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Open Access Highly Accessed Research

Access, acceptability and utilization of community health workers using diagnostics for case management of fever in Ugandan children: a cross-sectional study

David Mukanga123*, James K Tibenderana4, Stefan Peterson256, George W Pariyo6, Juliet Kiguli7, Peter Waiswa268, Rebecca Babirye3, Godfrey Ojiambo3, Simon Kasasa1, Franco Pagnoni9 and Karin Kallander124

Author Affiliations

1 Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda

2 Division of Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, SE, 17177, Sweden

3 The African Field Epidemiology Network, P.O. Box 12874, Kampala, Uganda

4 Malaria Consortium Africa, P.O. Box 8045, Kampala, Uganda

5 International Maternal and Child Health Unit, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden

6 Department of Health Policy, Planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda

7 Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda

8 Iganga/Mayuge Demographic Surveillance Site, P.O. Box 111, Iganga, Uganda

9 Evidence for Antimalarial Policy and Access Unit, UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland

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Malaria Journal 2012, 11:121  doi:10.1186/1475-2875-11-121

Published: 20 April 2012

Abstract

Background

Use of diagnostics in integrated community case management (iCCM) of fever is recognized as an important step in improving rational use of drugs and quality of care for febrile under-five children. This study assessed household access, acceptability and utilization of community health workers (CHWs) trained and provided with malaria rapid diagnostic tests (RDTs) and respiratory rate timers (RRTs) to practice iCCM.

Methods

A total of 423 households with under-five children were enrolled into the study in Iganga district, Uganda. Households were selected from seven villages in Namungalwe sub-county using probability proportionate to size sampling. A semi-structured questionnaire was administered to caregivers in selected households. Data were entered into Epidata statistical software, and analysed using SPSS Statistics 17.0, and STATA version 10.

Results

Most (86%, 365/423) households resided within a kilometre of a CHW’s home, compared to 26% (111/423) residing within 1 km of a health facility (p < 0.001). The median walking time by caregivers to a CHW was 10 minutes (IQR 5–20). The first option for care for febrile children in the month preceding the survey was CHWs (40%, 242/601), followed by drug shops (33%, 196/601).

Fifty-seven percent (243/423) of caregivers took their febrile children to a CHW at least once in the three month period preceding the survey. Households located 1–3 km from a health facility were 72% (AOR 1.72; 95% CI 1.11–2.68) more likely to utilize CHW services compared to households within 1 km of a health facility. Households located 1–3 km from a CHW were 81% (AOR 0.19; 95% CI 0.10–0.36) less likely to utilize CHW services compared to those households residing within 1 km of a CHW.

A majority (79%, 336/423) of respondents thought CHWs services were better with RDTs, and 89% (375/423) approved CHWs’ continued use of RDTs. Eighty-six percent (209/243) of respondents who visited a CHW thought RRTs were useful.

Conclusion

ICCM with diagnostics is acceptable, increases access, and is the first choice for caregivers of febrile children. More than half of caregivers of febrile children utilized CHW services over a three-month period. However, one-third of caregivers used drug shops in spite of the presence of CHWs.

Keywords:
Community health worker; Case management; Malaria; Pneumonia; Febrile children; Diagnostics; Access; Acceptability; Utilization; Uganda