Where there is no doctor: can volunteer community health workers in rural Uganda provide integrated community case management?|
Brenner, Jennifer L.; Barigye, Celestine; Maling, Samuel; Kabakyenga, Jerome; Nettel-Aguirre, Alberto; Buchner, Denise; Kyomuhangi, Teddy; Pim, Carolyn; Wotton, Kathryn; Amon, Natukwatsa & Singhal, Nalini
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.
Uganda; maternal health; child health; community health worker; integrated community case management