Long-term quality of integrated community case management care for children in Bugoye Subcounty, Uganda: a retrospective observational study

Abstract

ObjectiveIntegrated 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.SettingVHWs 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.ParticipantsAll children receiving iCCM care in 18 430 clinical encounters occurring between April 2014 and December 2018.Primary and secondary outcome measuresThe 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.ResultsOverall, 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).ConclusionQuality 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.

Management of children with danger signs in integrated community case management care in rural southwestern Uganda (2014–2018)

“…17 Studies conducted in Uganda and other African countries are in agreement concerning the efforts of CHWs in providing proper care, offering prereferral treatment and overall disease management, especially for fever, cough and diarrhea, in accordance with the iCCM protocols. 21 , 22 …”

Uptake of community health care provision by community health entrepreneurs for febrile illness and diarrhoea: a cross-sectional survey in rural communities in Bunyangabu district, Uganda

“…4 10 Depending on a volunteer workforce may lead to diminishing motivation over time or a necessity to prioritise income-generating activities, prompting the exploration of alternative approaches. 11 In this study, we focus on a novel approach aimed at making CHW programmes more effective and sustainable, by using the principles of microentrepreneurship. In this approach, regular CHWs are trained to become community health entrepreneurs (CHEs) who continue their standard community health activities within the public health system, while making a modest income from selling basic health products, such as antimalaria medicine, oral rehydration salts (ORS), soap and fortified foods.…”

“…The lack of medicine and other supplies undermines the effectiveness and motivation of CHWs and leads patients to go elsewhere 4 10. Depending on a volunteer workforce may lead to diminishing motivation over time or a necessity to prioritise income-generating activities, prompting the exploration of alternative approaches 11…”

Cost-effectiveness of village health worker-led integrated community case management (iCCM) versus health facility based management for childhood illnesses in rural southwestern Uganda

“…an outcome measure. A detailed description of the definition of children “treated appropriately” can be found elsewhere [ 12 , 17 ]. The effectiveness data were gathered from VHW records in 22 villages and 8 health facilities in Bugoye sub-county.…”

“…Amua software v0.3.0 was used to perform a cost-effectiveness analysis using a decision model [ 21 ]. The probabilities used in the tree were derived from primary data from VHW records in 22 villages and 8 health facilities in Bugoye sub-county, as well as related studies on the management of malaria, pneumonia, and diarrhoea in children under the age of five [ 12 , 17 , 22 , 23 ]. Figure 1 depicts the decision tree model that was used.…”