Maternal, Child Health and Nutrition Directorate, Ministry of Health, Sudan Street, Addis Ababa, Ethiopia
| |
Collapse
|
5
|
Altaras R, Montague M, Graham K, Strachan CE, Senyonjo L, King R, Counihan H, Mubiru D, Källander K, Meek S, Tibenderana J. Integrated community case management in a peri-urban setting: a qualitative evaluation in Wakiso District, Uganda. BMC Health Serv Res 2017; 17:785. [PMID: 29183312 PMCID: PMC5706411 DOI: 10.1186/s12913-017-2723-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 11/10/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Integrated community case management (iCCM) strategies aim to reach poor communities by providing timely access to treatment for malaria, pneumonia and diarrhoea for children under 5 years of age. Community health workers, known as Village Health Teams (VHTs) in Uganda, have been shown to be effective in hard-to-reach, underserved areas, but there is little evidence to support iCCM as an appropriate strategy in non-rural contexts. This study aimed to inform future iCCM implementation by exploring caregiver and VHT member perceptions of the value and effectiveness of iCCM in peri-urban settings in Uganda. METHODS A qualitative evaluation was conducted in seven villages in Wakiso district, a rapidly urbanising area in central Uganda. Villages were purposively selected, spanning a range of peri-urban settlements experiencing rapid population change. In each village, rapid appraisal activities were undertaken separately with purposively selected caregivers (n = 85) and all iCCM-trained VHT members (n = 14), providing platforms for group discussions. Fifteen key informant interviews were also conducted with community leaders and VHT members. Thematic analysis was based on the 'Health Access Livelihoods Framework'. RESULTS iCCM was perceived to facilitate timely treatment access and improve child health in peri-urban settings, often supplanting private clinics and traditional healers as first point of care. Relative to other health service providers, caregivers valued VHTs' free, proximal services, caring attitudes, perceived treatment quality, perceived competency and protocol use, and follow-up and referral services. VHT effectiveness was perceived to be restricted by inadequate diagnostics, limited newborn care, drug stockouts and VHT member absence - factors which drove utilisation of alternative providers. Low community engagement in VHT selection, lack of referral transport and poor availability of referral services also diminished perceived effectiveness. The iCCM strategy was widely perceived to result in economic savings and other livelihood benefits. CONCLUSIONS In peri-urban areas, iCCM was perceived as an effective, well-utilised strategy, reflecting both VHT attributes and gaps in existing health services. Depending on health system resources and organisation, iCCM may be a useful transitional service delivery approach. Implementation in peri-urban areas should consider tailored community engagement strategies, adapted selection criteria, and assessment of population density to ensure sufficient coverage.
Collapse
Affiliation(s)
- Robin Altaras
- Malaria Consortium Uganda, Plot 25 Upper Naguru East Road, P.O. Box 8045, Kampala, Uganda
| | - Mark Montague
- Malaria Consortium Uganda, Plot 25 Upper Naguru East Road, P.O. Box 8045, Kampala, Uganda
| | - Kirstie Graham
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2R 4LT, UK
| | - Clare E Strachan
- Malaria Consortium Uganda, Plot 25 Upper Naguru East Road, P.O. Box 8045, Kampala, Uganda.,London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Laura Senyonjo
- Malaria Consortium Uganda, Plot 25 Upper Naguru East Road, P.O. Box 8045, Kampala, Uganda
| | - Rebecca King
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Helen Counihan
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2R 4LT, UK.
| | - Denis Mubiru
- Malaria Consortium Uganda, Plot 25 Upper Naguru East Road, P.O. Box 8045, Kampala, Uganda
| | - Karin Källander
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2R 4LT, UK.,Karolinska Institutet, Tomtebodavägen 18A, 17177, Stockholm, Sweden
| | - Sylvia Meek
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2R 4LT, UK
| | - James Tibenderana
- Malaria Consortium Africa, Plot 25 Upper Naguru East Road, P.O. Box 8045, Kampala, Uganda
| |
Collapse
|
6
|
Sunguya BF, Mlunde LB, Ayer R, Jimba M. Towards eliminating malaria in high endemic countries: the roles of community health workers and related cadres and their challenges in integrated community case management for malaria: a systematic review. Malar J 2017; 16:10. [PMID: 28049486 PMCID: PMC5209914 DOI: 10.1186/s12936-016-1667-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 12/22/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Human resource for health crisis has impaired global efforts against malaria in highly endemic countries. To address this, the World Health Organization (WHO) recommended scaling-up of community health workers (CHWs) and related cadres owing to their documented success in malaria and other disease prevention and management. Evidence is inconsistent on the roles and challenges they encounter in malaria interventions. This systematic review aims to summarize evidence on roles and challenges of CHWs and related cadres in integrated community case management for malaria (iCCM). METHODS This systematic review retrieved evidence from PubMed, CINAHL, ISI Web of Knowledge, and WHO regional databases. Terms extracted from the Boolean phrase used for PubMed were also used in other databases. The review included studies with Randomized Control Trial, Quasi-experimental, Pre-post interventional, Longitudinal and cohort, Cross-sectional, Case study, and Secondary data analysis. Because of heterogeneity, only narrative synthesis was conducted for this review. RESULTS A total of 66 articles were eligible for analysis out of 1380 studies retrieved. CHWs and related cadre roles in malaria interventions included: malaria case management, prevention including health surveillance and health promotion specific to malaria. Despite their documented success, CHWs and related cadres succumb to health system challenges. These are poor and unsustainable finance for iCCM, workforce related challenges, lack of and unsustainable supply of medicines and diagnostics, lack of information and research, service delivery and leadership challenges. CONCLUSIONS Community health workers and related cadres had important preventive, case management and promotive roles in malaria interventions. To enable their effective integration into the health systems, the identified challenges should be addressed. They include: introducing sustainable financing on iCCM programmes, tailoring their training to address the identified gaps, improving sustainable supply chain management of malaria drugs and diagnostics, and addressing regulatory challenges in the local contexts.
Collapse
Affiliation(s)
- Bruno F. Sunguya
- Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Linda B. Mlunde
- Management for Development and Health, Dar es Salaam, Tanzania
| | - Rakesh Ayer
- Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
| | - Masamine Jimba
- Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
| |
Collapse
|