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

Miller, James S.; Patel, Palka; Mian-McCarthy, Sara; Wesuta, Andrew Christopher; Matte, Michael; Ntaro, Moses; Bwambale, Shem; Kenney, Jessica; Stone, Geren S.; Mulogo, Edgar Mugema

doi:10.1186/s12936-021-03601-9

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…Timely services were statistically significantly associated with Uptake of ICCM services in Apac district (P<0.00, AOR 12.7(3.4-47), caregivers who received timely services were 12 times more likely to accept ICCM services by the VHT than those who did not receive timely services. These results are similar to those revealed by Miller and colleagues in which timely access to services offered by VHTs increased the acceptability of ICCM services (J. S. Miller et al, 2021;Mukanga et al, 2012). In the circumstances of a sick child, there is always anxiety among any caregiver and hence if care is rendered in a timely way, this builds confidence in the service offered hence acceptability is likely to be high.…”

Section: Factors Associated With Uptake Of Iccm Services Among Caregi...supporting

confidence: 89%

Uptake of Integrated Community Case Management and Associated Factors Among Caregivers of Children Under Five Years in Apac District, Northern Uganda

Job¹,

Omech²,

Akello³

et al. 2023

Curr. Res. Interdiscip. Stud.

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Background: Globally, child mortality remains a public health concern with 38 deaths per 1000 live births and accounting for 5.2 million deaths in children under 5 years, with Sub-Saharan Africa region having the highest figure of 76 deaths per 1,000 live births that is equivalent to one child in 13 dying before reaching age five in 2019. In Uganda, the child mortality rate has reduced gradually from 191 deaths per 1000 live births to 45.8 deaths per 1000 live births in 2019. Objective: To determine the Uptake of integrated community case management of childhood illnesses and associated factors among caregivers of children under five years in Apac district. Methods: This was a cross-sectional study using quantitative methods, 403 family caregivers of children under five in Apac District. Data was collected using a semi-structured questionnaire on Uptake, associated factors, and perceptions of caregivers towards ICCM services. Data was analyzed using STATA version 15.1. Results: The majority of the caregivers were female 337 (83.6%), with a mean age of 27.7 years and standard deviation of 6.64 years, attained primary education, 253(62.8%), Christians, 393 (97.5%), and married 346 (85.9%) were married. The level of Uptake of ICCM services was 38.7% (156/403). Results of the study indicate that the child’s illness (p=0.01, AOR=3.5(2.1-7.2), knowledge of ICCM (P<0.01, AOR12.1 (1.7-87), timely services (p<0.001, AOR (12.7(3.4-47), and referral by VHT (P<0.01, AOR 4.0(1.4-11.0). were statistically significant. Conclusion: The Uptake level of ICCM services provided by the VHTs was low, though caregivers had a good perception of ICCM services and child referral to health facilities by VHT. To improve Uptake of ICCM services, there is a need to provide more information regarding ICCM within the community.

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Section: Factors Associated With Uptake Of Iccm Services Among Caregi...supporting

confidence: 89%

Uptake of Integrated Community Case Management and Associated Factors Among Caregivers of Children Under Five Years in Apac District, Northern Uganda

Job¹,

Omech²,

Akello³

et al. 2023

Curr. Res. Interdiscip. Stud.

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“…While HSR measurement is not widely reported in the literature for CHW-delivered care, our findings for these patient-reported experiences are similar but slightly lower than the results from Miller and colleagues who conducted a cross-sectional study in Uganda among individuals receiving iCCM from village health workers (VHWs) [ 21 ]. Using a five-point Likert scale, they found that 60% rated their overall experience as very good/excellent, and 92% stated that they were confident/very confident in the VHW’s overall abilities.…”

Section: Discussioncontrasting

confidence: 49%

Measuring health system responsiveness in a national community health worker primary care programme in rural Liberia

Mendin¹,

Krause²,

Gweh

et al. 2023

International Journal for Quality in Health Care

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Background As many low- and middle-income countries scale up community health worker (CHW) programs to achieve universal health coverage, ensuring quality as well as access is critical. Health system responsiveness (HSR) is a core domain of quality patient-centred care, but has not been widely measured in CHW-delivered care. We report results from a household survey measuring HSR and health systems quality of CHW-delivered care in two Liberian counties where the national CHW program of Community Health Assistants (CHAs) for communities five kilometres or more from a health center has been implemented. Methods We conducted a cross-sectional population-based household survey in 2019 in Rivercess (RC) and Grand Gedeh (GG) counties, using a two-stage cross-sectional cluster sampling approach. We included validated HSR questions on six responsiveness domains and patient-reported health system outcomes, such as satisfaction and trust in the CHA’s skills and abilities. The HSR questions were administered to women aged 18-49 who reported seeking care from a CHA in the three months prior to the survey. A composite responsiveness score was calculated and divided into tertiles. Multivariable analysis using Poisson regression with log link and adjusting for respondent characteristics was used to determine the association between responsiveness and patient-reported health system outcomes. Results The proportion of individuals rating responsiveness as very good or excellent were similar across all domains within a district, with ratings were lower in RC (23-29%) than GG (52-59%). High ratings in both counties were seen for high trust in the CHA’s skills and abilities (GG 84%, RC 75) and high confidence in CHA (GG 58%, RC 60%). Compared with women in the lowest responsiveness tertile (score ≤3), women in the highest tertile (score 4.25) were significantly more likely to report high quality of CHA-delivered care (prevalence ratio, PR=14.1), very good/excellent at meeting health needs (PR=8.0), high confidence in the CHA to provide future care (PR=2.4), and high level of trust in CHA’s skills and abilities (PR=1.4). Controlling for respondent characteristics, the composite responsiveness score was significantly associated with all patient-reported health system outcomes (P<0.001). Conclusion We found that HSR was associated with important patient-reported health system quality outcomes, including satisfaction, trust, and confidence in the CHA. Measuring patients’ experience and outcomes of care is important to complement more common measures of technical quality for CHW-delivered care to ensure that this domain of quality is central to community health program design and delivery.

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“…While patients’ families were not directly involved in developing the research question or outcome measures for this study, community members play a key role in selecting the VHWs who provide care in their communities. In a separate study, we have also sought to understand families’ experience of and satisfaction with iCCM care to identify programme strengths and areas for improvement 25. Evaluation of iCCM quality of care has also helped tailor the content of VHW refresher trainings and other quality improvement efforts.…”

Section: Methodsmentioning

confidence: 99%

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

Miller

Mulogo

Wesuta³

et al. 2022

BMJ Open

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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.

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

Cited by 5 publications

References 5 publications

Uptake of Integrated Community Case Management and Associated Factors Among Caregivers of Children Under Five Years in Apac District, Northern Uganda

Uptake of Integrated Community Case Management and Associated Factors Among Caregivers of Children Under Five Years in Apac District, Northern Uganda

Measuring health system responsiveness in a national community health worker primary care programme in rural Liberia

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

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