Use of Community Health Workers for Management of Malaria and Pneumonia in Urban and Rural Areas in Eastern Uganda

Abstract

Use of community health workers (CHWs) has been implemented the same way in urban and rural areas despite differences in availability of health providers and sociodemographic characteristics. A household survey was conducted in rural and urban areas in eastern Uganda, and all children who were febrile in the previous two weeks were assessed for their symptoms, treatment received at home, and when and where they first went for treatment. Rural children were more likely to use CHWs than urban children. Urban children received outside treatment more promptly, and used herbs at home less. Symptoms and proportion of children being taken out for treatment were similar. Children from the poorest households used CHWs less and private providers more than the middle quintiles. Drug shops and private clinics should be included in the community case management to cater for the poorest in rural areas and persons in urban areas.

Factors affecting implementation of integrated community case management of childhood illnesses in South West Shoa Zone, Central Ethiopia

“…The studies done in rural Uganda also found that supervision were less than optimal. Less than 40% of HSAs included in the sample had received an ICCM-specific supervisory visit in the previous 3 months, and only 16% received a visit that included clinical observation of case management (Rutebemberwa et al, 2012). This is almost the same result with this study outcome of 42.04% HEWs mentored, of which only 16.61% were reported as case observation.…”

Where there is no doctor: can volunteer community health workers in rural Uganda provide integrated community case management?

“…20 In a multi-methods Ethiopian study, volunteer CHWs treating diarrhoea, pneumonia, and fever and were highly accessed by community members 22 . Our study is complimentary suggesting multi-illness iCCM using CHWs with variable formal education is feasible, which is supportive of work in Eastern Uganda 23,[27][28][29][30] ; however, caution is needed to further understand quality of work, an issue highlighted by a recent study from Central Uganda. 38 A strength of this implementation study was existing government health structure integration, which demonstrated real-life iCCM-programming feasibility and outcomes.…”

“…'Best practise' evidence on training, monitoring, and evaluation is urgently needed. Although several iCCM study projects are underway, only one group from Eastern Uganda has published intervention outcomes and operational data thus far, specifically demonstrating feasible CHW management using a dual illness algorithm, 27 an increase in care-seeking by rural families with access to iCCM, 28 a sustained quality of care by CHWs using iCCM compared to single-illness management, 29 a sustained adherence to dual illness medicines by families under iCCM compared to single illness treatments, 30 and an increase in prompt and appropriate treatment of pneumonia under iCCM. 23 Healthy Child Uganda (HCU) is a Ugandan-Canadian university partnership that has developed, implemented, and evaluated community-based maternal and child health initiatives involving volunteer CHWs for over a decade.…”

Caregivers’ treatment-seeking behaviors and predictors of whether a child received an appropriate antimalarial treatment: a household survey in rural Uganda

“…Over the course of the index child’s febrile illness, about half were reported to have been seen at a public health facility, a proportion larger than what has been previously reported for eastern Uganda (range: 17–26 %) or nationally (21–24 %) [15, 22–25]. Despite this increased rate of visits to public facilities, ACT usage across Butaleja was reported to be 41.0 % and receipt of an appropriate antimalarial only 31.6 %.…”