Abstract
BackgroundFour university medical training institutions in Uganda have trained students at off-site health facilities under community-based education and Research Service (COBERS) programme for over 5 years. One of the major components of COBERS placement is for the students to provide health education in the communities about malaria as a major public health disease in Uganda. This study seeks to assess if targeted community-based medical education programme is associated with better prevention and treatment seeking behaviours in the management of malaria, a leading cause of morbidity and mortality of children under five in Uganda.MethodsA cross-sectional survey was done to compare communities around health facilities where medical students were placed at COBERS sites with communities around similar health facilities where medical students were not placed (non-COBERS sites). We randomly selected two villages near each health facility and consecutively selected 10 households per village for interviews using nearest-neighbour method. We used a structured questionnaire to interview household heads on malaria prevention and treatment seeking behaviour for children under 5 years. We performed univariate analysis to determine site and demographic characteristics and performed a multivariate logistic regression to assess association between dependant and independent variables.ResultsFive hundred twenty-three (66.8%) of the children under 5 years in COBERS communities slept under Insecticide Treated Nets (ITNs) the night before survey compared with 1451 (57.8%) in non-COBERS communities (AOR = 0.66, p = 0.017). 100 (60.0%) of children under 5 years in COBERS communities sought care for fever within 24 h of onset compared with 268 (47.0%) in non-COBERS communities (AOR = 0.71, P = 0.009).ConclusionThe presence of COBERS in communities is associated with improved malaria prevention and treatment-seeking behaviour for parents of children under 5 years. Further study needs to be done to determine the long-term impact of COBERS training program on malaria control and prevention in Uganda, along with other effects of COBERS.
Highlights
Four university medical training institutions in Uganda have trained students at off-site health facilities under community-based education and Research Service (COBERS) programme for over 5 years
The 2009 Uganda Malaria Indicator Survey showed that 52% of children under 5 years had malaria as determined by rapid diagnostic blood testing [7] while the 2014–15 Uganda Malaria Indicator Survey (UMIS) shows that overall, 31% of children had a fever in the two weeks preceding the survey [malaria indicator survey]
We compared communities near health facilities that have been used for student placements during COBERS (COBERS sites) with communities near health facilities that have not been used for COBERS
Summary
Four university medical training institutions in Uganda have trained students at off-site health facilities under community-based education and Research Service (COBERS) programme for over 5 years. One of the major components of COBERS placement is for the students to provide health education in the communities about malaria as a major public health disease in Uganda. This study seeks to assess if targeted community-based medical education programme is associated with better prevention and treatment seeking behaviours in the management of malaria, a leading cause of morbidity and mortality of children under five in Uganda. Children under five years are vulnerable to severe disease and death when infected with malaria in endemic areas [2]. Malaria and malaria related-illnesses contributed to between 20 to 23% of deaths among children aged less than five years in Uganda [6]. OR p-value AOR 95% CI Site status Sector Wealth Quintile
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