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Bagenda F, Wesuta AC, Stone G, Ntaro M, Patel P, Kenney J, Baguma S, Ayebare DS, Bwambale S, Matte M, Kawungezi PC, Mulogo EM. Contribution of community health workers to the treatment of common illnesses among under 5-year-olds in rural Uganda. Malar J 2022; 21:296. [PMID: 36271397 PMCID: PMC9587615 DOI: 10.1186/s12936-022-04316-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background The control of malaria, pneumonia, and diarrhoea is important for the reduction in morbidity and mortality among children under 5 years. Uganda has adopted the Integrated Community Case Management strategy using Community Health Workers (CHWs) to address this challenge. The extent and trend of these three conditions managed by the CHWs are not well documented. This study was done to describe the epidemiology and trends of the three common illnesses treated by the CHWs in Bugoye Sub-County in rural Uganda. Methods A retrospective review of monthly morbidity data for children less than 5 years of age for the period April 2014–December 2018 for CHWs in rural Bugoye Sub-County in Kasese district, Uganda was done. The total number reviewed was 18,430 records. The data were analysed using STATA version 14. Results In total male were 50.2% of the sample, pneumonia was the highest cause of illness among the infants (< 1 year), while malaria was the highest among the children 1 year–59 months. Infection with a single illness was the commonest recorded cause of presentation but there were some children recorded with multiple illnesses. All the CHWs were managing the three common illnesses among children under 5 years. The trend of the three common illnesses was changing from malaria to pneumonia being the commonest. Children aged 12–24 months and 25–59 months were at 2.1 times (95% CI 1.7–2.4) and 5.2 times (95% CI 4.6–5.9), respectively, more likely to get malaria but less likely to get pneumonia and diarrhoea. Conclusion Community Health Workers in rural Uganda are contributing significantly to the management of all the three commonest illnesses among under-5 years-old children. The trend of the commonest illness is changing from malaria to pneumonia. Children under 1 year are at a higher risk of getting pneumonia and diarrhoea and at a lower risk of getting malaria.
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Affiliation(s)
- Fred Bagenda
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
| | - Andrew Christopher Wesuta
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Geren Stone
- Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, Boston, MA, 02114, USA
| | - Moses Ntaro
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Palka Patel
- Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, Boston, MA, 02114, USA
| | - Jessica Kenney
- Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, Boston, MA, 02114, USA
| | | | - David Santson Ayebare
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | | | - Michael Matte
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Peter Chris Kawungezi
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Edgar Mugema Mulogo
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
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Khan AM, O’Donald A, Shi T, Ahmed S, McCollum ED, King C, Baqui AH, Cunningham S, Campbell H. Accuracy of non-physician health workers in respiratory rate measurement to identify paediatric pneumonia in low- and middle-income countries: A systematic review and meta-analysis. J Glob Health 2022. [PMCID: PMC9037577 DOI: 10.7189/jogh.12.04037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Ahad M Khan
- Projahnmo Research Foundation, Dhaka, Bangladesh
- The University of Edinburgh, Edinburgh, UK
| | | | - Ting Shi
- The University of Edinburgh, Edinburgh, UK
| | - Salahuddin Ahmed
- Projahnmo Research Foundation, Dhaka, Bangladesh
- The University of Edinburgh, Edinburgh, UK
| | - Eric D McCollum
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Abdullah H Baqui
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Miller JS, Mulogo EM, Wesuta AC, Mumbere N, Mbaju J, Matte M, Ntaro M, Guiles DA, Patel PR, Bwambale S, Kenney J, Reyes R, Stone GS. Long-term quality of integrated community case management care for children in Bugoye Subcounty, Uganda: a retrospective observational study. BMJ Open 2022; 12:e051015. [PMID: 35459661 PMCID: PMC9036460 DOI: 10.1136/bmjopen-2021-051015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Integrated community case management (iCCM) of childhood illness in Uganda involves protocol-based care of malaria, pneumonia and diarrhoea for children under 5 years old. This study assessed volunteer village health workers' (VHW) ability to provide correct iCCM care according to the national protocol and change in their performance over time since initial training. SETTING VHWs affiliated with the Ugandan national programme provide community-based care in eight villages in Bugoye Subcounty, a rural area in Kasese District. The first cohort of VHWs began providing iCCM care in March 2013, the second cohort in July 2016. PARTICIPANTS All children receiving iCCM care in 18 430 clinical encounters occurring between April 2014 and December 2018. PRIMARY AND SECONDARY OUTCOME MEASURES The descriptive primary outcome measure was the proportion of patients receiving overall correct care, defined as adherence to the iCCM protocol for the presenting condition (hereafter quality of care). The analytic primary outcome was change in the odds of receiving correct care over time, assessed using logistic regression models with generalised estimating equations. Secondary outcome measures included a set of binary measures of adherence to specific elements of the iCCM protocol. Preplanned and final measures were the same. RESULTS Overall, VHWs provided correct care in 74% of clinical encounters. For the first cohort of VHWs, regression modelling demonstrated a modest increase in quality of care until approximately 3 years after their initial iCCM training (OR 1.022 per month elapsed, 95% CI 1.005 to 1.038), followed by a modest decrease thereafter (OR 0.978 per month, 95% CI 0.970 to 0.986). For the second cohort, quality of care was essentially constant over time (OR 1.007 per month, 95% CI 0.989 to 1.025). CONCLUSION Quality of care was relatively constant over time, though the trend towards decreasing quality of care after 3 years of providing iCCM care requires further monitoring.
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Affiliation(s)
- James S Miller
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Edgar Mugema Mulogo
- Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Bugoye Community Health Collaboration, Bugoye, Uganda
| | - Andrew Christopher Wesuta
- Bugoye Community Health Collaboration, Bugoye, Uganda
- Global Health Collaborative-MUST Uganda, Mbarara, Uganda
| | - Nobert Mumbere
- Bugoye Community Health Collaboration, Bugoye, Uganda
- Global Health Collaborative-MUST Uganda, Mbarara, Uganda
| | - Jackson Mbaju
- Bugoye Community Health Collaboration, Bugoye, Uganda
- Global Health Collaborative-MUST Uganda, Mbarara, Uganda
| | - Michael Matte
- Bugoye Community Health Collaboration, Bugoye, Uganda
- Global Health Collaborative-MUST Uganda, Mbarara, Uganda
| | - Moses Ntaro
- Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Bugoye Community Health Collaboration, Bugoye, Uganda
| | - Daniel A Guiles
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Palka R Patel
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shem Bwambale
- Bugoye Community Health Collaboration, Bugoye, Uganda
- Bugoye Health Center, Bugoye, Uganda
| | - Jessica Kenney
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Bugoye Community Health Collaboration, Bugoye, Uganda
| | - Raquel Reyes
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Geren S Stone
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Miller JS, Mbusa RK, Baguma S, Patel P, Matte M, Ntaro M, Wesuta AC, Mumbere N, Bwambale S, Mian-McCarthy S, Kenney J, Guiles D, Mulogo EM, Stone GS. A cross-sectional study comparing case scenarios and record review to measure quality of Integrated Community Case Management care in western Uganda. Trans R Soc Trop Med Hyg 2021; 115:627-633. [PMID: 33002128 DOI: 10.1093/trstmh/traa097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/28/2020] [Accepted: 09/12/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In Integrated Community Case Management (iCCM), village health workers (VHW) assess and treat malaria, pneumonia and diarrhea using a clinical algorithm. Study objectives included: 1) Compare VHWs' performance on case scenario exercises to record review data; 2) assess impact of formal education on performance in the case scenario exercises. METHODS 36 VHWs in Bugoye Subcounty, Uganda completed the case scenarios exercise, which included video case scenarios and brief oral case vignettes, between July 2017 and February 2018. We obtained clinical records for all iCCM encounters in the same time period. RESULTS In the video case scenarios, 45% of mock patients received all correct management steps (including all recommended education), while 94% received all critical management steps. Based on the level of data available from record review, 74% of patients in the record review dataset received overall correct management compared to 94% in the video case scenarios. In the case scenarios, VHWs with primary school education performed similarly to those with some or all secondary school education. CONCLUSIONS The case scenarios produced higher estimates of quality of care than record review. VHWs often omitted recommended health education topics in the case scenarios. Level of formal education did not appear to influence performance in the case scenarios.
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Affiliation(s)
- James S Miller
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Global Health Collaborative, Mbarara, Uganda
| | | | | | - Palka Patel
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Global Health Collaborative, Mbarara, Uganda
| | | | - Moses Ntaro
- Global Health Collaborative, Mbarara, Uganda.,Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | - Sara Mian-McCarthy
- Massachusetts General Hospital, Boston, MA, USA.,Global Health Collaborative, Mbarara, Uganda
| | - Jessica Kenney
- Massachusetts General Hospital, Boston, MA, USA.,Global Health Collaborative, Mbarara, Uganda
| | - Daniel Guiles
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Global Health Collaborative, Mbarara, Uganda
| | - Edgar Mugema Mulogo
- Global Health Collaborative, Mbarara, Uganda.,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Geren S Stone
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Global Health Collaborative, Mbarara, Uganda
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Orkin AM, Venugopal J, Curran JD, Fortune MK, McArthur A, Mew E, Ritchie SD, Drennan IR, Exley A, Jamieson R, Johnson DE, MacPherson A, Martiniuk A, McDonald N, Osei-Ampofo M, Wegier P, Van de Velde S, VanderBurgh D. Emergency care with lay responders in underserved populations: a systematic review. Bull World Health Organ 2021; 99:514-528H. [PMID: 34248224 PMCID: PMC8243031 DOI: 10.2471/blt.20.270249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the individual and community health effects of task shifting for emergency care in low-resource settings and underserved populations worldwide. Methods We systematically searched 13 databases and additional grey literature for studies published between 1984 and 2019. Eligible studies involved emergency care training for laypeople in underserved or low-resource populations, and any quantitative assessment of effects on the health of individuals or communities. We conducted duplicate assessments of study eligibility, data abstraction and quality. We synthesized findings in narrative and tabular format. Findings Of 19 308 papers retrieved, 34 studies met the inclusion criteria from low- and middle-income countries (21 studies) and underserved populations in high-income countries (13 studies). Targeted emergency conditions included trauma, burns, cardiac arrest, opioid poisoning, malaria, paediatric communicable diseases and malnutrition. Trainees included the general public, non-health-care professionals, volunteers and close contacts of at-risk populations, all trained through in-class, peer and multimodal education and public awareness campaigns. Important clinical and policy outcomes included improvements in community capacity to manage emergencies (14 studies), patient outcomes (13 studies) and community health (seven studies). While substantial effects were observed for programmes to address paediatric malaria, trauma and opioid poisoning, most studies reported modest effect sizes and two reported null results. Most studies were of weak (24 studies) or moderate quality (nine studies). Conclusion First aid education and task shifting to laypeople for emergency care may reduce patient morbidity and mortality and build community capacity to manage health emergencies for a variety of emergency conditions in underserved and low-resource settings.
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Affiliation(s)
- Aaron M Orkin
- Department of Family and Community Medicine, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada
| | | | | | - Melanie K Fortune
- Division of Clinical Sciences, Northern Ontario School of Medicine, Timmins, Canada
| | | | - Emma Mew
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Ian R Drennan
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Adam Exley
- Division of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Canada
| | | | - David E Johnson
- Wilderness Medical Associates International, Portland, United States of America
| | - Andrew MacPherson
- Department of Emergency Medicine, University of British Columbia, Victoria, Canada
| | - Alexandra Martiniuk
- Faculty of Medicine School of Public Health, University of Sydney, Sydney, Australia
| | | | - Maxwell Osei-Ampofo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Stijn Van de Velde
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - David VanderBurgh
- Division of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Canada
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