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

Abstract

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.

Lay Field-worker–Led School Health Program for Primary Schools in Low- and Middle-Income Countries

“…Task shifting has been successful in many other areas of health care delivery, including maternal health, integrated case management of childhood illnesses, and mental health. [47][48][49][50][51] Researches of a recent trial in India evaluated the effectiveness of a health promotion intervention in secondary schools. When delivered by lay counselors, there was strong evidence of impact; however, no effect was observed with teacher led delivery.…”

Qualitative analysis of the health system effects of a community-based malaria elimination program in Rwanda

“…This was the case in a study that promoted integrated service delivery for childhood diseases through volunteer health workers, therefore stimulating workforce expansion. 23 How to efficiently ensure motivation and create incentives for these workers remains open to investigation, but lessons can be learned from similar efforts. 24 , 25 Interestingly, a multi-country study on community-led interventions reported non-financial incentives as being more effective in motivating community volunteers.…”

A demonstration of mobile phone deployment to support the treatment of acutely ill children under five in Bushenyi district, Uganda

“…As presented in Figure 1, nine parishes in Kyabugimbi sub-county were selected as sites for advanced CHW training in iCCM as per the protocol of a controlled intervention trial 35 building on previous studies of CHW engagement in iCCM. [32][33][34] The choice of sites was based on the burden of childhood illness in this sub-county and on difficulty of access to the nearest level IV health centre.…”

“…The centres include ward beds, an operating theatre, laboratory and blood transfusion facilities. 36 In 98 villages participating in the background trial, 35 selected CHWs (n=196) received 5-day basic training followed by additional iCCM preparation. Training in iCCM focused on skills and knowledge needed to assess, treat and, if necessary, refer to a higher level of care, young children with fever, presumed pneumonia or diarrhoea.…”