Quantifying and Valuing Community Health Worker Time in Improving Access to Malaria Diagnosis and Treatment

Castellani, Joëlle; Mihaylova, Borislava; Ajayi, IkeOluwapo O.; Siribié, Mohamadou; Nsungwa-Sabiiti, Jesca; Afonne, Chinenye; Sermé, Luc; Balyeku, Andrew; Kabarungi, Vanessa; Kyaligonza, Josephine; Evers, Silvia M. A. A.; Paulus, Aggie; Petzold, Max; Singlovic, Jan; Gomes, Melba

doi:10.1093/cid/ciw629

Cited by 10 publications

(9 citation statements)

References 12 publications

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“…When given an opportunity to report challenges, the time taken to do COSMIC related activities was not mentioned. Our ndings echo other studies that found CHWs increasingly involved in CSST programmes face signi cant challenges [24,38]. The results vary depending on the setting.…”

Section: Discussionsupporting

confidence: 84%

Screening and Treating Malaria in Pregnancy by Community Health Workers in Benin, Burkina Faso and Gambia: Profiles, Perceptions and Time Commitments

Duval

Scott

Traoré

et al. 2020

Preprint

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Abstract Background To date, there have been few studies on the roles and challenges that community health workers (CHWs) face when encouraging pregnant women to attend health facilities and provide community-based interventions including scheduled screening and treatment (CSST) for malaria. This study investigates the characteristics, daily activities and time commitments of CHWs tasked with delivering CSST as part of a cluster-randomized controlled trial in Benin, Burkina Faso and Gambia. Methods 45 CHWs were interviewed and observed in three rural settings in West Africa, both during and outside the malaria transmission seasons. Results CHWs in all three settings were predominantly male, over 30 years old and relied on farming for income. Most had completed secondary school in Benin (77%) but not in Burkina Faso (33%) or The Gambia (27%). In Benin, most had been in post between 5 to 10 years; in Burkina Faso and The Gambia the majority had been CHWs for over 10 years. CHWs in Burkina Faso received the highest monthly financial reward for taking part in the trial (US$40), next was Benin (US$22.60) and finally Gambian CHWs received US$11. While the CHWs welcomed the increased training, knowledge and skills they acquired on screening and treating malaria in pregnancy afforded by the trial, they also expressed concern about the transportation challenges of successful community-based interventions in remote areas. CHW duties were a bigger time commitment in Burkina Faso than Benin. The time committed to CHW activities (trial and non-trial) was longer during than outside the malaria transmission season. Conclusions This study highlights the importance of taking into account the variety of existing CHW responsibilities when designing and implementing evidence-based policy to address malaria in pregnancy. The findings emphasise the need to consider both financial and non-financial factors likely to impact the scale-up and sustainability of interventions beyond trial conditions.

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Section: Discussionsupporting

confidence: 84%

Screening and Treating Malaria in Pregnancy by Community Health Workers in Benin, Burkina Faso and Gambia: Profiles, Perceptions and Time Commitments

Duval

Scott

Traoré

et al. 2020

Preprint

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“…Severe malaria reflects delays in effective antimalarial treatment. Speed of recovery is important for the child and the family who bear the costs [12]. Reassuringly, there were very few severe malaria cases, even fewer malaria-negative patients treated with an ACT, and deaths were rare.…”

Section: Discussionmentioning

confidence: 99%

“…The impact of the intervention was evaluated through pre- and post-quantitative household surveys to assess impact (changes in treatment-seeking behavior), qualitative surveys that documented acceptability of the program [11], and an economic evaluation of the package [12]. In addition, CHW performance was assessed.…”

Section: Methodsmentioning

confidence: 99%

Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study

Ajayi¹,

Nsungwa-Sabiiti²,

Siribié

et al. 2016

Clin Infect Dis.

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Background. Malaria-endemic countries are encouraged to increase, expedite, and standardize care based on parasite diagnosis and treat confirmed malaria using oral artemisinin-based combination therapy (ACT) or rectal artesunate plus referral when patients are unable to take oral medication.Methods. In 172 villages in 3 African countries, trained community health workers (CHWs) assessed and diagnosed children aged between 6 months and 6 years using rapid histidine-rich protein 2 (HRP2)–based diagnostic tests (RDTs). Patients coming for care who could take oral medication were treated with ACTs, and those who could not were treated with rectal artesunate and referred to hospital. The full combined intervention package lasted 12 months. Changes in access and speed of care and clinical course were determined through 1746 random household interviews before and 3199 during the intervention.Results. A total of 15 932 children were assessed: 6394 in Burkina Faso, 2148 in Nigeria, and 7390 in Uganda. Most children assessed (97.3% [15 495/15 932]) were febrile and most febrile cases (82.1% [12 725/15 495]) tested were RDT positive. Almost half of afebrile episodes (47.6% [204/429]) were RDT positive. Children eligible for rectal artesunate contributed 1.1% of episodes. The odds of using CHWs as the first point of care doubled (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.9–2.4; P < .0001). RDT use changed from 3.2% to 72.9% (OR, 80.8; 95% CI, 51.2–127.3; P < .0001). The mean duration of uncomplicated episodes reduced from 3.69 ± 2.06 days to 3.47 ± 1.61 days, Degrees of freedom (df) = 2960, Student's t (t) = 3.2 (P = .0014), and mean duration of severe episodes reduced from 4.24 ± 2.26 days to 3.7 ± 1.57 days, df = 749, t = 3.8, P = .0001. There was a reduction in children with danger signs from 24.7% before to 18.1% during the intervention (OR, 0.68; 95% CI, .59–.78; P < .0001).Conclusions. Provision of diagnosis and treatment via trained CHWs increases access to diagnosis and treatment, shortens clinical episode duration, and reduces the number of severe cases. This approach, recommended by the World Health Organization, improves malaria case management.Clinical Trials Registration. ISRCTN13858170.

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“…CHWs provided voluntary services to underserved populations but were evaluated and held accountable as if they were salaried workers and were aggrieved to learn that community members did not understand or appreciate the volunteer nature of their contribution. Although the time they spent on healthcare was small [16], the cost savings to the community were significant [9] in a context where formal health services were limited. The existing evidence overwhelmingly suggests that CHWs are a good investment in providing access to and coverage of basic health services.…”

Section: Discussionmentioning

confidence: 99%

Motivation of Community Health Workers in Diagnosing, Treating, and Referring Sick Young Children in a Multicountry Study

Sanou

Jegede²,

Nsungwa-Sabiiti³

et al. 2016

Clin Infect Dis.

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Background. Community health workers (CHWs) are an important element of care provision for a wide range of conditions, but their turnover rate is high. Many studies have been conducted on health workers’ motivation, focusing on formal sector staff but not CHWs. Although CHWs are easy to recruit, motivating and retaining them for service delivery is difficult. This article investigates factors influencing CHW motivation and retention in health service delivery.Methods. Quantitative and qualitative data were collected to identify the key factors favoring motivation and retention of CHWs as well as those deterring them. We interviewed 47, 25, and 134 CHWs in Burkina Faso, Nigeria, and Uganda, respectively, using a structured questionnaire. Focus group discussions (FGDs) were also conducted with CHWs, community participants, and facility health workers.Results. Except for Burkina Faso, most CHWs were female. Average age was between 38 and 41 years, and most came from agricultural communities. The majority (52%–80%) judged they had a high to very high level of satisfaction, but most CHWs (approximately 75%) in Burkina Faso and Uganda indicated that they would be prepared to leave the job, citing income as a major reason. Community recognition and opportunities for training and supervision were major incentives in all countries, but the volume of unremunerated work, at a time when both malaria-positive cases and farming needs were at their peak, was challenging.Conclusions. Most CHWs understood the volunteer nature of their position but desired community recognition and modest financial remuneration.Clinical Trials Registration. ISRCTN13858170.

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Quantifying and Valuing Community Health Worker Time in Improving Access to Malaria Diagnosis and Treatment

Cited by 10 publications

References 12 publications

Screening and Treating Malaria in Pregnancy by Community Health Workers in Benin, Burkina Faso and Gambia: Profiles, Perceptions and Time Commitments

Screening and Treating Malaria in Pregnancy by Community Health Workers in Benin, Burkina Faso and Gambia: Profiles, Perceptions and Time Commitments

Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study

Motivation of Community Health Workers in Diagnosing, Treating, and Referring Sick Young Children in a Multicountry Study

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