Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

Shaw, Brian I.; Asadhi, Elijah; Owuor, Kevin; Okoth, Peter; Abdi, Mohammed; Cohen, Craig R.; Onono, Maricianah

doi:10.4269/ajtmh.15-0784

Cited by 10 publications

(12 citation statements)

References 49 publications

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“…Their top-ranked research objective was to “assess perceptions of beneficiaries and levels of community satisfaction in community health workers’ capacity.” Since then, one other study, also in Uganda, has assessed community usage and perspectives on iCCM services, reporting that 53% of those who had received iCCM services were satisfied with care [ 2 ]. Other studies have examined satisfaction with home-based fever or pneumonia management alone rather than iCCM; one study in Ghana demonstrates that a majority of caregivers rated home-based management of fever by a VHW as “good” or “excellent” [ 3 ], while another study in Kenya describes caregivers’ expressed preference for home-based pneumonia care over facility-based care [ 4 ]. By comparison, a study in Pakistan of home-based pneumonia and diarrhoea care described very low use of and confidence in community health workers to provide care for these conditions [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Usage of and satisfaction with Integrated Community Case Management care in western Uganda: a cross-sectional survey

Miller,

Patel,

Mian-McCarthy

et al. 2021

Malar J

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Background In some areas of Uganda, village health workers (VHW) deliver Integrated Community Case Management (iCCM) care, providing initial assessment of children under 5 years of age as well as protocol-based treatment of malaria, pneumonia, and diarrhoea for eligible patients. Little is known about community perspectives on or satisfaction with iCCM care. This study examines usage of and satisfaction with iCCM care as well as potential associations between these outcomes and time required to travel to the household’s preferred health facility. Methods A cross-sectional household survey was administered in a rural subcounty in western Uganda during December 2016, using a stratified random sampling approach in villages where iCCM care was available. Households were eligible if the household contained one or more children under 5 years of age. Results A total of 271 households across 8 villages were included in the final sample. Of these, 39% reported that it took over an hour to reach their preferred health facility, and 73% reported walking to the health facility; 92% stated they had seen a VHW for iCCM care in the past, and 55% had seen a VHW in the month prior to the survey. Of respondents whose households had sought iCCM care, 60% rated their overall experience as “very good” or “excellent,” 97% stated they would seek iCCM care in the future, and 92% stated they were “confident” or “very confident” in the VHW’s overall abilities. Longer travel time to the household’s preferred health facility did not appear to be associated with higher propensity to seek iCCM care or higher overall satisfaction with iCCM care. Conclusions In this setting, community usage of and satisfaction with iCCM care for malaria, pneumonia, and diarrhoea appears high overall. Ease of access to facility-based care did not appear to impact the choice to access iCCM care or satisfaction with iCCM care.

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Section: Introductionmentioning

confidence: 99%

Usage of and satisfaction with Integrated Community Case Management care in western Uganda: a cross-sectional survey

Miller,

Patel,

Mian-McCarthy

et al. 2021

Malar J

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“…A mixed methods approach allowing triangulation of qualitative and quantitative findings would have provided a deeper understanding of the drivers of health seeking preferences, satisfaction and perceived quality of the services. While we did not conduct qualitative work, a substudy within the parent project compared the perceived quality of services and health seeking behaviors among those seeking care from CHWs versus health facilities[19]. This substudy found that caregivers perceived CHWs to provide higher quality care in terms of accessibility and patient relationship and equal quality care in terms of clinical aspects[19].…”

Section: Discussionmentioning

confidence: 99%

“…While we did not conduct qualitative work, a substudy within the parent project compared the perceived quality of services and health seeking behaviors among those seeking care from CHWs versus health facilities[19]. This substudy found that caregivers perceived CHWs to provide higher quality care in terms of accessibility and patient relationship and equal quality care in terms of clinical aspects[19]. Our results are therefore complimentary to this previous study and support that notion that iCCM for pneumonia is cost-effective and acceptable.…”

Section: Discussionmentioning

confidence: 99%

Patient-level cost of home- and facility-based child pneumonia treatment in Suba Sub County, Kenya

Machuki¹,

Aduda²,

Omondi³

et al. 2019

PLoS ONE

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Background Globally, pneumonia accounted for 16% of deaths among children under 5 years of age and was one of the major causes of death overall in 2018. Kenya is ranked among the top 15 countries with regard to pneumonia prevalence and contributed approximately 74% of the world's annual pneumonia cases in 2018. Unfortunately, less than 50% of children with pneumonia receive appropriate antibiotics for treatment. Homa-Bay County implemented pneumonia community case management utilizing community health workers, as recommended by the World Health Organization (WHO), in 2014. However, since implementation of the program, the relative patient-level cost of home-based and facility-based treatment of pneumonia, as well as the main drivers of these costs in Suba Subcounty, remain uncertain. Therefore, the main objective of this study was to compare the patient-level costs of home based treatment of pneumonia by a community health worker with those of health facilitybased treatment. Methods and findings Using a cross-sectional study design, a structured questionnaire was used to collect quantitative data from 208 caregivers on the direct costs (consultation, medicine, transportation) and indirect costs (opportunity cost) of pneumonia treatment. The average household cost for the community managed patients was KSH 122.65 ($1.29) compared with KSh 447.46 ($4.71), a 4-fold difference, for those treated at the health facility. The largest cost drivers for home treatment and health facility treatment were opportunity costs (KSH 88.25

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“…In an effort to improve the quality of child health services, the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF) developed the Integrated Community Case Management (iCCM) of childhood illnesses strategy [7]. This strategy aims to reduce morbidity and mortality among children under the age of 5 years through improved health workers' skills by training and supportive supervision; improved health systems, including equipment, supplies, organization of work and referral systems; and improved key family practices and child care at community and household levels [8].…”

Section: Introductionmentioning

confidence: 99%

Assessing the quality of care in sick child services at health facilities in Ethiopia

Getachew

Abebe

Yitayal

et al. 2020

BMC Health Serv Res

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Background: Quality of care depends on system, facility, provider, and client-level factors. We aimed at examining structural and process quality of services for sick children and its association with client satisfaction at health facilities in Ethiopia. Methods: Data from the Ethiopia Service Provision Assessment Plus (SPA+) survey 2014 were used. Measures of quality were assessed based on the Donabedian framework: structure, process, and outcome. A total of 1908 mothers or caretakers were interviewed and their child consultations were observed. Principal component analysis was used to construct quality of care indices including a structural composite score, a process composite score, and a client satisfaction score. Multilevel mixed linear regression was used to analyze the association between structural and process factors with client satisfaction. Result: Among children diagnosed with suspected pneumonia, respiratory rate was counted in 56% and temperature was checked in 77% of the cases. A majority of children (92%) diagnosed with fever had their temperature taken. Only 3% of children with fever were either referred or admitted, and 60% received antibiotics. Among children diagnosed with malaria, 51% were assessed for all three Integrated Management of Childhood Illnesses (IMCI) main symptoms, and 4% were assessed for all three general danger signs. Providers assessed dehydration in 54% of children with diarrhea with dehydration, 17% of these children were admitted or referred to another facility, and Oral Rehydration Solution was prescribed for 67% while none received intravenous fluids. The number of basic amenities in the facility was negatively associated with the clients' satisfaction. Private facilities, when the providers had got training for care of sick children in the past 2 years, had higher client satisfaction. There was no statistical association between structure, process composite indicators and client satisfaction. Conclusion: The assessment of sick children was of low quality, with many missing procedures when comparing with IMCI guidelines. In spite of this, most clients were satisfied with the services they received. Structural and process composite indicators were not associated with client's satisfaction. These findings highlight the need to assess other dimensions of quality of care besides structure and process that may influence client satisfaction.

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Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

Cited by 10 publications

References 49 publications

Usage of and satisfaction with Integrated Community Case Management care in western Uganda: a cross-sectional survey

Usage of and satisfaction with Integrated Community Case Management care in western Uganda: a cross-sectional survey

Patient-level cost of home- and facility-based child pneumonia treatment in Suba Sub County, Kenya

Assessing the quality of care in sick child services at health facilities in Ethiopia

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