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Abate BB, Zemariam AB, Wondimagegn A, Abebe GK, Araya FG, Kassie AM, Bizuayehu MA. Knowledge, attitude and practice of home management of diarrhea among under-five children in East Africa: A systematic review and meta-analysis. PLoS One 2024; 19:e0298801. [PMID: 38394284 PMCID: PMC10890776 DOI: 10.1371/journal.pone.0298801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Diarrhea is particularly prevalent in low-income or marginalized populations because these groups have less access to clean water sources, hygienic conditions, and healthcare. Dehydration due to electrolyte and fluid loss is the main cause of deaths associated with diarrhea. An especially important factor in this death from dehydration is the caregivers' knowledge, attitude, and diarrhea management techniques. While a number of research have been done on managing diarrhea at home, the results tend not to be consistent. This systematic review and meta-analysis aimed to assess the pooled estimate of knowledge, attitude and practice of home-based management of diarrhea in East Africa. METHODS Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was used to search articles from electronic databases (Cochrane library, Ovid platform (Medline, Embase, and Emcare), Google Scholar, CINAHL, PubMed, and institutional repositories in East Africa countries. The last search date was on 01/06/ 2023 Gregorian Calendar. The authors extracted year of publication, country, study design, knowledge level, attitude level and practice level of home-based management of diarrhea. A weighted inverse variance random-effects model was used to estimate the pooled prevalence of knowledge, attitude and practice of home-based management of diarrhea. Subgroup analysis was done by country, and sample size. Publication bias and sensitivity analysis were also done. RESULTS A total of 19 articles with (n = 7470 participants) were included for the final analysis. From the random-effects model analysis, the pooled prevalence of good practice, good knowledge and favorable attitude towards home based management of diarrhea in East Africa was found to be 52.62% (95% CI: 45.32%, 59.92%) (95% CI: I2 = 78.3%; p < 0.001), 37.44% (95% CI: 26.99%, 47.89%) (95% CI: I2 = 89.2%; p < 0.001) and 63.05% (95% CI: 35.7%, 90.41%) (95% CI: I2 = 97.8%; p < 0.001) respectively. CONCLUSION AND RECOMMENDATIONS The level of good knowledge, attitude and practice of home based management of diarrhea in East Africa is found to be low. A collaborative effort from different stakeholders to enhance the knowledge, attitude and practice is needed to tackle the burden of diarrhea and its consequences.
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Affiliation(s)
- Biruk Beletew Abate
- Assistant Professor in Pediatrics and Child Health Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Alemu Birara Zemariam
- MSc in Pediatrics and Child Health Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Addis Wondimagegn
- MSc in Emergency Medicine and Critical Care Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Gebremeskel Kibret Abebe
- MSc in Emergency Medicine and Critical Care Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | | | - Ayelign Mengesha Kassie
- Assistant Professor in Adult Health Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Molla Azmeraw Bizuayehu
- MSc in Pediatrics and Child Health Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
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Haile TG, Benova L, Mirkuzie AH, Asefa A. Effective coverage of curative child health services in Ethiopia: analysis of the Demographic and Health Survey and Service Provision Assessment survey. BMJ Open 2024; 14:e077856. [PMID: 38382958 PMCID: PMC10882307 DOI: 10.1136/bmjopen-2023-077856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVES Despite a remarkable decline, childhood morbidity and mortality in Ethiopia remain high and inequitable. Thus, we estimated the effective coverage of curative child health services in Ethiopia. DESIGN We conducted a cross-sectional analysis of data from the 2016 Ethiopia Demographic and Health Survey (DHS) and the 2014 Ethiopia Service Provision Assessment Plus (SPA+) survey. SETTING Nationally representative household and facility surveys. PARTICIPANTS AND OUTCOMES We included a sample of 2096 children under 5 years old (from DHS) who had symptoms of one or more common childhood illnesses (diarrhoea, fever and acute respiratory infection) and estimated the percentage of sick children who were taken to a health facility (crude coverage). To construct a quality index of child health services, we used the SPA+ survey, which was conducted in 1076 health facilities and included observations of care for 1980 sick children and surveys of 1908 mothers/caregivers and 5328 health providers. We applied the Donabedian quality of care framework to identify 58 quality parameters (structure, 31; process, 16; and outcome, 11) and used the weighted additive method to estimate the overall quality of care index. Finally, we multiplied the crude coverage by the quality of care index to estimate the effective coverage of curative child health services, nationally and by region. RESULTS Among the 2096 sick children, only 38.4% (95% CI: 36.5 to 40.4) of them were taken to a health facility. The overall quality of care was 54.4%, weighted from structure (30.0%), process (9.2%) and outcome (15.2%). The effective coverage of curative child health services was estimated at 20.9% (95%CI: 19.9 to 22.0) nationally, ranging from 16.9% in Somali to 34.6% in Dire Dawa regions. CONCLUSIONS System-wide interventions are required to address both demand-side and supply-side bottlenecks in the provision of child health services if child health-related targets are to be achieved in Ethiopia.
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Affiliation(s)
- Tsegaye Gebremedhin Haile
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Carboni C, Maroto IJ, Galindo M, Plessis L, Lambert Y, Bardon T, Vreden S, Suárez-Mutis M, Bordalo JM, Douine M, Sanna A. Training-of-trainers program for community health workers involved in an innovative and community-based intervention against malaria among goldminers in the Guiana shield: a quality and effectiveness evaluation. Front Public Health 2024; 11:1306432. [PMID: 38259795 PMCID: PMC10800722 DOI: 10.3389/fpubh.2023.1306432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction An innovative and community-based intervention is implemented in the Guiana Shield to eliminate malaria among people involved in artisanal and small-scale gold mining. The intervention consists of the distribution of malaria self-management kits to goldminers and the presumptive treatment for individuals at risk of carrying Plasmodium vivax hypnozoites. The intervention is possible owing to community health workers (CHWs) who are previously trained to master all intervention procedures, including health education activities and goldmining training. This study aimed to evaluate the training program provided to CHWs in terms of quality and effectiveness. Methods A training-of-trainers program for CHWs has been developed based on the CDC framework. A mixed-method case study was implemented in two steps between February and March 2023. The evaluation was based on a knowledge survey, satisfaction test, observations, and semi-structured interviews. Quantitative and qualitative data were analyzed and triangulated. Results A total of 20 CHWs participated in the training and the first-step evaluation. For the second step, four semi-structured interviews were conducted. The Qualitative data showed that group dynamics and adaptations were central elements of a high-quality training program. Quantitative analysis found that CHWs' satisfaction was elevated (> 4/5 overall), especially regarding format and learning results. Improvements in knowledge level demonstrated good effectiveness (pre-training vs. post-training, p < 0.05). Nevertheless, some difficulties persisted regarding tasks of the intervention procedure, such as informed consent and smartphone application procedures (with an inaccuracy rate of 29.2% and 16.7%, respectively). Further on-the-job training permitted to address these issues. The project team's previous experience and the Guiana Shield countries' commitment to the WHO-E-2025-initiative were identified as levers for the quality of the training, while the complexity of the project context was a challenge. Discussion High-quality, effective, and appropriate training programs are required for effective and sustainable interventions involving CHW profiles. Training design is a crucial point to address to accomplish quality and effectiveness. The training-of-trainers model has been shown to allow a high level of satisfaction, good learning results, and satisfactory implementation in the field. Initial and continuing training is an indispensable continuum to sustain good practices in the field and CHWs' motivation. Training evaluation permits standardizing methods and facilitates transferability.
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Affiliation(s)
- Carlotta Carboni
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Irene Jimeno Maroto
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Muriel Galindo
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Lorraine Plessis
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Yann Lambert
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Teddy Bardon
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Stephen Vreden
- Foundation for the Advancement of Scientific Research in Suriname (SWOS), Paramaribo, Suriname
| | - Martha Suárez-Mutis
- Laboratório de Doenças Parasitárias, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | | | - Maylis Douine
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Alice Sanna
- Département Recherche, Innovation et Santé Publique, Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
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Badolo H, Bado AR, Hien H, De Allegri M, Susuman AS. Determinants of Antenatal Care Utilization Among Childbearing Women in Burkina Faso. Front Glob Womens Health 2022; 3:848401. [PMID: 35686201 PMCID: PMC9173586 DOI: 10.3389/fgwh.2022.848401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAntenatal care (ANC) is one of the pillars of maternal and child health programs aimed at preventing and reducing maternal and child morbidity and mortality. This study aims to identify the factors associated with ANC use, considering both health care demand and supply factors in the single analysis.MethodsWe used data from the endline survey conducted to evaluate the impact of the performance-based financing (PBF) program in Burkina Faso in 2017. This study was a blocked-by-region cluster random trial using a pre–post comparison design. The sample was derived in a three-stage cluster sampling procedure. Data collection for the endline surveys included a household survey and a facility-based survey. Women of childbearing age who gave birth at least once in the past 2 years prior to this survey and residing in the study area for more than 6 months were included in this study. Multilevel statistical techniques were used to examine individual and contextual effects related to health care demand and supply simultaneously and thus measure the relative contribution of the different levels to explaining factors associated with ANC use.ResultsThe working women were five times [odd ratio (OR): 5.41, 95% confidence intervals (CI) 4.36–6.70] more likely to report using ANC services than the women who were not working (OR: 5.41, 95% CI 4.36–6.70). Women living in a community with high poverty concentration were 32.0% (OR: 0.68, 95% CI 0.50–0.91) less likely to use ANC services than those in a community with low poverty concentration. Women living in a community with a medium concentration of women's modern contraceptive use were almost two times (OR: 1.88, 95% CI 1.70–2.12) more likely to use ANC services than those living in a community with a low concentration of women's modern contraceptive use. Women living in the health area where the level of ANC quality was high were three times (OR: 2.96, 95% CI 1.46–6.12) more likely to use ANC services than those in the health area where the ANC quality was low.ConclusionPolicies that increase the opportunity for improving the average ANC quality at the health facility (HF), the level of women's modern contraceptive use and women employment would likely be effective in increasing the frequency of use of antenatal services.
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Affiliation(s)
- Hermann Badolo
- Department of Statistics and Population Studies, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
- Centre MURAZ, Institut National de Santé Publique, Ouagadougou, Burkina Faso
- *Correspondence: Hermann Badolo
| | - Aristide Romaric Bado
- Département Biomedical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
- West African Health Organization, Bobo-Dioulasso, Burkina Faso
| | - Hervé Hien
- Centre MURAZ, Institut National de Santé Publique, Ouagadougou, Burkina Faso
- Département Biomedical et Santé Publique, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Appunni Sathiya Susuman
- Department of Statistics and Population Studies, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
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Tariku A, Berhane Y, Worku A, Biks GA, Persson LÅ, Okwaraji YB. Health postservice readiness and use of preventive and curative services for suspected childhood pneumonia in Ethiopia: a cross-sectional study. BMJ Open 2022; 12:e058055. [PMID: 35477882 PMCID: PMC9047705 DOI: 10.1136/bmjopen-2021-058055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/08/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Pneumonia is the single-leading cause of infectious disease deaths in children under-5. Despite this challenge, the utilisation of preventive and curative child health services remains low in Ethiopia. We investigated the association between health post service readiness and caregivers' awareness of pneumonia services, care-seeking and utilisation of pneumonia-relevant immunisation in four Ethiopian regions. DESIGN AND SETTING This cross-sectional study was conducted in 52 districts of four regions of Ethiopia from December 2018 to February 2019. The health posts preparedness for sick child care was assessed using the WHO Health Service Availability and Readiness Assessment tool. Multilevel analyses were employed to examine the associations between health post readiness and household-level awareness and utilisation of services. PARTICIPANTS We included 165 health posts, 274 health extension workers (community health workers) and 4729 caregivers with 5787 children 2-59 months. OUTCOME MEASURES Awareness of pneumonia treatment, care-seeking behaviour and coverage of pentavalent-3 immunisation. RESULTS Only 62.8% of health posts were ready to provide sick child care services. One-quarter of caregivers were aware of pneumonia services, and 56.8% sought an appropriate care provider for suspected pneumonia. Nearly half (49.3%) of children (12-23 months) had received pentavalent-3 immunisation. General health post readiness was not associated with caregivers' awareness of pneumonia treatment (adjusted OR, AOR 0.9, 95% CI 0.7 to 1.1) and utilisation of pentavalent-3 immunisation (AOR=1.2, 95% CI 0.8 to 1.6), but negatively associated with care-seeking for childhood illnesses (AOR=0.6, 95% CI 0.4 to 0.8). CONCLUSION We found no association between facility readiness and awareness or utilisation of child health services. There were significant deficiencies in health post preparedness for services. Caregivers had low awareness and utilisation of pneumonia-related services. The results underline the importance of enhancing facility preparedness, providing high-quality care and intensifying demand generation efforts to prevent and treat pneumonia.
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Affiliation(s)
- Amare Tariku
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
- Department of Epidemiology and Biostatistics and Department of Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics and Department of Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Department of Epidemiology and Biostatistics and Department of Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gashaw Andargie Biks
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lars Åke Persson
- London School of Hygiene and Tropical Medicine, London, UK
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yemisrach Behailu Okwaraji
- London School of Hygiene and Tropical Medicine, London, UK
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Allen KC, Whitfield K, Rabinovich R, Sadruddin S. The role of governance in implementing sustainable global health interventions: review of health system integration for integrated community case management (iCCM) of childhood illnesses. BMJ Glob Health 2021; 6:bmjgh-2020-003257. [PMID: 33789866 PMCID: PMC8016094 DOI: 10.1136/bmjgh-2020-003257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 01/16/2023] Open
Abstract
Improving health outcomes in countries with the greatest burden of under-5 child mortality requires implementing innovative approaches like integrated community case management (iCCM) to improve coverage and access for hard-to-reach populations. ICCM improves access for hard-to-reach populations by deploying community health workers to manage malaria, diarrhoea and pneumonia. Despite documented impact, challenges remain in programme implementation and sustainability. An analytical review was conducted using evidence from published and grey literature from 2010 to 2019. The goal was to understand the link between governance, policy development and programme sustainability for iCCM. A Governance Analytical Framework revealed thematic challenges and successes for iCCM adaptation to national health systems. Governance in iCCM included the collective problems, actors in coordination and policy-setting, contextual norms and programmatic interactions. Key challenges were country leadership, contextual evidence and information-sharing, dependence on external funding, and disease-specific stovepipes that impede funding and coordination. Countries that tailor and adapt programmes to suit their governance processes and meet their specific needs and capacities are better able to achieve sustainability and impact in iCCM.
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Affiliation(s)
- Koya C Allen
- Malaria Eradication Scientific Alliance (MESA), Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Kate Whitfield
- Malaria Eradication Scientific Alliance (MESA), Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Regina Rabinovich
- Malaria Elimination Initiative, Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalunya, Spain.,ExxonMobil Malaria Scholar in Residence, Department of Immunology and Infectious Diseases, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Salim Sadruddin
- Child Health, MOMENTUM Country and Global Leadership, Washington, DC, USA
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Ezezika O, Ragunathan A, El-Bakri Y, Barrett K. Barriers and facilitators to implementation of oral rehydration therapy in low- and middle-income countries: A systematic review. PLoS One 2021; 16:e0249638. [PMID: 33886584 PMCID: PMC8062013 DOI: 10.1371/journal.pone.0249638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oral rehydration therapy (ORT) is an effective and cheap treatment for diarrheal disease; globally, one of the leading causes of death in children under five. The World Health Organization launched a global campaign to improve ORT coverage in 1978, with activities such as educational campaigns, training health workers and the creation of designate programming. Despite these efforts, ORT coverage remains relatively low. The objective of this systematic review is to identify the barriers and facilitators to the implementation of oral rehydration therapy in low and middle-income countries. METHODS A comprehensive search strategy comprised of relevant subject headings and keywords was executed in 5 databases including OVID Medline, OVID Embase, OVID HealthStar, Web of Science and Scopus. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. RESULTS The search identified 1570 citations and following removal of duplicates as well as screening according to our inclusion/exclusion criteria, 55 articles were eligible for inclusion in the review. Twenty-three countries were represented in this review, with India, Bangladesh, Egypt, Nigeria, and South Africa having the most representation of available studies. Study dates ranged from 1981 to 2020. Overarching thematic areas spanning the barriers and facilitators that were identified included: availability and accessibility, knowledge, partnership engagement, and design and acceptability. CONCLUSION A systematic review of studies on implementation of ORT in low- and middle-income countries (LMICs) highlights key activities that facilitate the development of successful implementation that include: (1) availability and accessibility of ORT, (2) awareness and education among communities, (3) strong partnership engagement strategies, and (4) adaptable design to enhance acceptability. The barriers and facilitators identified under the CIFR domains can be used to build knowledge on how to adapt ORT to national and local settings and contribute to a better understanding on the implementation and use of ORT in LMICs. The prospects for scaling and sustaining ORT (after years of low use) will increase if implementation research informs local applications, and implementers engage appropriate stakeholders and test assumptions around localized theories of change from interventions to expected outcomes. REGISTRATION A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD420201695).
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Affiliation(s)
- Obidimma Ezezika
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- African Centre for Innovation and Leadership Development, Abuja, Nigeria
| | - Apira Ragunathan
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Yasmine El-Bakri
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
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Changes in care-seeking for common childhood illnesses in the context of Integrated Community Case Management (iCCM) program implementation in Benishangul Gumuz region of Ethiopia. PLoS One 2020; 15:e0242451. [PMID: 33186375 PMCID: PMC7665800 DOI: 10.1371/journal.pone.0242451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background Integrated Community Case Management (iCCM) is a strategy for promoting access of under-served populations to lifesaving treatments through extending case management of common childhood illnesses to trained frontline health workers. In Ethiopia iCCM is provided by health extension workers (HEWs) deployed at health posts. We evaluated the association between the implementation of iCCM program in Assosa Zuria zone, Benishangul Gumuz region and changes in care-seeking for common childhood illnesses. Methods We conducted a pre-post study without control arm to evaluate the association of interest. The iCCM program that incorporated training, mentoring and supportive supervision of HEWs with community-based demand creation activities was implemented for two years (2017–18). Baseline, midline and endline surveys were completed approximately one year apart. Across the surveys, children aged 2–59 months (n = 1,848) who recently had cough, fever or diarrhea were included. Data were analysed using mixed-effects logistic regression model. Results Over the two-year period, care-seeking from any health facility and from health posts significantly increased by 10.7 and 17.4 percentage points (PP) from baseline levels of 64.5 and 34.1%, respectively (p<0.001). Care sought from health centres (p = 0.420) and public hospitals (p = 0.129) did not meaningfully change while proportion of caregivers who approached private (p = 0.003) and informal providers (p<0.001) declined. Caregivers who visited health posts for the treatment of diarrhea (19.2 PP, p<0.001), fever (15.5 PP, p<0.001), cough (17.8 PP, p<0.001) and cough with respiratory difficulty (17.3 PP, p = 0.038) significantly increased. After accounting for extraneous variables, we observed that care-seeking from iCCM providers was almost doubled (adjusted odds ratio = 2.32: 95% confidence interval; 1.88–2.86) over the period. Conclusion iCCM implementation was associated with a meaningful shift in care-seeking to health posts.
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Isiguzo C, Herrera S, Ufere J, Enebeli U, Oluoha C, Anyanti J, Prosnitz D. Improving access to appropriate case management for common childhood illnesses in hard-to-reach areas of Abia State, Nigeria. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Baynes C, Mboya D, Likasi S, Maganga D, Pemba S, Baraka J, Ramsey K, Semu H. Quality of Sick Child-Care Delivered by Community Health Workers in Tanzania. Int J Health Policy Manag 2018; 7:1097-1109. [PMID: 30709085 PMCID: PMC6358652 DOI: 10.15171/ijhpm.2018.63] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/02/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Community health worker (CHW) interventions to manage childhood illness is a strategy promoted by
the global health community which involves training and supporting CHW to assess, classify and treat sick children
at home, using an algorithm adapted from the Integrated Management of Childhood Illness (IMCI). To inform CHW
policy, the Government of Tanzania launched a program in 2011 to determine if community case management (CCM)
of malaria, pneumonia and diarrhea could be implemented by CHW in that country.
Methods: This paper reports the results of an observational study on the CCM service delivery quality of a trial cohort
of CHW in Tanzania, called WAJA. In 2014, teams of data collectors, employees of the Ministry of Health and Social
Welfare trained in IMCI, assessed the IMCI skills rendered by a sample of WAJA on sick children who presented to
WAJA with illness signs and symptoms in their communities. The assessment included direct observations of WAJA
IMCI episodes and expert re-assessment of the same children seen by WAJA to assess the congruence between the
assessment, classification and treatment outcomes of WAJA cases and those from cases conducted by expert re-assessors.
Results: In the majority of cases, WAJA correctly assess sick children for CCM-treatable illnesses (malaria, pneumonia,
and diarrhea) and general danger signs (90% and 89%, respectively), but too few correctly assess for physical danger signs
(39%); on classification in the majority of cases (73%) WAJA correctly classified illness, though more for CCM-treatable
illnesses (83%). In majority of cases (78%) WAJA treated children correctly (84% of malaria, 74% pneumonia, and 71%
diarrhea cases). Errors were often associated with lapses in health systems support, mainly supervision and logistics.
Conclusion: CCM is a feasible strategy for CHW in Tanzania, who, in the majority of cases, implemented the approach
as well as IMCI expert re-assessors. Nevertheless, for CCM to be effective, in Tanzania, a strategy to implement it must
be coordinated with efforts to strengthen local health systems
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Affiliation(s)
- Colin Baynes
- Mailman School of Public Health, Columbia University, New York City, NY, USA
| | | | | | | | - Senga Pemba
- Tanzania Training Center for International Health, Ifakara, Tanzania
| | | | - Kate Ramsey
- Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Helen Semu
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
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Taneja S, Dalpath S, Bhandari N, Kaur J, Mazumder S, Chowdhury R, Mundra S, Bhan MK. Operationalising integrated community case management of childhood illnesses by community health workers in rural Haryana. Acta Paediatr 2018; 107 Suppl 471:80-88. [PMID: 30570793 DOI: 10.1111/apa.14428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/15/2018] [Accepted: 05/31/2018] [Indexed: 12/16/2022]
Abstract
AIM To conduct implementation research in integrated community case management (ICCM) of childhood pneumonia, diarrhoea and fever by promoting accredited social health activists as treatment providers and generate lessons for upscaling this approach. METHODS In this one-sample study, 49 Accredited Social Health Activists were trained in ICCM. Community awareness and demand generation activities undertaken included announcements, pamphlets and posters. Supplies of medicines and supervision of activists were maintained throughout the 10-month implementation period. Three cross-sectional surveys were conducted in households with children aged 2-59 months for documenting two-week prevalence of illnesses and care-seeking practices. Focus group discussions and in-depth interviews were carried out with mothers/grandmothers and activists for documenting perceptions about health activists as treatment providers. RESULTS One third of pneumonia (113/334) and one quarter of diarrhoea (102/408) cases at end-line were treated by Accredited Social Health Activists. Proportion of households seeking care from private providers (mostly unqualified) reduced significantly from baseline to endline (81-56% for diarrhoea, p < 0.01; 78-48% for pneumonia, p < 0.01). At endline, activists were considered an acceptable and attractive source for treatment near home. CONCLUSION Trained Accredited Social Health Activists can treat uncomplicated childhood illnesses and are accepted by the community in this role.
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Affiliation(s)
- Sunita Taneja
- Centre for Health Research and Development; Society for Applied Studies; New Delhi India
| | - Suresh Dalpath
- Child Health and Immunisation; National Rural Health Mission; Chandigarh India
| | - Nita Bhandari
- Centre for Health Research and Development; Society for Applied Studies; New Delhi India
| | - Jasmine Kaur
- Centre for Health Research and Development; Society for Applied Studies; New Delhi India
| | - Sarmila Mazumder
- Centre for Health Research and Development; Society for Applied Studies; New Delhi India
| | - Ranadip Chowdhury
- Centre for Health Research and Development; Society for Applied Studies; New Delhi India
| | - Sudarshan Mundra
- Centre for Health Research and Development; Society for Applied Studies; New Delhi India
| | - Maharaj Kishan Bhan
- Indian Institute of Technology, New Delhi, India and Chair; Knowledge Integration and Technology Platform; Biotechnology Industry Research Assistance Council; New Delhi India
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Sarrassat S, Meda N, Badolo H, Ouedraogo M, Some H, Bambara R, Murray J, Remes P, Lavoie M, Cousens S, Head R. Effect of a mass radio campaign on family behaviours and child survival in Burkina Faso: a repeated cross-sectional, cluster-randomised trial. Lancet Glob Health 2018; 6:e330-e341. [PMID: 29433668 PMCID: PMC5817351 DOI: 10.1016/s2214-109x(18)30004-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 10/31/2022]
Abstract
BACKGROUND Media campaigns can potentially reach a large audience at relatively low cost but, to our knowledge, no randomised controlled trials have assessed their effect on a health outcome in a low-income country. We aimed to assess the effect of a radio campaign addressing family behaviours on all-cause post-neonatal under-5 child mortality in rural Burkina Faso. METHODS In this repeated cross-sectional, cluster randomised trial, clusters (distinct geographical areas in rural Burkina Faso with at least 40 000 inhabitants) were selected by Development Media International based on their high radio listenership (>60% of women listening to the radio in the past week) and minimum distances between radio stations to exclude population-level contamination. Clusters were randomly allocated to receive the intervention (a comprehensive radio campaign) or control group (no radio media campaign). Household surveys were performed at baseline (from December, 2011, to February, 2012), midline (in November, 2013, and after 20 months of campaigning), and endline (from November, 2014, to March, 2015, after 32 months of campaigning). Primary analyses were done on an intention-to-treat basis, based on cluster-level summaries and adjusted for imbalances between groups at baseline. The primary outcome was all-cause post-neonatal under-5 child mortality. The trial was designed to detect a 20% reduction in the primary outcome with a power of 80%. Routine data from health facilities were also analysed for evidence of changes in use and these data had high statistical power. The indicators measured were new antenatal care attendances, facility deliveries, and under-5 consultations. This trial is registered with ClinicalTrial.gov, number NCT01517230. FINDINGS The intervention ran from March, 2012, to January, 2015. 14 clusters were selected and randomly assigned to the intervention group (n=7) or the control group (n=7). The average number of villages included per cluster was 34 in the control group and 29 in the intervention group. 2269 (82%) of 2784 women in the intervention group reported recognising the campaign's radio spots at endline. Post-neonatal under-5 child mortality decreased from 93·3 to 58·5 per 1000 livebirths in the control group and from 125·1 to 85·1 per 1000 livebirths in the intervention group. There was no evidence of an intervention effect (risk ratio 1·00, 95% CI 0·82-1·22; p>0·999). In the first year of the intervention, under-5 consultations increased from 68 681 to 83 022 in the control group and from 79 852 to 111 758 in the intervention group. The intervention effect using interrupted time-series analysis was 35% (95% CI 20-51; p<0·0001). New antenatal care attendances decreased from 13 129 to 12 997 in the control group and increased from 19 658 to 20 202 in the intervention group in the first year (intervention effect 6%, 95% CI 2-10; p=0·004). Deliveries in health facilities decreased from 10 598 to 10 533 in the control group and increased from 12 155 to 12 902 in the intervention group in the first year (intervention effect 7%, 95% CI 2-11; p=0·004). INTERPRETATION A comprehensive radio campaign had no detectable effect on child mortality. Substantial decreases in child mortality were observed in both groups over the intervention period, reducing our ability to detect an effect. This, nevertheless, represents the first randomised controlled trial to show that mass media alone can change health-seeking behaviours. FUNDING Wellcome Trust and Planet Wheeler Foundation.
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Affiliation(s)
- Sophie Sarrassat
- Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | | | - Henri Some
- Africsanté, Bobo Dioulasso, Burkina Faso
| | - Robert Bambara
- Direction Générale des Études et des Statistiques Sectorielles (DGESS), Ministère de la Santé, Ouagadougou, Burkina Faso
| | | | - Pieter Remes
- Development Media International, Ouagadougou, Burkina Faso
| | | | - Simon Cousens
- Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Roy Head
- Development Media International, London, UK
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13
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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.
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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
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Horwood C, Butler L, Barker P, Phakathi S, Haskins L, Grant M, Mntambo N, Rollins N. A continuous quality improvement intervention to improve the effectiveness of community health workers providing care to mothers and children: a cluster randomised controlled trial in South Africa. HUMAN RESOURCES FOR HEALTH 2017; 15:39. [PMID: 28610590 PMCID: PMC5470211 DOI: 10.1186/s12960-017-0210-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/31/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Community health workers (CHWs) play key roles in delivering health programmes in many countries worldwide. CHW programmes can improve coverage of maternal and child health services for the most disadvantaged and remote communities, leading to substantial benefits for mothers and children. However, there is limited evidence of effective mentoring and supervision approaches for CHWs. METHODS This is a cluster randomised controlled trial to investigate the effectiveness of a continuous quality improvement (CQI) intervention amongst CHWs providing home-based education and support to pregnant women and mothers. Thirty CHW supervisors were randomly allocated to intervention (n = 15) and control (n = 15) arms. Four CHWs were randomly selected from those routinely supported by each supervisor (n = 60 per arm). In the intervention arm, these four CHWs and their supervisor formed a quality improvement team. Intervention CHWs received a 2-week training in WHO Community Case Management followed by CQI mentoring for 12 months (preceded by 3 months lead-in to establish QI processes). Baseline and follow-up surveys were conducted with mothers of infants <12 months old living in households served by participating CHWs. RESULTS Interviews were conducted with 736 and 606 mothers at baseline and follow-up respectively; socio-demographic characteristics were similar in both study arms and at each time point. At follow-up, compared to mothers served by control CHWs, mothers served by intervention CHWs were more likely to have received a CHW visit during pregnancy (75.7 vs 29.0%, p < 0.0001) and the postnatal period (72.6 vs 30.3%, p < 0.0001). Intervention mothers had higher maternal and child health knowledge scores (49 vs 43%, p = 0.02) and reported higher exclusive breastfeeding rates to 6 weeks (76.7 vs 65.1%, p = 0.02). HIV-positive mothers served by intervention CHWs were more likely to have disclosed their HIV status to the CHW (78.7 vs 50.0%, p = 0.007). Uptake of facility-based interventions were not significantly different. CONCLUSIONS Improved training and CQI-based mentoring of CHWs can improve quantity and quality of CHW-mother interactions at household level, leading to improvements in mothers' knowledge and infant feeding practices. TRIAL REGISTRATION ClinicalTrials.Gov NCT01774136.
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Affiliation(s)
- Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal South Africa
| | - Lisa Butler
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT United States of America
| | - Pierre Barker
- Institute for Healthcare Improvement, Cambridge, MA United States of America
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC United States of America
| | - Sifiso Phakathi
- Centre for Rural Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal South Africa
| | - Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal South Africa
| | - Merridy Grant
- Centre for Rural Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal South Africa
| | - Ntokozo Mntambo
- Centre for Rural Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal South Africa
| | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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15
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Wilson PT, Baiden F, Brooks JC, Morris MC, Giessler K, Punguyire D, Apio G, Agyeman-Ampromfi A, Lopez-Pintado S, Sylverken J, Nyarko-Jectey K, Tagbor H, Moresky RT. Continuous positive airway pressure for children with undifferentiated respiratory distress in Ghana: an open-label, cluster, crossover trial. LANCET GLOBAL HEALTH 2017; 5:e615-e623. [DOI: 10.1016/s2214-109x(17)30145-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/15/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
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16
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Kassebaum N, Kyu HH, Zoeckler L, Olsen HE, Thomas K, Pinho C, Bhutta ZA, Dandona L, Ferrari A, Ghiwot TT, Hay SI, Kinfu Y, Liang X, Lopez A, Malta DC, Mokdad AH, Naghavi M, Patton GC, Salomon J, Sartorius B, Topor-Madry R, Vollset SE, Werdecker A, Whiteford HA, Abate KH, Abbas K, Damtew SA, Ahmed MB, Akseer N, Al-Raddadi R, Alemayohu MA, Altirkawi K, Abajobir AA, Amare AT, Antonio CAT, Arnlov J, Artaman A, Asayesh H, Avokpaho EFGA, Awasthi A, Ayala Quintanilla BP, Bacha U, Betsu BD, Barac A, Bärnighausen TW, Baye E, Bedi N, Bensenor IM, Berhane A, Bernabe E, Bernal OA, Beyene AS, Biadgilign S, Bikbov B, Boyce CA, Brazinova A, Hailu GB, Carter A, Castañeda-Orjuela CA, Catalá-López F, Charlson FJ, Chitheer AA, Choi JYJ, Ciobanu LG, Crump J, Dandona R, Dellavalle RP, Deribew A, deVeber G, Dicker D, Ding EL, Dubey M, Endries AY, Erskine HE, Faraon EJA, Faro A, Farzadfar F, Fernandes JC, Fijabi DO, Fitzmaurice C, Fleming TD, Flor LS, Foreman KJ, Franklin RC, Fraser MS, Frostad JJ, Fullman N, Gebregergs GB, Gebru AA, Geleijnse JM, Gibney KB, Gidey Yihdego M, Ginawi IAM, Gishu MD, Gizachew TA, Glaser E, Gold AL, Goldberg E, Gona P, Goto A, Gugnani HC, Jiang G, Gupta R, Tesfay FH, Hankey GJ, Havmoeller R, Hijar M, Horino M, Hosgood HD, Hu G, Jacobsen KH, Jakovljevic MB, Jayaraman SP, Jha V, Jibat T, Johnson CO, Jonas J, Kasaeian A, Kawakami N, Keiyoro PN, Khalil I, Khang YH, Khubchandani J, Ahmad Kiadaliri AA, Kieling C, Kim D, Kissoon N, Knibbs LD, Koyanagi A, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kulikoff R, Kumar GA, Lal DK, Lam HY, Larson HJ, Larsson A, Laryea DO, Leung J, Lim SS, Lo LT, Lo WD, Looker KJ, Lotufo PA, Magdy Abd El Razek H, Malekzadeh R, Markos Shifti D, Mazidi M, Meaney PA, Meles KG, Memiah P, Mendoza W, Abera Mengistie M, Mengistu GW, Mensah GA, Miller TR, Mock C, Mohammadi A, Mohammed S, Monasta L, Mueller U, Nagata C, Naheed A, Nguyen G, Nguyen QL, Nsoesie E, Oh IH, Okoro A, Olusanya JO, Olusanya BO, Ortiz A, Paudel D, Pereira DM, Perico N, Petzold M, Phillips MR, Polanczyk GV, Pourmalek F, Qorbani M, Rafay A, Rahimi-Movaghar V, Rahman M, Rai RK, Ram U, Rankin Z, Remuzzi G, Renzaho AMN, Roba HS, Rojas-Rueda D, Ronfani L, Sagar R, Sanabria JR, Kedir Mohammed MS, Santos IS, Satpathy M, Sawhney M, Schöttker B, Schwebel DC, Scott JG, Sepanlou SG, Shaheen A, Shaikh MA, She J, Shiri R, Shiue I, Sigfusdottir ID, Singh J, Silpakit N, Smith A, Sreeramareddy C, Stanaway JD, Stein DJ, Steiner C, Sufiyan MB, Swaminathan S, Tabarés-Seisdedos R, Tabb KM, Tadese F, Tavakkoli M, Taye B, Teeple S, Tegegne TK, Temam Shifa G, Terkawi AS, Thomas B, Thomson AJ, Tobe-Gai R, Tonelli M, Tran BX, Troeger C, Ukwaja KN, Uthman O, Vasankari T, Venketasubramanian N, Vlassov VV, Weiderpass E, Weintraub R, Gebrehiwot SW, Westerman R, Williams HC, Wolfe CDA, Woodbrook R, Yano Y, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaki MES, Zegeye EA, Zuhlke LJ, Murray CJL, Vos T. Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study. JAMA Pediatr 2017; 171:573-592. [PMID: 28384795 PMCID: PMC5540012 DOI: 10.1001/jamapediatrics.2017.0250] [Citation(s) in RCA: 250] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/16/2017] [Indexed: 01/06/2023]
Abstract
Importance Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health. Objective To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion. Evidence Review Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss. Findings Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries. Conclusions and Relevance Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.
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Affiliation(s)
- Nicholas Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Hmwe Hmwe Kyu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Leo Zoeckler
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Katie Thomas
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Christine Pinho
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Zulfiqar A Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Public Health Foundation of India, Gurgaon-122002, National Capital Region, India
| | - Alize Ferrari
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Yohannes Kinfu
- Centre for Research & Action in Public Health, University of Canberra, Canberra, Australia
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Alan Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - George C Patton
- Murdoch Childrens Research Institute, University of Melbourne, Victoria, Australia
| | - Joshua Salomon
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Benn Sartorius
- School of Nursing and Public Health, University of KwaZulu-Natal, South African Medical Research Council/University of KwaZulu-Natal Gastrointestinal Cancer Research Center, Durban, South Africa
| | - Roman Topor-Madry
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Stein Emil Vollset
- Center for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Harvey A Whiteford
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | | | - Kaja Abbas
- Department of Population Health, Virginia Tech, Blacksburg
| | | | | | - Nadia Akseer
- The Hospital for Sick Children, Centre for Child Health, Toronto, Ontario, Canada
| | | | | | | | | | | | - Carl A T Antonio
- Department of Health Policy and Administration, University of Philippines-Manila, Manila, Philippines
| | - Johan Arnlov
- Department of Medical Services, Uppsala University, Uppsala, Sweden
- Dalarna University, Uppsala, Sweden
| | - Al Artaman
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Ashish Awasthi
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Umar Bacha
- School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | | | | | | | | | - Neeraj Bedi
- College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
| | | | - Adugnaw Berhane
- College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | | | | | | | | | - Boris Bikbov
- Department of Nephrology Issues of Transplanted Kidney, V. I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia
| | - Cheryl Anne Boyce
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Alexandra Brazinova
- Faculty of Health Sciences and Social Work, Department of Public Health, Trnava University, Trnava, Slovakia
| | | | - Austin Carter
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Ferrán Catalá-López
- University of Valencia, Valencia, Spain
- Health Research Institute and CIBERSAM, Valencia, Spain
| | - Fiona J Charlson
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | | | | | | | - John Crump
- Departmentà Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | | | - Amare Deribew
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Gabrielle deVeber
- The Hospital for Sick Children, Centre for Child Health, Toronto, Ontario, Canada
| | - Daniel Dicker
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Eric L Ding
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Manisha Dubey
- International Institute for Population Sciences, Mumbai, India
| | | | - Holly E Erskine
- Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
| | | | - Andre Faro
- Federal University of Sergipe, Aracaju, Brazil
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Joao C Fernandes
- Center for Biotechnology and Fine Chemistry, Catholic University of Portugal, Porto, Portugal
| | - Daniel Obadare Fijabi
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | | | - Thomas D Fleming
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Luisa Sorio Flor
- Escola Nacional de Saúde Pública Sergio Arouca/Fiocruz, Rio De Janeiro, Brazil
| | - Kyle J Foreman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Maya S Fraser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Joseph J Frostad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | - Katherine B Gibney
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Mahari Gidey Yihdego
- Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, Mizan-Tepi University, Ethiopia
| | | | | | | | - Elizabeth Glaser
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Audra L Gold
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Ellen Goldberg
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | - Harish Chander Gugnani
- Department of Microbiology, Departments of Epidemiology and Biostatistics, St James School of Medicine, the Quarter, Anguilla
| | - Guohong Jiang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | | | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | | | | | - Masako Horino
- Nevada Division of Public and Behavioral Health, Carson City, Nevada
| | | | - Guoqing Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, China
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
| | | | | | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India
- University of Oxford, Oxford, United Kingdom
| | - Tariku Jibat
- Wageningen University, Wageningen, Netherlands
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Catherine O Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Jost Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karlas University, Heidelberg, Germany
| | - Amir Kasaeian
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Ibrahim Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | - Christian Kieling
- Federal University of Rio Grande de Sul, Porto Alegre, Brazil
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Niranjan Kissoon
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Luke D Knibbs
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Kristopher J Krohn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | - Rachel Kulikoff
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | | | - Hilton Y Lam
- Institute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines
| | - Heidi J Larson
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anders Larsson
- Department of Medical Services, Uppsala University, Uppsala, Sweden
| | | | - Janni Leung
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Loon-Tzian Lo
- UnionHealth Associates LLC, St Louis, Missouri
- Alton Mental Health Center, Alton, Illinois
| | - Warren D Lo
- Department of Pediatrics, Department of Neurology, The Ohio State University, Columbus
| | | | - Paulo A Lotufo
- College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | | | - Reza Malekzadeh
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohsen Mazidi
- Institute of Genetics and Developmental Biology, Key State Laboratory of Molecular Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Peter A Meaney
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | | | | | | | - George A Mensah
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Ted R Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Charles Mock
- School of Medicine, School of Global Health, University of Washington, Seattle
| | | | | | - Lorenzo Monasta
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Ulrich Mueller
- Federal Institute for Population Research, Wiesbaden, Germany
| | - Chie Nagata
- National Center for Child Health and Development, Tokyo, Japan
| | - Aliya Naheed
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Grant Nguyen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Quyen Le Nguyen
- Institute for Global Health, Duy Tan University, Da Nang, Vietnam
| | - Elaine Nsoesie
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - In-Hwan Oh
- Department of Preventive Medicine, College of Medicine, Kyung Hee University, Seoul, South Korea
| | | | | | | | | | - Deepak Paudel
- UK Department for International Development, Lalitpur, Nepal
| | | | - Norberto Perico
- Istituto di Richerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Max Petzold
- Health Metrics Unit, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | - Mostafa Qorbani
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Anwar Rafay
- Contect International Health Consultants, Lahore, Punjab, Pakistan
| | - Vafa Rahimi-Movaghar
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahfuzar Rahman
- Research and Evaluation Division, Building Resources Access Communities, Dhaka, Bangladesh
| | | | - Usha Ram
- International Institute for Population Sciences, Mumbai, India
| | - Zane Rankin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | | | - Luca Ronfani
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Rajesh Sagar
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Institute of Health Care and Social Sciences, FOM University, Essen, Germany
| | | | - James G Scott
- Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Sadaf G Sepanlou
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amira Shaheen
- Department of Public Health, An-Najah University, Nablus, Palestine
| | | | - June She
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Work Organizations, Disability Program, University of Helsinki, Helsinki, Finland
| | - Ivy Shiue
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | | | | | - Naris Silpakit
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Alison Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Jeffrey D Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Caitlyn Steiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | - Karen M Tabb
- University of Illinois at Urbana-Champaign, Champaign
| | | | | | - Bineyam Taye
- Department of Biology, Colgate University, Hamilton, New York
| | - Stephanie Teeple
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | - Bernadette Thomas
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Alan J Thomson
- Adaptive Knowledge Management, Victoria, British Columbia, Canada
| | - Ruoyan Tobe-Gai
- National Center for Child Health and Development, Tokyo, Japan
| | | | | | - Christopher Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | | | | | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Insitutet, Stockholm, Sweden
- Institute of Population-based Cancer Research, Cancer Registry of Norway, Oslo, Norway
| | | | | | - Ronny Westerman
- Federal Institute for Population Research, Wiesbaden, Germany
| | | | | | - Rachel Woodbrook
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Yuichiro Yano
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | | | - Seok-Jun Yoon
- Department of Preventive Medicine, School of Medicine, Korea University, Seoul, South Korea
| | | | | | | | | | | | | | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
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Alvarez Morán JL, Alé FGB, Rogers E, Guerrero S. Quality of care for treatment of uncomplicated severe acute malnutrition delivered by community health workers in a rural area of Mali. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28378463 DOI: 10.1111/mcn.12449] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/16/2017] [Accepted: 02/18/2017] [Indexed: 12/13/2022]
Abstract
An alternative Community-based Management of Acute Malnutrition model with community health workers (CHWs) delivering treatment for uncomplicated severe acute malnutrition (SAM) was piloted in Mali. The capacity of the CHWs to evaluate, classify, and treat cases of uncomplicated SAM, to provide nutritional counselling to caretakers of children receiving treatment for SAM, malaria, pneumonia or diarrhoea and to correctly refer cases of complicated SAM, was assessed. This was done using direct observation by trained enumerators of the management of SAM cases using checklists, re-diagnosing the cases admitted for treatment and reviewing admissions cards and registers. One hundred twenty-five cases, assessed and treated by the CHWs, were observed. The majority of children were correctly assessed for the presence of major clinical signs (cough, diarrhoea, fever, and vomiting; 97.6%), and similarly most children were checked for the presence of danger signs (95.2%). Mid-upper arm circumference was correctly assessed in 96.8% of children and oedema was correctly assessed in 78.4% (The composite indicator, which includes all essential tasks to provide high-quality treatment, was achieved in 79.5% of cases. This paper concludes that well-trained and supervised CHWs are capable of managing cases of uncomplicated SAM. This suggests that such a strategy is an opportunity to increase access to quality treatment in Mali for SAM cases. However, further evidence is required to ensure that this level of care can be achieved at scale.
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Affiliation(s)
| | - Franck G B Alé
- Programa de Doctorado en Epidemiología y Salud Pública, Universidad Rey Juan Carlos, Móstoles, Spain
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Sreeramareddy CT, Low YP, Forsberg BC. Slow progress in diarrhea case management in low and middle income countries: evidence from cross-sectional national surveys, 1985-2012. BMC Pediatr 2017; 17:83. [PMID: 28320354 PMCID: PMC5360044 DOI: 10.1186/s12887-017-0836-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 03/08/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Diarrhea remains to be a main cause of childhood mortality. Diarrhea case management indicators reflect the effectiveness of child survival interventions. We aimed to assess time trends and country-wise changes in diarrhea case management indicators among under-5 children in low-and-middle-income countries. METHODS We analyzed aggregate data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys done from 1986 to 2012 in low-and-middle-income countries. Two-week prevalence rates of diarrhea, caregiver's care seeking behavior and three case management indicators were analyzed. We assessed overall time trends across the countries using panel data analyses and country-level changes between two sequential surveys. RESULTS Overall, yearly increase in case management indicators ranged from 1 · 3 to 2 · 5%. In the year 2012, <50% of the children were given correct treatment (received oral rehydration and increased fluids) for diarrhea. Annually, an estimated 300 to 350 million children were not given oral rehydration solutions, or recommended home fluids or 'increased fluids' and 304 million children not taken to a healthcare provider during an episode of diarrhea. Overall, care seeking for diarrhea, increased from pre-2000 to post-2000, i.e. from 35 to 45%; oral rehydration rates increased by about 7% but the rate of 'increased fluids' decreased by 14%. Country-level trends showed that care seeking had decreased in 15 countries but increased in 33 countries. Care seeking from a healthcare provider increased by ≥10% in about 23 countries. Oral rehydration rates had increased by ≥10% in 15 countries and in 30 countries oral rehydration rates increased by <10%. CONCLUSIONS Very limited progress has been made in the case management of childhood diarrhea. A better understanding of caregiver's care seeking behavior and health care provider's case management practices is needed to improve diarrhea case management in low- and-middle-income countries.
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Affiliation(s)
| | - Yue-Peng Low
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Birger Carl Forsberg
- Health Systems and Policy Research (HSP), Department of Public Health Sciences, Karolinska Institutet, S-17177 Stockholm, Sweden
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Boschi-Pinto C, Dilip TR, Costello A. Association between community management of pneumonia and diarrhoea in high-burden countries and the decline in under-five mortality rates: an ecological analysis. BMJ Open 2017; 7:e012639. [PMID: 28196943 PMCID: PMC5318559 DOI: 10.1136/bmjopen-2016-012639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The objective of the paper is to explore if the adoption of national policies to use community-based health providers for the management of pneumonia and diarrhoea is associated with the decline in under-five mortality, including achievement of the Millennium Development Goal (MDG)4 target, in high-burden countries. SETTING This country level analysis covers 75 high-burden low-income and middle-income countries which accounted for 98% of the 5.9 million global under-five deaths in 2015. One-fourth of these deaths were due to pneumonia and diarrhoea. METHODS χ2 tests and multiple regression analysis were used to examine the association between reduction in under-five mortality rates and community case management of pneumonia and diarrhoea by adjusting for the influence of other possible determinants. PARTICIPANTS No patient or population interviewed/examined for this analysis. Countries were the unit of analysis. INTERVENTIONS Community case management (CCM) of pneumonia and diarrhoea policies. OUTCOME MEASURES Changes in under-five mortality rates over time. RESULTS Countries that had adopted both CCM policies were three times more likely to achieve the MDG4 target than countries that did not have both policies in place. This association was further confirmed by the multivariate analysis (β-coefficient=10.4; 95% CI 2.4 to 18.5; p value=0.012). DISCUSSION There is a statistically significant association between adoption of CCM policies for treatment of pneumonia and diarrhoea and the rate of decline in child mortality levels. It is important to promote CCM in countries lagging behind to achieve the new target of 25 or fewer deaths per 1000 live births by 2030.
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Affiliation(s)
- Cynthia Boschi-Pinto
- Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland
- Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niteroi, Brazil
| | | | - Anthony Costello
- Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Rodríguez DC, Shearer J, Mariano ARE, Juma PA, Dalglish SL, Bennett S. Evidence-informed policymaking in practice: country-level examples of use of evidence for iCCM policy. Health Policy Plan 2017; 30 Suppl 2:ii36-ii45. [PMID: 26516149 PMCID: PMC4625759 DOI: 10.1093/heapol/czv033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Integrated Community Case Management of Childhood Illness (iCCM) is a policy for providing treatment for malaria, diarrhoea and pneumonia for children below 5 years at the community level, which is generating increasing evidence and support at the global level. As countries move to adopt iCCM, it becomes important to understand how this growing evidence base is viewed and used by national stakeholders. This article explores whether, how and why evidence influenced policy formulation for iCCM in Niger, Kenya and Mozambique, and uses Carol Weiss’ models of research utilization to further explain the use of evidence in these contexts. A documentary review and in-depth stakeholder interviews were conducted as part of retrospective case studies in each study country. Findings indicate that all three countries used national monitoring data to identify the issue of children dying in the community prior to reaching health facilities, whereas international research evidence was used to identify policy options. Nevertheless, policymakers greatly valued local evidence and pilot projects proved critical in advancing iCCM. World Health Organization and United Nations Children's Fund (UNICEF) functioned as knowledge brokers, bringing research evidence and experiences from other countries to the attention of local policymakers as well as sponsoring site visits and meetings. In terms of country-specific findings, Niger demonstrated both Interactive and Political models of research utilization by using iCCM to capitalize on the existing health infrastructure. Both Mozambique and Kenya exhibit Problem-Solving research utilization with different outcomes. Furthermore, the persistent quest for additional evidence suggests a Tactical use of research in Kenya. Results presented here indicate that while evidence from research studies and other contexts can be critical to policy development, local evidence is often needed to answer key policymaker questions. In the end, evidence may not be enough to overcome resistance if the policy is viewed as incompatible with national goals.
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Affiliation(s)
- Daniela C Rodríguez
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, 615 N Wolfe Street, Baltimore, MD 21205, USA,
| | - Jessica Shearer
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Alda R E Mariano
- Universidade Eduardo Mondlane, Community Health Department, Maputo, Mozambique and
| | - Pamela A Juma
- African Population and Health Research Center, Nairobi, Kenya
| | - Sarah L Dalglish
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Sara Bennett
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
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Bennett S, Dalglish SL, Juma PA, Rodríguez DC. Altogether now... understanding the role of international organizations in iCCM policy transfer. Health Policy Plan 2017; 30 Suppl 2:ii26-ii35. [PMID: 26516147 DOI: 10.1093/heapol/czv071] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Policy transfer theories explain how policy ideas move across time and geography and offer an approach to understanding waves of policy change, a common phenomenon in global health. Four primary mechanisms for the transfer of policies from global to national levels are posited: learning, coercion, socialization and competition. METHODS We used six concurrent country case studies of policy change for child survival followed by a global study to analyse (1) mechanisms for policy transfer and (2) the roles of international organizations in promoting policy transfer. Our six country cases drew upon early adopters of integrated Community Case Management of Childhood Illness policy (Malawi, Niger), as well as countries that were slower to adopt due either to practical implementation challenges (Mozambique, Mali) and/or policy resistance (Burkina Faso, Kenya). In total, 145 semi-structured interviews and 283 document reviews were conducted across the six country cases, and 25 semi-structured interviews and 72 document reviews for the global study. RESULTS Three of the four diffusion mechanisms (learning, coercion and socialization) were important in these cases, but not competition. Multiple strategies were employed by multilateral organizations to support policy transfer, such as regional meetings or academic publications, frequently serving multiple diffusion mechanisms simultaneously (e.g. both learning and socialization). In just one country case, funding conditionalities were used to press for policy change. The emphasis of policy transfer mechanisms varied between early and later adopters. Early adopters, for example, were more likely to engage in learning. International multilateral organizations were active policy transfer agents, and national policy-makers perception of them as "trusted partners" made them well suited for this role. However, on occasion their role became more that of advocates than neutral facilitators. CONCLUSIONS International actors use multiple synergistic channels to promote uptake of global health policies in low- and middle-income countries, and tailor strategies employed to country contexts.
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Affiliation(s)
| | - Sarah L Dalglish
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA and
| | - Pamela A Juma
- African Population and Health Research Centre, Nairobi, Kenya
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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.
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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
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23
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Gill CJ, Le Ngoc B, Halim N, Nguyen Viet H, Larson Williams A, Nguyen Van T, McNabb M, Tran Thi Ngoc L, Falconer A, An Phan Ha H, Rohr J, Hoang H, Michiel J, Nguyen Thi Thanh T, Bird L, Pham Vu H, Yeshitla M, Ha Van N, Sabin L. The mCME Project: A Randomized Controlled Trial of an SMS-Based Continuing Medical Education Intervention for Improving Medical Knowledge among Vietnamese Community Based Physicians' Assistants. PLoS One 2016; 11:e0166293. [PMID: 27861516 PMCID: PMC5115715 DOI: 10.1371/journal.pone.0166293] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022] Open
Abstract
Background Community health workers (CHWs) provide critical services to underserved populations in low and middle-income countries, but maintaining CHW’s clinical knowledge through formal continuing medical education (CME) activities is challenging and rarely occurs. We tested whether a Short Message Service (SMS)-based mobile CME (mCME) intervention could improve medical knowledge among a cadre of Vietnamese CHWs (Community Based Physician’s Assistants–CBPAs) who are the leading providers of primary medical care for rural underserved populations. Methods The mCME Project was a three arm randomized controlled trial. Group 1 served as controls while Groups 2 and 3 experienced two models of the mCME intervention. Group 2 (passive model) participants received a daily SMS bullet point, and were required to reply to the text to acknowledge receipt; Group 3 (interactive model) participants received an SMS in multiple choice question format addressing the same thematic area as Group 2, entering an answer (A, B, C or D) in their response. The server provided feedback immediately informing the participant whether the answer was correct. Effectiveness was based on standardized examination scores measured at baseline and endline (six months later). Secondary outcomes included job satisfaction and self-efficacy. Results 638 CBPAs were enrolled, randomized, and tested at baseline, with 592 returning at endline (93.7%). Baseline scores were similar across all three groups. Over the next six months, participation of Groups 2 and 3 remained high; they responded to >75% of messages. Group 3 participants answered 43% of the daily SMS questions correctly, but their performance did not improve over time. At endline, the CBPAs reported high satisfaction with the mCME intervention, and deemed the SMS messages highly relevant. However, endline exam scores did not increase over baseline, and did not differ between the three groups. Job satisfaction and self-efficacy scores also did not improve. Average times spent on self-study per week did not increase, and the kinds of knowledge resources used by the CBPAs did not differ between the three groups; textbooks, while widely available, were seldom used. Conclusions The SMS-based mCME intervention, while feasible and acceptable, did not result in increased medical knowledge. We hypothesize that this was because the intervention failed to stimulate lateral learning. For an intervention of this kind to be effective, it will be essential to find more effective ways to couple SMS as a stimulus to promote increased self-study behaviors. Trial Registration ClinicalTrials.gov NCT02381743
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Affiliation(s)
- Christopher J. Gill
- Center for Global Health and Development, Boston University, Boston, MA, United States of America
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
- * E-mail:
| | - Bao Le Ngoc
- Pathfinder International in Vietnam, Hanoi, Vietnam
| | - Nafisa Halim
- Center for Global Health and Development, Boston University, Boston, MA, United States of America
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Ha Nguyen Viet
- Center for Population Research Information and Databases (CPRID), Ministry of Health, Hanoi, Vietnam
| | - Anna Larson Williams
- Center for Global Health and Development, Boston University, Boston, MA, United States of America
| | - Tan Nguyen Van
- General Office for Population and Family Planning (GOPFP), Ministry of Health, Hanoi, Vietnam
| | - Marion McNabb
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
- Pathfinder International, Watertown, MA, United States of America
| | - Lien Tran Thi Ngoc
- Thái Nguyên Provincial Department of Public Health, Thái Nguyên City, Vietnam
| | - Ariel Falconer
- Center for Global Health and Development, Boston University, Boston, MA, United States of America
| | | | - Julia Rohr
- Center for Global Health and Development, Boston University, Boston, MA, United States of America
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Hai Hoang
- Thái Nguyên Provincial Department of Public Health, Thái Nguyên City, Vietnam
| | - James Michiel
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Tam Nguyen Thi Thanh
- Center for Population Research Information and Databases (CPRID), Ministry of Health, Hanoi, Vietnam
| | - Liat Bird
- Boston University School of Medicine, Boston, MA, United States of America
| | - Hoang Pham Vu
- Center for Population Research Information and Databases (CPRID), Ministry of Health, Hanoi, Vietnam
| | - Mahlet Yeshitla
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Nhu Ha Van
- Hanoi School of Public Health, Hanoi, Vietnam
| | - Lora Sabin
- Center for Global Health and Development, Boston University, Boston, MA, United States of America
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
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Kasteng F, Settumba S, Källander K, Vassall A. Valuing the work of unpaid community health workers and exploring the incentives to volunteering in rural Africa. Health Policy Plan 2016; 31:205-16. [PMID: 26001813 PMCID: PMC4748129 DOI: 10.1093/heapol/czv042] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 11/12/2022] Open
Abstract
Community health worker (CHW) programmes are currently being scaled-up in sub-Saharan Africa to improve access to healthcare. CHWs are often volunteers; from an economic perspective, this raises considerations whether reliance on an unpaid workforce is sustainable and how to appropriately cost and value the work of CHWs. Both these questions can be informed by an understanding of CHWs' workload, their opportunity costs of time and the perceived benefits of being a CHW. However, to date few studies have fully explored the methodological challenges in valuing CHW time. We examined the costs and benefits of volunteering in a sample of 45 CHWs providing integrated community case management of common childhood illnesses in rural Uganda in February 2012 using different methods. We assessed the value of CHW time using the minimum public sector salary rate and a CHW-elicited replacement wage, as well as the opportunity cost of time based on CHW-estimated annual income and alternative work opportunities, respectively. Reported monthly CHW workload, a median of 19.3 h (range 2.5-57), was valued at USD 6.9 (range 0.9-20.4) per month from the perspective of the healthcare system (applicable replacement wage) and at a median of USD 4.1 (range 0.4-169) from the perspective of the CHWs (individual opportunity cost of time). In a discrete choice experiment on preferred work characteristics, remuneration and community appreciation dominated. We find that volunteering CHWs value the opportunity to make a social contribution, but the decision to volunteer is also influenced by anticipated future rewards. Care must be taken by those costing and designing CHW programmes to acknowledge the opportunity cost of CHWs at the margin and over the long term. Failure to properly consider these issues may lead to cost estimations below the amount necessary to scale up and sustain programmes.
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Affiliation(s)
- Frida Kasteng
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Health Economics and Systems Analysis Group, London, UK,
| | | | - Karin Källander
- Malaria Consortium, London, UK, Department of Public Health Sciences, Karolinska Institutet, Health Systems and Policy group, Stockholm, Sweden, Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda, and
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Social and Mathematical Epidemiology Group, London, UK
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Munos M, Guiella G, Roberton T, Maïga A, Tiendrebeogo A, Tam Y, Bryce J, Baya B. Independent Evaluation of the Rapid Scale-Up Program to Reduce Under-Five Mortality in Burkina Faso. Am J Trop Med Hyg 2016; 94:584-595. [PMID: 26787147 PMCID: PMC4775895 DOI: 10.4269/ajtmh.15-0585] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/29/2015] [Indexed: 12/14/2022] Open
Abstract
We conducted a prospective evaluation of the "Rapid Scale-Up" (RSU) program in Burkina Faso, focusing on the integrated community case management (iCCM) component of the program. We used a quasi-experimental design in which nine RSU districts were compared with seven districts without the program. The evaluation included documentation of program implementation, assessments of implementation and quality of care, baseline and endline coverage surveys, and estimation of mortality changes using the Lives Saved Tool. Although the program trained large numbers of community health workers, there were implementation shortcomings related to training, supervision, and drug stockouts. The quality of care provided to sick children was poor, and utilization of community health workers was low. Changes in intervention coverage were comparable in RSU and comparison areas. Estimated under-five mortality declined by 6.2% (from 110 to 103 deaths per 1,000 live births) in the RSU area and 4.2% (from 114 to 109 per 1,000 live births) in the comparison area. The RSU did not result in coverage increases or mortality reductions in Burkina Faso, but we cannot draw conclusions about the effectiveness of the iCCM strategy, given implementation shortcomings. The evaluation results highlight the need for greater attention to implementation of iCCM programs.
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Affiliation(s)
- Melinda Munos
- *Address correspondence to Melinda Munos, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205. E-mail:
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Amouzou A, Kanyuka M, Hazel E, Heidkamp R, Marsh A, Mleme T, Munthali S, Park L, Banda B, Moulton LH, Black RE, Hill K, Perin J, Victora CG, Bryce J. Independent Evaluation of the integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design. Am J Trop Med Hyg 2016; 94:574-583. [PMID: 26787158 PMCID: PMC4775894 DOI: 10.4269/ajtmh.15-0584] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/03/2015] [Indexed: 12/03/2022] Open
Abstract
We evaluated the impact of integrated community case management of childhood illness (iCCM) on careseeking for childhood illness and child mortality in Malawi, using a National Evaluation Platform dose-response design with 27 districts as units of analysis. “Dose” variables included density of iCCM providers, drug availability, and supervision, measured through a cross-sectional cellular telephone survey of all iCCM-trained providers. “Response” variables were changes between 2010 and 2014 in careseeking and mortality in children aged 2–59 months, measured through household surveys. iCCM implementation strength was not associated with changes in careseeking or mortality. There were fewer than one iCCM-ready provider per 1,000 under-five children per district. About 70% of sick children were taken outside the home for care in both 2010 and 2014. Careseeking from iCCM providers increased over time from about 2% to 10%; careseeking from other providers fell by a similar amount. Likely contributors to the failure to find impact include low density of iCCM providers, geographic targeting of iCCM to “hard-to-reach” areas although women did not identify distance from a provider as a barrier to health care, and displacement of facility careseeking by iCCM careseeking. This suggests that targeting iCCM solely based on geographic barriers may need to be reconsidered.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jennifer Bryce
- *Address correspondence to Jennifer Bryce, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205. E-mail:
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Bagonza J, Rutebemberwa E, Eckmanns T, Ekirapa-Kiracho E. What influences availability of medicines for the community management of childhood illnesses in central Uganda? Implications for scaling up the integrated community case management programme. BMC Public Health 2015; 15:1180. [PMID: 26608029 PMCID: PMC4660670 DOI: 10.1186/s12889-015-2525-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 11/18/2015] [Indexed: 11/29/2022] Open
Abstract
Background The integrated Community Case Management (iCCM) of childhood illnesses strategy has been adopted world over to reduce child related ill health and mortality. Community Health workers (CHWs) who implement this strategy need a regular supply of drugs to effectively treat children under 5 years with malaria, pneumonia and diarrhea. In this paper, we report the prevalence and factors influencing availability of medicines for managing malaria, pneumonia and diarrhea in communities in central Uganda. Methods A cross sectional study was conducted among 303 CHWs in Wakiso district in central Uganda. Eligible CHWs from two randomly selected Health Sub Districts (HSDs) were interviewed. Questionnaires, check lists, record reviews were used to collect information on CHW background characteristics, CHW’s prescription behaviors, health system support factors and availability of iCCM drugs. Multivariable logistic regression analysis was done to assess factors associated with availability of iCCM drugs. Results Out of 300 CHWs, 239 (79.9 %) were females and mean age was 42.1 (standard deviation =11.1 years). The prevalence of iCCM drug availability was 8.3 % and 33 respondents (11 %) had no drugs at all. Factors associated with iCCM drug availability were; being supervised within the last month (adjusted OR = 3.70, 95 % CI 1.22–11.24), appropriate drug prescriptions (adjusted OR = 3.71, 95 % CI 1.38–9.96), regular submission of drug reports (adjusted OR = 4.02, 95 % CI 1.62–10.10) and having a respiratory timer as a diagnostic tool (adjusted OR =3.11, 95 % CI 1.08–9.00). Conclusions The low medicine stocks for the community management of childhood illnesses calls for strengthening of CHW supervision, medicine prescription and reporting, and increasing availability of functional diagnostic tools.
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Affiliation(s)
- James Bagonza
- Department of Health Policy Planning and Management, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
| | - Elizeus Rutebemberwa
- Department of Health Policy Planning and Management, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
| | | | - Elizabeth Ekirapa-Kiracho
- Department of Health Policy Planning and Management, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
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George A, Young M, Nefdt R, Basu R, Sylla M, Clarysse G, Bannicq MY, de Sousa A, Binkin N, Diaz T. Community health workers providing government community case management for child survival in sub-Saharan Africa: who are they and what are they expected to do? Am J Trop Med Hyg 2015; 87:85-91. [PMID: 23136282 PMCID: PMC3748527 DOI: 10.4269/ajtmh.2012.11-0757] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We describe community health workers (CHWs) in government community case management (CCM) programs for child survival across sub-Saharan Africa. In sub-Saharan Africa, 91% of 44 United Nations Children's Fund (UNICEF) offices responded to a cross-sectional survey in 2010. Frequencies describe CHW profiles and activities in government CCM programs (N = 29). Although a few programs paid CHWs a salary or conversely, rewarded CHWs purely on a non-financial basis, most programs combined financial and non-financial incentives and had training for 1 week. Not all programs allowed CHWs to provide zinc, use timers, dispense antibiotics, or use rapid diagnostic tests. Many CHWs undertake health promotion, but fewer CHWs provide soap, water treatment products, indoor residual spraying, or ready-to-use therapeutic foods. For newborn care, very few promote kangaroo care, and they do not provide antibiotics or resuscitation. Even if CHWs are as varied as the health systems in which they work, more work must be done in terms of the design and implementation of the CHW programs for them to realize their potential.
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Affiliation(s)
- Asha George
- *Address correspondence to Asha George, Bloomberg School of Public Health, John Hopkins University, 615 North Wolfe Street, Suite E-8146, Baltimore, MD 21205. E-mail:
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Simen-Kapeu A, Seale AC, Wall S, Nyange C, Qazi SA, Moxon SG, Young M, Liu G, Darmstadt GL, Dickson KE, Lawn JE. Treatment of neonatal infections: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth 2015; 15 Suppl 2:S6. [PMID: 26391217 PMCID: PMC4578441 DOI: 10.1186/1471-2393-15-s2-s6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Around one-third of the world's 2.8 million neonatal deaths are caused by infections. Most of these deaths are preventable, but occur due to delays in care-seeking, and access to effective antibiotic treatment with supportive care. Understanding variation in health system bottlenecks to scale-up of case management of neonatal infections and identifying solutions is essential to reduce mortality, and also morbidity. Methods A standardised bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the development of the Every Newborn Action Plan. Country workshops involved technical experts to complete a survey tool, to grade health system "bottlenecks" hindering scale up of maternal-newborn intervention packages. Quantitative and qualitative methods were used to analyse the data, combined with literature review, to present priority bottlenecks and synthesise actions to improve case management of newborn infections. Results For neonatal infections, the health system building blocks most frequently graded as major or significant bottlenecks, irrespective of mortality context and geographical region, were health workforce (11 out of 12 countries), and community ownership and partnership (11 out of 12 countries). Lack of data to inform decision making, and limited funding to increase access to quality neonatal care were also major challenges. Conclusions Rapid recognition of possible serious bacterial infection and access to care is essential. Inpatient hospital care remains the first line of treatment for neonatal infections. In situations where referral is not possible, the use of simplified antibiotic regimens for outpatient management for non-critically ill young infants has recently been reported in large clinical trials; WHO is developing a guideline to treat this group of young infants. Improving quality of care through more investment in the health workforce at all levels of care is critical, in addition to ensuring development and dissemination of national guidelines. Improved information systems are needed to track coverage and adequately manage drug supply logistics for improved health outcomes. It is important to increase community ownership and partnership, for example through involvement of community groups.
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Impact of an integrated community case management programme on uptake of appropriate diarrhoea and pneumonia treatments in Uganda: A propensity score matching and equity analysis study. Int J Equity Health 2015; 14:74. [PMID: 26337975 PMCID: PMC4559074 DOI: 10.1186/s12939-015-0202-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/13/2015] [Indexed: 11/10/2022] Open
Abstract
Introduction Pneumonia and diarrhoea disproportionately affect children in resource-poor settings. Integrated community case management (iCCM) involves community health workers treating diarrhoea, pneumonia and malaria. Studies on impact of iCCM on appropriate treatment and its effects on equity in access to the same are limited. The objective of this study was to measure the impact of integrated community case management (iCCM) as the first point of care on uptake of appropriate treatment for children with a classification of pneumonia (cough and fast breathing) and/or diarrhoea and to measure the magnitude and distribution of socioeconomic status related inequality in use of iCCM. Methods Following introduction of iCCM, data from cross-sectional household surveys were examined for socioeconomic inequalities in uptake of treatment and use of iCCM among children with a classification of pneumonia or diarrhoea using the Erreygers’ corrected concentration index (CCI). Propensity score matching methods were used to estimate the average treatment effects on the treated (ATT) for children treated under the iCCM programme with recommended antibiotics for pneumonia, and ORS plus or minus zinc for diarrhoea. Findings Overall, more children treated under iCCM received appropriate antibiotics for pneumonia (ATT = 34.7 %, p < 0.001) and ORS for diarrhoea (ATT = 41.2 %, p < 0.001) compared to children not attending iCCM. No such increase was observed for children receiving ORS-zinc combination (ATT = -0.145, p < 0.05). There were no obvious inequalities in the uptake of appropriate treatment for pneumonia among the poorest and least poor (CCI = -0.070; SE = 0.083). Receiving ORS for diarrhoea was more prevalent among the least poor groups (CCI = 0.199; SE = 0.118). The use of iCCM for pneumonia was more prevalent among the poorest groups (CCI = -0.099; SE = 0.073). The use of iCCM for diarrhoea was not significantly different among the poorest and least poor (CCI = -0.073; SE = 0.085). Conclusion iCCM is a potentially equitable strategy that significantly increased the uptake of appropriate antibiotic treatment for pneumonia and ORS for diarrhoea, but not the uptake of zinc for diarrhoea. For maximum impact, interventions increasing zinc uptake should be considered when scaling up iCCM programmes.
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Estimating the cost of referral and willingness to pay for referral to higher-level health facilities: a case series study from an integrated community case management programme in Uganda. BMC Health Serv Res 2015; 15:347. [PMID: 26315661 PMCID: PMC4551371 DOI: 10.1186/s12913-015-1019-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/21/2015] [Indexed: 11/12/2022] Open
Abstract
Background Integrated community case management (iCCM) relies on community health workers (CHWs) managing children with malaria, pneumonia, diarrhoea, and referring children when management is not possible. This study sought to establish the cost per sick child referred to seek care from a higher-level health facility by a CHW and to estimate caregivers’ willingness to pay (WTP) for referral. Methods Caregivers of 203 randomly selected children referred to higher-level health facilities by CHWs were interviewed in four Midwestern Uganda districts. Questionnaires and document reviews were used to capture direct, indirect and opportunity costs incurred by caregivers, CHWs and health facilities managing referred children. WTP for referral was assessed through the ‘bidding game’ approach followed by an open-ended question on maximum WTP. Descriptive analysis was conducted for factors associated with referral completion and WTP using logistic and linear regression methods, respectively. The cost per case referred to higher-level health facilities was computed from a societal perspective. Results Reasons for referral included having fever with a negative malaria test (46.8 %), danger signs (29.6 %) and drug shortage (37.4 %). Among the referred, less than half completed referral (45.8 %). Referral completion was 2.8 times higher among children with danger signs (p = 0.004) relative to those without danger signs, and 0.27 times lower among children who received pre-referral treatment (p < 0.001). The average cost per case referred was US$ 4.89 and US$7.35 per case completing referral. For each unit cost per case referred, caregiver out of pocket expenditure contributed 33.7 %, caregivers’ and CHWs’ opportunity costs contributed 29.2 % and 5.1 % respectively and health facility costs contributed 39.6 %. The mean (SD) out of pocket expenditure was US$1.65 (3.25). The mean WTP for referral was US$8.25 (14.70) and was positively associated with having received pre-referral treatment, completing referral and increasing caregiver education level. Conclusion The mean WTP for referral was higher than the average out of pocket expenditure. This, along with suboptimal referral completion, points to barriers in access to higher-level facilities as the primary cause of low referral. Community mobilisation for uptake of referral is necessary if the policy of referring children to the nearest health facility is to be effective.
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Fotso JC, Fogarty L. Progress towards Millennium Development Goals 4 & 5: strengthening human resources for maternal, newborn and child health. BMC Health Serv Res 2015; 15 Suppl 1:S1. [PMID: 26062408 PMCID: PMC4464219 DOI: 10.1186/1472-6963-15-s1-s1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Affiliation(s)
- Melba F. Gomes
- Special Programme on Research and Training in Tropical Diseases (TDR), a co-sponsored Programme of UNICEF/UNDP/World Bank/WHO, based at the World Health Organization, Geneva, Switzerland
| | - Annette C. Kuesel
- Special Programme on Research and Training in Tropical Diseases (TDR), a co-sponsored Programme of UNICEF/UNDP/World Bank/WHO, based at the World Health Organization, Geneva, Switzerland
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Gomes MF, Kuesel AC. From bright ideas to tools: the case of malaria. PLoS Negl Trop Dis 2015. [PMID: 25569712 DOI: 10.1371/journal.pntd] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Affiliation(s)
- Melba F Gomes
- Special Programme on Research and Training in Tropical Diseases (TDR), a co-sponsored Programme of UNICEF/UNDP/World Bank/WHO, based at the World Health Organization, Geneva, Switzerland
| | - Annette C Kuesel
- Special Programme on Research and Training in Tropical Diseases (TDR), a co-sponsored Programme of UNICEF/UNDP/World Bank/WHO, based at the World Health Organization, Geneva, Switzerland
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Friberg IK, Walker N. Using the Lives Saved Tool as part of evaluations of community case management programs. J Glob Health 2014; 4:020412. [PMID: 25520802 PMCID: PMC4267103 DOI: 10.7189/jogh.04.020412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Integrated community case management (iCCM) has been recommended by the World Health Organization to reduce mortality among children in populations with limited access to facility–based health care providers. Although many countries have introduced iCCM, interpretation of the impact is difficult due to many other activities occurring in the community. This paper suggests a method for using the Lives Saved Tool to model the independent impact of iCCM on child mortality. Model The Lives Saved Tool (LiST) is a multi–cause model of mortality which allows users to look at the potential impacts of one or many interventions on one or many causes of death without double counting their impact. LiST uses changes in intervention coverage and cause–specific effectiveness estimates on mortality and risk factors to model overall changes in mortality as well as to attribute mortality reduction to specific interventions. Collecting data on the source of the care seeking behaviors is critical to being able to model and interpret the changes observed. Discussion The complexity of implementation of iCCM in the environment of broader health changes requires modeling to understand the program specific impacts. Using LiST results as additional data in combination with observed coverage change and mortality reduction can help explain the isolated impact of a given iCCM program when other changes are ongoing. LiST is unable to determine why the changes in health care seeking behaviors occur, but can be useful in helping to explain whether or not the changes were beneficial.
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Affiliation(s)
- Ingrid K Friberg
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neff Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Rabbani F, Mukhi AAA, Perveen S, Gul X, Iqbal SP, Qazi SA, Syed IA, Shaikh KH, Aftab W. Improving community case management of diarrhoea and pneumonia in district Badin, Pakistan through a cluster randomised study--the NIGRAAN trial protocol. Implement Sci 2014; 9:186. [PMID: 25490971 PMCID: PMC4297376 DOI: 10.1186/s13012-014-0186-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/28/2014] [Indexed: 11/24/2022] Open
Abstract
Background Diarrhoea and pneumonia contribute 30% of deaths in children under 5 in Pakistan. Pakistan’s Lady Health Workers Programme (LHW-P) covers about 60% of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers. An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors (LHSs) is a key determinant of this problem. Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs. Ultimately, community case management (CCM) of childhood pneumonia and diarrhoea will improve. Methods/Design NIGRAAN is a cluster-randomised trial in District Badin, Pakistan. There are approximately 1100 LHWs supervised by 36 LHSs in Badin. For this study, each LHS serves as a cluster. All LHSs working permanently in Badin who regularly conduct and report field visits are eligible. Thirty-four LHSs have been allocated to either intervention or control arms in a ratio of 1:1 through computer-generated simple randomisation technique. Five LHWs from each LHSs are also randomly picked. All 34 LHSs and 170 LHWs will be actively monitored. The intervention consists of training to build LHS knowledge and skills, clinical mentorship and written feedback to LHWs. Pre- and post-intervention assessments of LHSs, LHWs and community caregivers will be conducted via focus group discussions, in-depth interviews, knowledge assessment questionnaires, skill assessment scorecards and household surveys. Primary outcome is improvement in CCM practices of childhood diarrhoea and pneumonia and will be assessed at the cluster level. Discussion NIGRAAN takes a novel approach to implementation research and explores whether training of LHSs in supervisory skills results in improving the CCM practices of childhood diarrhoea and pneumonia. No significant harm to participants is anticipated. The enablers and barriers towards improved CCM would provide recommendations to policymakers for scale up of this intervention nationally and regionally. Trial registration NIGRAAN is registered with the ‘Australian New Zealand Clinical Trials Registry’. Registration Number: ACTRN12613001261707
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Affiliation(s)
- Fauziah Rabbani
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
| | - Aftab Akbar Ali Mukhi
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
| | - Shagufta Perveen
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
| | - Xaher Gul
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
| | - Saleem Perwaiz Iqbal
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
| | - Shamim Ahmed Qazi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
| | - Iqbal Azam Syed
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
| | - Khalid Hussain Shaikh
- Department of Health, Government of Sindh, 6th floor, New Sindh Secretariat, Karachi, Pakistan.
| | - Wafa Aftab
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
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Blanas DA, Ndiaye Y, MacFarlane M, Manga I, Siddiqui A, Velez O, Kanter AS, Nichols K, Hennig N. Health worker perceptions of integrating mobile phones into community case management of malaria in Saraya, Senegal. Int Health 2014; 7:176-82. [PMID: 25316707 DOI: 10.1093/inthealth/ihu075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 07/18/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although community case management of malaria increases access to life-saving care in isolated settings, it contends with many logistical challenges. Mobile phone health information technology may present an opportunity to address a number of these barriers. METHODS Using the wireless adaptation of the technology acceptance model, this study assessed availability, ease of use, usefulness, and job relevance of mobile phones by health workers in Saraya, Senegal. RESULTS This study conducted seven key informant interviews with government health workers, and three focus groups and 76 surveys with lay health workers. Principal findings included that mobile phones are already widely available and used, and that participants valued using phones to address training, stock management, programme reporting, and transportation challenges. CONCLUSIONS By documenting widespread use of mobile phones and health worker perceptions of their most useful applications, this paper provides a framework for their integration into the community case management of malaria programme in Saraya, Senegal.
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Affiliation(s)
- Demetri A Blanas
- Harlem Residency in Family Medicine, Institute for Family Health, New York, New York, 10029, USA
| | - Youssoupha Ndiaye
- Health District of Saraya, Senegalese Ministry of Health, Saraya, Senegal
| | | | - Isaac Manga
- Health District of Saraya, Senegalese Ministry of Health, Saraya, Senegal
| | - Ammar Siddiqui
- Mount Sinai Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Olivia Velez
- ICF International, New York, New York, 10028, USA
| | - Andrew S Kanter
- Earth Institute, Columbia University, New York, New York, 10027, USA
| | - Kim Nichols
- African Services Committee, New York, New York, 10027, USA
| | - Nils Hennig
- Mount Sinai Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
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Yansaneh AI, Moulton LH, George AS, Rao SR, Kennedy N, Bangura P, Brieger WR, Kabano A, Diaz T. Influence of community health volunteers on care seeking and treatment coverage for common childhood illnesses in the context of free health care in rural Sierra Leone. Trop Med Int Health 2014; 19:1466-76. [PMID: 25243929 DOI: 10.1111/tmi.12383] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine whether community health volunteers induced significant changes in care seeking and treatment of ill children under five 2 years after their deployment in two underserved districts of Sierra Leone. METHODS A pre-test-post-test study with intervention and comparison groups was used. A household cluster survey was conducted among caregivers of 5643 children at baseline and of 5259 children at endline. RESULTS In the intervention districts, treatments provided by community health volunteers increased from 0 to 14.3% for all three conditions combined (P < 0.001). Care seeking from an appropriate provider was not statistically significant (OR = 1.50, 95% CI: 0.88-2.54) between intervention and comparison districts and coverage of appropriate treatment increased in both study groups for all three illnesses. However, the presence of community health volunteers was associated with a 105% increase in appropriate treatment for pneumonia (OR = 2.05, 95% CI: 1.22-3.42) and a 55% drop in traditional treatment for diarrhoea (OR = 0.45, 95% CI: 0.21-0.96). Community health volunteers were also associated with fewer facility treatments for malaria (OR = 0.21, 95% CI: 0.07-0.62). CONCLUSION After implementing free care, coverage for treatment for all three illnesses in both study groups improved. Deployment of community health volunteers was associated with a reduced treatment burden at facilities and less reliance on traditional treatments.
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Affiliation(s)
- Aisha I Yansaneh
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Paintain LS, Willey B, Kedenge S, Sharkey A, Kim J, Buj V, Webster J, Schellenberg D, Ngongo N. Community health workers and stand-alone or integrated case management of malaria: a systematic literature review. Am J Trop Med Hyg 2014; 91:461-470. [PMID: 24957538 PMCID: PMC4155545 DOI: 10.4269/ajtmh.14-0094] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A systematic literature review was conducted to assess the effectiveness of strategies to improve community case management (CCM) of malaria. Forty-three studies were included; most (38) reported indicators of community health worker (CHW) performance, 14 reported on malaria CCM integrated with other child health interventions, 16 reported on health system capacity, and 13 reported on referral. The CHWs are able to provide good quality malaria care, including performing procedures such as rapid diagnostic tests. Appropriate training, clear guidelines, and regular supportive supervision are important facilitating factors. Crucial to sustainable success of CHW programs is strengthening health system capacity to support commodity supply, supervision, and appropriate treatment of referred cases. The little evidence available on referral from community to health facility level suggests that this is an area that needs priority attention. The studies of integrated CCM suggest that additional tasks do not reduce the quality of malaria CCM provided sufficient training and supervision is maintained.
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Affiliation(s)
- Lucy Smith Paintain
- *Address correspondence to Lucy Smith Paintain, Disease Control Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom. E-mail:
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Miller NP, Amouzou A, Tafesse M, Hazel E, Legesse H, Degefie T, Victora CG, Black RE, Bryce J. Integrated community case management of childhood illness in Ethiopia: implementation strength and quality of care. Am J Trop Med Hyg 2014; 91:424-434. [PMID: 24799369 PMCID: PMC4125273 DOI: 10.4269/ajtmh.13-0751] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Ethiopia has scaled up integrated community case management of childhood illness (iCCM) in most regions. We assessed the strength of iCCM implementation and the quality of care provided by health extension workers (HEWs). Data collectors observed HEWs' consultations with sick children and carried out gold standard re-examinations. Nearly all HEWs received training and supervision, and essential commodities were available. HEWs provided correct case management for 64% of children. The proportions of children correctly managed for pneumonia, diarrhea, and malnutrition were 72%, 79%, and 59%, respectively. Only 34% of children with severe illness were correctly managed. Health posts saw an average of 16 sick children in the previous 1 month. These results show that iCCM can be implemented at scale and that community-based HEWs can correctly manage multiple illnesses. However, to increase the chances of impact on child mortality, management of severe illness and use of iCCM services must be improved.
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Affiliation(s)
- Nathan P. Miller
- *Address correspondence to Nathan P. Miller, Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205. E-mail:
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Bennett S, George A, Rodriguez D, Shearer J, Diallo B, Konate M, Dalglish S, Juma P, Namakhoma I, Banda H, Chilundo B, Mariano A, Cliff J. Policy challenges facing integrated community case management in Sub-Saharan Africa. Trop Med Int Health 2014; 19:872-82. [PMID: 24750516 PMCID: PMC4282431 DOI: 10.1111/tmi.12319] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change. METHODS Qualitative retrospective case studies drawing from document reviews, semi-structured interviews and in-country validation workshops were conducted in Burkina Faso, Kenya, Malawi, Mali, Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status, community health worker (CHW) models and different African regions. RESULTS Country iCCM policies evolved in an ad hoc fashion, but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors, but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals, together with recognition of the shortcomings of existing child health programmes, led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change. CONCLUSIONS iCCM policy change has been promoted by international agencies, but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level, political ownership of iCCM policies could facilitate policy change, as could clearer strategies for ensuring the long-term sustainability of such policies.
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Affiliation(s)
- Sara Bennett
- Johns Hopkins School of Public Health, Baltimore, MD, USA
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Druetz T, Siekmans K, Goossens S, Ridde V, Haddad S. The community case management of pneumonia in Africa: a review of the evidence. Health Policy Plan 2013; 30:253-66. [PMID: 24371218 DOI: 10.1093/heapol/czt104] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pneumonia causes around 750 000 child deaths per year in sub-Saharan African (SSA) countries. The lack of accessibility to prompt and effective treatment is an important contributor to this burden. Community case management of pneumonia (CCMp) uses trained community health workers (CHWs) to administer antibiotics to suspected child pneumonia cases in villages. This strategy has been gaining momentum in low- and middle-income countries, and the World Health Organization and United Nations children's fund have recently encouraged countries to broaden community case management to other diseases. Recommendations in favour CCMp are based on three meta-analyses showing its efficacy to reduce childhood mortality and morbidity attributable to pneumonia although most of the studies in the meta-analyses were conducted in Asian countries. This is problematic as community case management strategies have been implemented in very different ways in Asian and SSA countries, partly due to differences in malaria prevalence. Therefore, we conducted a narrative synthesis to systematically review the evidence on CCMp in SSA. Results show that there is a lack of evidence concerning its efficacy and effectiveness in SSA, irrespective of whether case management is integrated with other diseases or not. CHWs encounter difficulties in counting the respiratory rate. Their adherence to the guidelines is poorer when they are required to manage several illnesses or children with severe signs. CCMp thus encompasses issues of over-treatment and missed treatment, with potentially negative consequences such as increased lethality in severe cases and antibiotics resistance. The current lack of evidence concerning its efficacy, effectiveness and the factors leading to successful implementation, coupled with CHWs' poor adherence, demand a thorough examination of the legitimacy of implementing CCMp in SSA countries.
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Affiliation(s)
- Thomas Druetz
- Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France
| | - Kendra Siekmans
- Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France
| | - Sylvie Goossens
- Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France
| | - Valéry Ridde
- Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France
| | - Slim Haddad
- Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France Research Centre of the University of Montreal Hospital Centre (CRCHUM), 850 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada School of Public Health, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada Healthbridge, 1 Nicholas Street, Ottawa, ON K1N 7B7, Canada and Independent Consultant, Paris, France
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Callaghan-Koru JA, Nonyane BAS, Guenther T, Sitrin D, Ligowe R, Chimbalanga E, Zimba E, Kachale F, Shah R, Baqui AH. Contribution of community-based newborn health promotion to reducing inequities in healthy newborn care practices and knowledge: evidence of improvement from a three-district pilot program in Malawi. BMC Public Health 2013; 13:1052. [PMID: 24199832 PMCID: PMC3833651 DOI: 10.1186/1471-2458-13-1052] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/29/2013] [Indexed: 11/29/2022] Open
Abstract
Background Inequities in both health status and coverage of health services are considered important barriers to achieving Millennium Development Goal 4. Community-based health promotion is a strategy that is believed to reduce inequities in rural low-income settings. This paper examines the contributions of community-based programming to improving the equity of newborn health in three districts in Malawi. Methods This study is a before-and-after evaluation of Malawi’s Community-Based Maternal and Newborn Care (CBMNC) program, a package of facility and community-based interventions to improve newborn health. Health Surveillance Assistants (HSAs) within the catchment area of 14 health facilities were trained to make pregnancy and postnatal home visits to promote healthy behaviors and assess women and newborns for danger signs requiring referral to a facility. “Core groups” of community volunteers were also trained to raise awareness about recommended newborn care practices. Baseline and endline household surveys measured the coverage of the intervention and targeted health behaviors for this before-and-after evaluation. Wealth indices were constructed using household asset data and concentration indices were compared between baseline and endline for each indicator. Results The HSAs trained in the intervention reached 36.7% of women with a pregnancy home visit and 10.9% of women with a postnatal home visit within three days of delivery. Coverage of the intervention was slightly inequitable, with richer households more likely to receive one or two pregnancy home visits (concentration indices (CI) of 0.0786 and 0.0960), but not significantly more likely to receive a postnatal visit or know of a core group. Despite modest coverage levels for the intervention, health equity improved significantly over the study period for several indicators. Greater improvements in inequities were observed for knowledge indicators than for coverage of routine health services. At endline, a greater proportion of women from the poorest quintile knew three or more danger signs for pregnancy, delivery, and postpartum mothers than did women from the least poor quintile (change in CI: -0.1704, -0.2464, and -0.4166, respectively; p < 0.05). Equity also significantly improved for coverage of some health behaviors, including delivery at a health facility (change in CI: -0.0591), breastfeeding within the first hour (-0.0379), and delayed bathing (-0.0405). Conclusions Although these results indicate promising improvements for newborn health in Malawi, the extent to which the CBMNC program contributed to these improvements in coverage and equity are not known. The strategies through which community-based programs are implemented likely play an important role in their ability to improve equity, and further research and program monitoring are needed to ensure that the poorest households are reached by community-based health programs.
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Affiliation(s)
- Jennifer A Callaghan-Koru
- International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Nanyonjo A, Makumbi F, Etou P, Tomson G, Källander K. Perceived quality of care for common childhood illnesses: facility versus community based providers in Uganda. PLoS One 2013; 8:e79943. [PMID: 24244581 PMCID: PMC3820538 DOI: 10.1371/journal.pone.0079943] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 09/27/2013] [Indexed: 11/29/2022] Open
Abstract
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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Affiliation(s)
- Agnes Nanyonjo
- Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- Malaria Consortium, Kampala, Uganda
| | | | | | - Göran Tomson
- Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- Medical Management Centre (MMC), Stockholm, Sweden
| | - Karin Källander
- Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- Makerere University School of Public Health, Kampala, Uganda
- Malaria Consortium, Kampala, Uganda
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Abstract
10 years ago, The Lancet published a Series about child survival. In this Review, we examine progress in the past decade in child survival, with a focus on epidemiology, interventions and intervention coverage, strategies of health programmes, equity, evidence, accountability, and global leadership. Knowledge of child health epidemiology has greatly increased, and although more and better interventions are available, they still do not reach large numbers of mothers and children. Child survival should remain at the heart of global goals in the post-2015 era. Many countries are now making good progress and need the time and support required to finish the task. The global health community should show its steadfast commitment to child survival by amassing knowledge and experience as a basis for ever more effective programmes. Leadership and accountability for child survival should be strengthened and shared among the UN system; governments in high-income, middle-income, and low-income countries; and non-governmental organisations.
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Affiliation(s)
- Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Hazel E, Requejo J, David J, Bryce J. Measuring coverage in MNCH: evaluation of community-based treatment of childhood illnesses through household surveys. PLoS Med 2013; 10:e1001384. [PMID: 23667329 PMCID: PMC3646213 DOI: 10.1371/journal.pmed.1001384] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Community case management (CCM) is a strategy for training and supporting workers at the community level to provide treatment for the three major childhood diseases--diarrhea, fever (indicative of malaria), and pneumonia--as a complement to facility-based care. Many low- and middle-income countries are now implementing CCM and need to evaluate whether adoption of the strategy is associated with increases in treatment coverage. In this review, we assess the extent to which large-scale, national household surveys can serve as sources of baseline data for evaluating trends in community-based treatment coverage for childhood illnesses. Our examination of the questionnaires used in Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2005 and 2010 in five sub-Saharan African countries shows that questions on care seeking that included a locally adapted option for a community-based provider were present in all the DHS surveys and in some MICS surveys. Most of the surveys also assessed whether appropriate treatments were available, but only one survey collected information on the place of treatment for all three illnesses. This absence of baseline data on treatment source in household surveys will limit efforts to evaluate the effects of the introduction of CCM strategies in the study countries. We recommend alternative analysis plans for assessing CCM programs using household survey data that depend on baseline data availability and on the timing of CCM policy implementation.
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Affiliation(s)
- Elizabeth Hazel
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
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Barriers to community case management of malaria in Saraya, Senegal: training, and supply-chains. Malar J 2013; 12:95. [PMID: 23497188 PMCID: PMC3607880 DOI: 10.1186/1475-2875-12-95] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 03/10/2013] [Indexed: 11/12/2022] Open
Abstract
Background Health workers in sub-Saharan Africa can now diagnose and treat malaria in the field, using rapid diagnostic tests and artemisinin-based combination therapy in areas without microscopy and widespread resistance to previously effective drugs. Objective This study evaluates communities’ perceptions of a new community case management of malaria programme in the district of Saraya, south-eastern Senegal, the effectiveness of lay health worker trainings, and the availability of rapid diagnostic tests and artemisinin-based combination therapy in the field. Methods The study employed qualitative and quantitative methods including focus groups with villagers, and pre- and post-training questionnaires with lay health workers. Results Communities approved of the community case management programme, but expressed concern about other general barriers to care, particularly transportation challenges. Most lay health workers acquired important skills, but a sizeable minority did not understand the rapid diagnostic test algorithm and were not able to correctly prescribe arteminisin-based combination therapy soon after the training. Further, few women lay health workers participated in the programme. Finally, the study identified stock-outs of rapid tests and anti-malaria medication products in over half of the programme sites two months after the start of the programme, thought due to a regional shortage. Conclusion This study identified barriers to implementation of the community case management of malaria programme in Saraya that include lay health worker training, low numbers of women participants, and generalized stock-outs. These barriers warrant investigation into possible solutions of relevance to community case management generally.
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Mitsunaga T, Hedt-Gauthier B, Ngizwenayo E, Farmer DB, Karamaga A, Drobac P, Basinga P, Hirschhorn L, Ngabo F, Mugeni C. Utilizing community health worker data for program management and evaluation: systems for data quality assessments and baseline results from Rwanda. Soc Sci Med 2013; 85:87-92. [PMID: 23540371 DOI: 10.1016/j.socscimed.2013.02.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 02/08/2013] [Accepted: 02/20/2013] [Indexed: 11/26/2022]
Abstract
Community health workers (CHWs) have and continue to play a pivotal role in health services delivery in many resource-constrained environments. The data routinely generated through these programs are increasingly relied upon for providing information for program management, evaluation and quality assurance. However, there are few published results on the quality of CHW-generated data, and what information exists suggests quality is low. An ongoing challenge is the lack of routine systems for CHW data quality assessments (DQAs). In this paper, we describe a system developed for CHW DQAs and results of the first formal assessment in southern Kayonza, Rwanda, May-June 2011. We discuss considerations for other programs interested in adopting such systems. While the results identified gaps in the current data quality, the assessment also identified opportunities for strengthening the data to ensure suitable levels of quality for use in management and evaluation.
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Affiliation(s)
- Tisha Mitsunaga
- Inshuti Mu Buzima, Partners In Health, PO Box 3432, Kigali, Rwanda.
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Gilroy KE, Callaghan-Koru JA, Cardemil CV, Nsona H, Amouzou A, Mtimuni A, Daelmans B, Mgalula L, Bryce J. Quality of sick child care delivered by Health Surveillance Assistants in Malawi. Health Policy Plan 2012; 28:573-85. [PMID: 23065598 PMCID: PMC3753880 DOI: 10.1093/heapol/czs095] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To assess the quality of care provided by Health Surveillance Assistants (HSAs)—a cadre of community-based health workers—as part of a national scale-up of community case management of childhood illness (CCM) in Malawi. Methods Trained research teams visited a random sample of HSAs (n = 131) trained in CCM and provided with initial essential drug stocks in six districts, and observed the provision of sick child care. Trained clinicians conducted ‘gold-standard’ reassessments of the child. Members of the survey team also interviewed caregivers and HSAs and inspected drug stocks and patient registers. Findings HSAs provided correct treatment with antimalarials to 79% of the 241 children presenting with uncomplicated fever, with oral rehydration salts to 69% of the 93 children presenting with uncomplicated diarrhoea and with antibiotics to 52% of 58 children presenting with suspected pneumonia (cough with fast breathing). About one in five children (18%) presented with danger signs. HSAs correctly assessed 37% of children for four danger signs by conducting a physical exam, and correctly referred 55% of children with danger signs. Conclusion Malawi’s CCM programme is a promising strategy for increasing coverage of sick child treatment, although there is much room for improvement, especially in the correct assessment and treatment of suspected pneumonia and the identification and referral of sick children with danger signs. However, HSAs provided sick child care at levels of quality similar to those provided in first-level health facilities in Malawi, and quality should improve if the Ministry of Health and partners act on the results of this assessment.
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Affiliation(s)
- Kate E Gilroy
- Institute for International Programs, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore MD 21205-2103, USA.
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