208: Can Volunteer Community Health Workers in Rural Uganda Provide Integrated Community Case Management?

Abstract

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. To assess whether iCCM by lay volunteer CHWs will affect the proportions of children treated for fever, presumed pneumonia and diarrhea in rural Uganda. A pre and post intervention study used quasi-experimental design and included comparison with a non-intervention community. CHWs in intervention areas received basic CHW training then two CHWs from each village were selected, trained and equipped to assess and treat children under five years old with fever, fast breathing and cough (presumed pneumonia), and diarrhea. Evaluation involved CHW registry analysis, retrospective review of CHW patient encounter records, and analysis of household mother surveys from intervention and control communities before and after iCCM intervention. A total of 196 CHWs (72% female, average age 36 years) received iCCM training and reported 6276 sick child assessments from April–October 2012 (average 4.6 monthly encounters/CHW), classified as 46% presumed pneumonia, 45% fever, and 9% diarrhea. 93% of treatment records were consistent with iCCM algorithm recommendations (96%, 90% and 92% for fever, pneumonia and diarrhea, respectively). Post intervention absolute proportions of children receiving (from any source by maternal report) treatment were significantly increased: antimalarial for fever (+24% intervention versus +4% control) and oral rehydration salts/zinc for diarrhea (+14% intervention versus +1% in control). A higher percentage of children had received antibiotics for pneumonia symptoms in intervention (64%) versus control communities (28%). In our rural Ugandan setting with limited health services, ICCM significantly increased the proportion of young children treated for malaria, pneumonia and diarrhea. ICCM involving lay CHWs is feasible here though more studies are needed to understand if and how iCCM scale up should occur, particularly to remote communities with limited human resources for health.