Contribution of community health workers to improving access to timely and appropriate case management of childhood fever in Mozambique
Bibliographic Data
| ID | 19550262 |
|---|---|
| Authors | Tanya Guenther (0000-0002-5192-2983, Save the Children, corresponding author), Salim Sadruddin (0000-0001-6023-2477, World Health Organization), Karen E Finnegan (0000-0001-9007-5417, Johns Hopkins University), Karen Finnegan, Erica Wetzler (0000-0002-3076-5034), Fatima Ibo, Paulo Rapaz, Jeanne Koepsell (Save the Children), Ibad ul Haque Khan, Agbessi Amouzou (0000-0002-6262-3866, Johns Hopkins University) |
| Year | 2017 |
| Volume | 7 |
| Issue | 1 |
| Pages | 010402-010402 |
| Publication date | 2017-06-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Journal of Global Health (JOURNAL) |
| Journal identifiers | ISSN: 2047-2978 • E-ISSN: 2047-2986 |
| Publisher | International Society of Global Health (PUBLISHER • GB) |
| DOI | 10.7189/jogh.07.010402 |
| PMID | 28400951 |
| OpenAlex | W2592158749 |
| Language | EN |
| Citations received | 6 |
| References cited | 22 |
BACKGROUND: (APEs). We assessed the contribution of the program to improved care-seeking and appropriate treatment of childhood febrile illness in Nampula Province. METHODS: We used a post-test quasi-experimental design with three intervention and one comparison districts to compare access and appropriateness of care for sick children in Nampula province. We carried out a household survey in the study districts to measure levels of care-seeking and treatment of childhood fever after approximately two years of full implementation of the iCCM program in the intervention districts. We also assessed consistency of care with standard case management protocols comparing children receiving care from (APEs) to those receiving care from first-level health facilities. RESULTS: A total of 773 children 6-59 months with fever in the last two weeks were included in the study. In iCCM served areas, APEs were the predominant source of care and treatment; 87.1% (95% confidence interval CI 80.8-93.4) of children 6-59 months with fever who sought care were taken first to an APE and APEs accounted for 86.2% (95% CI 79.7-92.7) of all first-line antimalarial treatments. Public health facilities were the leading source of care in comparison areas, providing care to 86.1% (95% CI 79.0-93.3) of children with fever taken for care outside the home. Timeliness of treatment was significantly better in intervention areas, where 63.9% (95% CI 54.4-73.3) of children received treatment within 24 hours of symptom onset compared to 37.5% (95% CI 31.1-43.9) in comparison areas. Children taken first to an APE were more likely to receive a rapid diagnostic test (RDT) (68.1%; 95% CI 57.2-79.0) and to have their respiratory rate assessed (60.0%; 95% CI 45.4-74.6) compared to children taken to health facilities (41.4%; 95% CI33.7-49.2 and 19.4%; 95% CI 8.4-30.5, respectively). Overall, 61.3% (95% CI 51.5-71.0) of children with fever receiving care from APEs received the correct drug within 24 hours and for the correct duration compared to 26.0% (95% CI 18.2-33.9) of those receiving care from health facilities. CONCLUSION: iCCM contributed to improved timely and appropriate treatment for fever for children living far from facilities. Trained, supplied and supervised APEs provided care consistent with iCCM protocols and performed significantly better than first level facilities on most measures of adherence to case management protocols. These findings reinforce the need for comprehensive efforts to strengthen the health system in Mozambique to enable reliable support for quality of case management of childhood illness at both health facility and community levels
Case management · Confidence interval · Environmental health · Family medicine · Health care · Public health · Global Maternal and Child Health · Malaria Research and Control · Medicine · Nursing · Viral Infections and Outbreaks Research
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| Citations per year | 0.75 |
|---|---|
| Citation span | 2018 - 2026 (9) |
| Highly cited | No |