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

Mukanga, David; Tibenderana, James; Peterson, Stefan; Pariyo, George; Kiguli, Juliet; Waiswa, Peter; Babirye, Rebecca; Ojiambo, Godfrey; Kasasa, Simon; Pagnoni, Franco; Källander, Karin

doi:10.1186/1475-2875-11-121

Cited by 70 publications

(84 citation statements)

References 40 publications

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“…The highly positive perceptions of RDTs demonstrated by patients in this study correspond closely with other similar studies conducted in Ghana, Tanzania and Uganda [20,21,23-25]. Others have also identified that RDT acceptability is based on its perceived role in aiding the clinician to reach a more definitive diagnosis and prescribe the right treatment for their illness [20,23].…”

Section: Discussionsupporting

confidence: 85%

“…In general, these studies have explored the ‘acceptability’ of the use of RDTs to communities, including patients and caregivers of children [20-25], often reporting high levels of acceptability and positive perceptions of RDTs. However, it is important to understand not only whether tests are acceptable or not to those receiving them, but also how the tests are experienced by patients in practice; studying the technology in action , from the patient’s perspective [26].…”

Section: Introductionmentioning

confidence: 99%

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“Even if the test result is negative, they should be able to tell us what is wrong with us”: a qualitative study of patient expectations of rapid diagnostic tests for malaria

Ansah

Reynolds

Akanpigbiam

et al. 2013

Malar J

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BackgroundThe debate on rapid diagnostic tests (RDTs) for malaria has begun to shift from whether RDTs should be used, to how and under what circumstances their use can be optimized. This has increased the need for a better understanding of the complexities surrounding the role of RDTs in appropriate treatment of fever. Studies have focused on clinician practices, but few have sought to understand patient perspectives, beyond notions of acceptability.MethodsThis qualitative study aimed to explore patient and caregiver perceptions and experiences of RDTs following a trial to assess the introduction of the tests into routine clinical care at four health facilities in one district in Ghana. Six focus group discussions and one in-depth interview were carried out with those who had received an RDT with a negative test result.ResultsPatients had high expectations of RDTs. They welcomed the tests as aiding clinical diagnoses and as tools that could communicate their problem better than they could, verbally. However, respondents also believed the tests could identify any cause of illness, beyond malaria. Experiences of patients suggested that RDTs were adopted into an existing system where patients are both physically and intellectually removed from diagnostic processes and where clinicians retain authority that supersedes tests and their results. In this situation, patients did not feel able to articulate a demand for test-driven diagnosis.ConclusionsImprovements in communication between the health worker and patient, particularly to explain the capabilities of the test and management of RDT negative cases, may both manage patient expectations and promote patient demand for test-driven diagnoses.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

“Even if the test result is negative, they should be able to tell us what is wrong with us”: a qualitative study of patient expectations of rapid diagnostic tests for malaria

Ansah

Reynolds

Akanpigbiam

et al. 2013

Malar J

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“…Will iCCM encourage drug 'overtreatment', resulting in drug resistance? Addition of rapid diagnostic testing to iCCM (proven feasible elsewhere in Uganda and sub-Saharan Africa) 20,29,39 should be seriously considered.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Introduction: Integrated community case management (iCCM) involves assessment and treatment of common childhood illnesses by community health workers (CHWs). Evaluation of a new Ugandan iCCM program is needed. Objectives: The objectives of this study were to assess if iCCM by lay volunteer CHWs is feasible and if iCCM would increase proportions of children treated for fever, pneumonia, and diarrhoea in rural Uganda. Methods: This pre/post study used a quasi-experimental design and non-intervention comparison community. CHWs were selected, trained, and equipped to assess and treat children under five years with signs of the three illnesses. Evaluation included CHW-patient encounter record review plus analysis of pre/post household surveys. Results: 196 iCCM-trained CHWs reported 6,276 sick child assessments (45% fever, 46% pneumonia, 9% diarrhoea). 93% of cases were managed according to algorithm recommendations. Absolute proportions of children receiving treatment significantly increased post-intervention: antimalarial for fever (+24% intervention versus +4% control) and oral rehydration salts/zinc for diarrhoea (+14% intervention versus +1% control). Conclusion: In our limited-resource, rural Ugandan setting, iCCM involving lay CHWs was feasible and significantly increased the proportion of young children treated for malaria and diarrhoea.

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“…Such targeting would also help reduce significant inequities found in malaria diagnosis, which must be addressed going forward. Integrated community case management with RDT-based malaria diagnosis has been successfully piloted in a number of settings by both community health workers and drug shop owners (39, 40), and it is a promising approach for bringing quality care to remote areas underserved by the formal health system.…”

Section: Discussionmentioning

confidence: 99%

Beyond ‘test and treat’ – malaria diagnosis for improved pediatric fever management in sub-Saharan Africa

Johansson

2016

Global Health Action

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BackgroundMalaria rapid diagnostic tests (RDTs) have great potential to improve quality care and rational drug use in malaria-endemic settings although studies have shown common RDT non-compliance. Yet, evidence has largely been derived from limited hospital settings in few countries. This article reviews a PhD thesis that analyzed national surveys from multiple sub-Saharan African countries to generate large-scale evidence of malaria diagnosis practices and its determinants across different contexts.DesignA mixed-methods approach was used across four studies that included quantitative analysis of national household and facility surveys conducted in multiple sub-Saharan African countries at the outset of new guidelines (Demographic and Health Surveys and Service Provision Assessments). Qualitative methods were used to explore reasons for quantitative findings in select settings.ResultsThere was low (17%) and inequitable test uptake across 13 countries in 2009–2011/12, with greater testing at hospitals than at peripheral clinics (odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.56–0.69) or community health workers (OR: 0.31, 95% CI: 0.23–0.43) (Study I). Significant variation was found in the effect of diagnosis on antimalarial use at the population level across countries (Uganda OR: 0.84, 95% CI: 0.66–1.06; Mozambique OR: 3.54, 95% CI: 2.33–5.39) (Study II). A Malawi national facility census indicated common compliance to malaria treatment guidelines (85% clients with RDT-confirmed malaria prescribed first-line treatment), although other fever assessments were not often conducted and there was poor antibiotic targeting (59% clients inappropriately prescribed antibiotics). RDT-negative patients had 16.8 (95% CI: 8.6–32.7) times higher odds of antibiotic overtreatment than RDT-positive patients conditioned by cough or difficult breathing complaints (Study III). In Mbarara (Uganda), health workers reportedly prescribed antimalarials to RDT-negative patients if no other fever cause was identified and non-compliance seemed further driven by RDT perceptions, system constraints, and client interactions (Study IV).ConclusionsA shift from malaria-focused test and treat strategies toward IMCI with testing is needed to improve quality care and rational use of both antimalarial and antibiotic medicines. Strengthened health systems are also needed to support quality clinical care, including adherence to malaria test results, and RDT deployment should be viewed as a unique opportunity to contribute to these important efforts.

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

Cited by 70 publications

References 40 publications

“Even if the test result is negative, they should be able to tell us what is wrong with us”: a qualitative study of patient expectations of rapid diagnostic tests for malaria

“Even if the test result is negative, they should be able to tell us what is wrong with us”: a qualitative study of patient expectations of rapid diagnostic tests for malaria

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

Beyond ‘test and treat’ – malaria diagnosis for improved pediatric fever management in sub-Saharan Africa

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