Factors associated with utilization of community health workers in improving access to malaria treatment among children in Kenya

Abstract

BackgroundThe success of community case management in improving access to effective malaria treatment for young children relies on broad utilization of community health workers (CHWs) to diagnose and treat fever cases. A better understanding of the factors associated with CHW utilization is crucial in informing national malaria control policy and strategy in Kenya. Specifically, little is known in Kenya on the extent to which CHWs are utilized, the characteristics of families who report utilizing CHWs and whether utilization is associated with improved access to prompt and effective malaria treatment. This paper examines factors associated with utilization of CHWs in improving access to malaria treatment among children under five years of age by women caregivers in two malaria endemic districts in Kenya.MethodsThis study was conducted in 113 hard-to-reach and poor villages in Malindi and Lamu districts in the coastal region classified as having endemic transmission of malaria. A cross-sectional household survey was conducted using a standardized malaria indicator questionnaire at baseline (n = 1,187) and one year later at endline assessment (n = 1,374) using two-stage cluster sampling.ResultsThere was an increase in reported utilization of CHWs as source of advice/treatment for child fevers from 2% at baseline to 35% at endline, accompanied by a decline in care-seeking from government facilities (from 67% to 48%) and other sources (26% to 2%) including shops. The most poor households and poor households reported higher utilization of CHWs at 39.4% and 37.9% respectively, compared to the least poor households (17.0%). Households in villages with less than 200 households reported higher CHWs utilization as compared to households in villages having >200 households. Prompt access to timely and effective treatment was 5.7 times higher (95% CI 3.4-9.7) when CHWs were the source of care sought. Adherence was high regardless of whether source was CHWs (73.1%) or public health facility (66.7%).ConclusionsThe potential for utilization of CHWs in improving access to malaria treatment at the community level is promising. This will not only enhance access to treatment by the poorest households but also provide early and appropriate treatment to vulnerable individuals, especially those living in hard to reach areas.

Influence of community health volunteers on care seeking and treatment coverage for common childhood illnesses in the context of free health care in rural Sierra Leone

“…; Kisia et al . ). In Zambia, CHWs’ provision of ICCM showed an increase in CHW use and a decrease in health facility use for children with fever and non‐severe pneumonia (Seidenberg et al .…”

Scaling-up malaria treatment: a review of the performance of different providers

“…CHWs are usually members of the community themselves and therefore understand beliefs, culture, and the socio-economic status of patients. There is also evidence that utilisation of CHWs is higher in remote areas, areas of small hamlets, and by poor and the poorest people [53]. There is clear evidence that CHWs correctly use RDTs, dispense ACT, and counsel patients, increasing treatment coverage in under-served areas in high and low seasons.…”

Utilization of community health workers for malaria treatment: results from a three-year panel study in the districts of Kaya and Zorgho, Burkina Faso

“…Therefore, little is known about its effectiveness, feasibility and acceptability under real-world conditions of implementation [ 24 - 26 ], despite the fact that several implementation barriers have been identified – drug stock-outs, referral completion, adherence to treatment guidelines, programme sustainability [ 27 - 30 ]. Finally, while it is argued that CCMm reduces the monetary and geographical barriers that impede individuals’ seeking treatment, few studies have evaluated the extent to which CHWs are used in an uncontrolled context of nation-wide CCMm, or how treatment coverage by CHWs varies with time [ 25 , 31 ].…”