Determinants of Utilization of Health Extension Workers in the Context of Scale-Up of Integrated Community Case Management of Childhood Illnesses in Ethiopia

Shaw, Bryan; Amouzou, Agbessi; Miller, Nathan P; Tsui, Amy O.; Bryce, Jennifer; Tafesse, Mengistu; Surkan, Pamela J.

doi:10.4269/ajtmh.14-0660

Cited by 40 publications

(55 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Predisposing factors, such as health beliefs, education and other user characteristics, have been found to determine the use of preventive and curative health services [ 25 , 44 , 46 ]. Consistent with findings from other studies on utilization of maternal health service [ 25 , 26 , 42 , 43 ] and integrated community case management of childhood illness [ 28 ], we found that maternal education was strongly associated with higher MTBT service utilization, particularly one-time use and for achieving minimum number of visits. Mothers with a higher level of education may be more informed and have greater awareness of or capacity to understand health problems experienced by their children as well as the benefits of health care services, which may lead to more effective use of information and to optimal health-seeking behavior [ 14 ].…”

Section: Discussionsupporting

confidence: 91%

“…The selection of factors potentially associated with service utilization was guided by the conceptual framework ( Fig 2 ) adapted from the behavioral model of health services utilization developed by Andersen [ 23 , 24 ]. This model has been used widely for empirical research on utilization of maternal health services [ 25 – 27 ], integrated community case management of childhood illness [ 28 ], and medical care [ 29 ]. The model proposed that use of health services is a function of characteristics of both individual user and the health system.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Supply- and Demand-Side Factors Influencing Utilization of Infant and Young Child Feeding Counselling Services in Viet Nam

Nguyen

Kim

Nguyen³

et al. 2016

PLoS ONE

View full text Add to dashboard Cite

Adequate utilization of services is critical to maximize the impact of counselling on infant and young child feeding (IYCF), but little is known about factors affecting utilization. Our study examined supply- and demand-side factors associated with the utilization of IYCF counselling services in Viet Nam. We used survey data from mothers with children <2y (n = 1,008) and health staff (n = 60) from the evaluation of a program that embedded IYCF counseling into the existing government health system. The frequency of never users, one-time users, repeat users, and achievers of the recommended minimum number of visits at health facilities were 45.1%, 13.0%, 28.4% and 13.5%, respectively. Poisson regression showed that demand-generation strategies, especially invitation cards, were the key factors determining one-time use (Prevalence ratio, PR 3.0, 95% CI: 2.2–4.2), repeated use (PR 3.2, 95% CI: 2.4–4.2), and achievement of minimum visits (PR 5.5, 95% CI: 3.6–8.4). Higher maternal education was associated with higher utilization both for one-time and repeated use. Being a farmer, belonging to an ethnic minority, and having a wasted child were associated with greater likelihood of achieving the minimum recommended number of visits, whereas child stunting or illness were not. Distance to health center was a barrier to repeated visits. Among supply-side factors, good counselling skills (PR: 1.3–1.8) was the most important factor associated with any service use, whereas longer employment duration and greater work pressure of health center staff were associated with lower utilization. Population attributable risk estimations showed that an additional 25% of the population would have achieved the minimum number of visits if exposed to three demand-generation strategies, and further increased to 49% if the health staff had good counseling skills and low work pressure. Our study provides evidence that demand-generation strategies are essential to increase utilization of facility-based IYCF counselling services in Viet Nam, and may be relevant for increasing and sustaining use of nutrition services in similar contexts.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Supply- and Demand-Side Factors Influencing Utilization of Infant and Young Child Feeding Counselling Services in Viet Nam

Nguyen

Kim

Nguyen³

et al. 2016

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…There were, however, concerns that the utilisation of iCCM services was low . The reasons included absent HEWs at the health posts, little trust in the HEWs , perceptions of which illness severity they could manage, the quality of their services , lack of community awareness of services provided at the health post , limited skills of HEWs in the management of sick children and lack of drugs and other supplies .…”

Section: Introductionmentioning

confidence: 99%

Health Extension Workers’ diagnostic accuracy for common childhood illnesses in four regions of Ethiopia: a cross‐sectional study

et al. 2019

View full text Add to dashboard Cite

Aim: The Ethiopian primary care of sick children is provided within the integrated Community Case Management of childhood illnesses by Health Extension Workers (HEW). There is limited knowledge whether this cadre correctly assess and classify common diseases. The aim was to study their ability to correctly classify common childhood illnesses.Methods: A survey was conducted from December 2016 to February 2017 in four regions of Ethiopia. Observations of the HEWs' assessment and classification of sick children were followed by child re-examination by a trained health officer. Results:The classification by the HEWs of 620 sick children as compared to the reexaminer had a sensitivity of 89% and specificity of 94% for diarrhoea, sensitivity 52% and specificity 91% for febrile disorders, and a sensitivity of 59% and specificity of 94% for acute respiratory tract infection. Malnutrition and ear infection had a sensitivity of 39 and 61%, and a specificity of 99 and 99%, respectively.Conclusion: Most cases of diarrhoea were correctly classified, while other illnesses were not frequently identified. The identification of malnutrition was especially at fault. These findings suggest that a significant number of sick children were undiagnosed that could lead to absent or incorrect management and treatment. 2100

show abstract

“…The final weakness to be discusses is that we did not include costs of demand generation, although evidence suggests that demand side barriers are major causes of sustained low intervention coverage [25,26]. To focus on demand generation would be especially appropriate in Ethiopia where community health workers have already been deployed throughout the country but the utilization of key health services remains low [26].…”

Section: Discussionmentioning

confidence: 99%

Reducing regional inequality in community-based treatment of childhood pneumonia in Ethiopia: A sub-national distributional cost-effectiveness analysis

Olsen

Norheim²,

Memirie

2020

Preprint

View full text Add to dashboard Cite

Background Scaling up coverage of community-based treatment of childhood pneumonia (CCM) is part of the strategy to promote equity and reduce under-five mortality rate (U5MR) in Ethiopia. However, urban children with symptoms of pneumonia are still more than twice as likely to receive treatment compared with rural children having similar symptoms. There are no sub-national cost-effectiveness analyses available to inform decision makers on the most equitable scale-up strategy. Objectives To model sub-national cost-effectiveness and inequality impacts of scaling up coverage of CCM in each of the 11 Ethiopian regions. We also explore three different scale-up strategies: reducing geographical inequalities, health maximization and universal scale-up. Methods For each region, we developed a Markov model and estimated the cost-effectiveness of scaling up coverage to 90 percent. Data inputs were collected through literature review. Effects were modeled as life years gained and under-five deaths averted. Inputs on unit costs were adjusted to the proportions of rural and urban population in each region. In scenario analysis, we estimated costs, health effects and, by the use of the Gini measure applied to health, the inequality impacts of three different scale-up strategies: 1) maximizing health by prioritizing the regions where the intervention was the most cost-effective, 2) reducing geographical inequality by prioritizing the regions with the highest baseline U5MR and 3) universally scaling up to 90% coverage in all the regions. Results Universal scale-up of CCM would cost about 1.3 billion USD and prevent about 90,000 under-five deaths. This is less than 15,000 USD per life saved and translates to an increase in life expectancy at birth of 1.6 years across Ethiopia. The regional incremental-cost effectiveness ratio (ICER) of scaling up the intervention coverage varied from 26 USD per life year gained in Addis to 199 USD per life year gained in the SNNP region. In scenario analysis, we found that prioritizing regions with high U5MR is effective in reducing geographical inequalities, although at the cost of some fewer lives saved. Conclusions Our model results illustrate a trade-off between maximizing health and reducing health inequalities, two common policy-aims in low-income settings.

show abstract

Determinants of Utilization of Health Extension Workers in the Context of Scale-Up of Integrated Community Case Management of Childhood Illnesses in Ethiopia

Cited by 40 publications

References 33 publications

Supply- and Demand-Side Factors Influencing Utilization of Infant and Young Child Feeding Counselling Services in Viet Nam

Supply- and Demand-Side Factors Influencing Utilization of Infant and Young Child Feeding Counselling Services in Viet Nam

Health Extension Workers’ diagnostic accuracy for common childhood illnesses in four regions of Ethiopia: a cross‐sectional study

Reducing regional inequality in community-based treatment of childhood pneumonia in Ethiopia: A sub-national distributional cost-effectiveness analysis

Contact Info

Product

Resources

About