Abstract
Kenya adopted the World Health Organization's recommendation of community case management of malaria (CCMM) in 2012. Trained community health volunteers (CHVs) provide CCMM but information on quality of services is limited. This study aimed to establish determinants of quality of service of CCMM conducted by CHVs. A cross-sectional survey was conducted in November 2016 in Bungoma County, Kenya. Data were collected through observing CHVs perform routine CCMM and through interviews of CHVs using structured questionnaires. A ≥ 75% score was considered as quality provision. Descriptive statistics were performed to describe basic characteristics of the study, followed by Chi-Square test and binary logistic regression to examine the differences and associations between the categorical variables. A total of 147 CHVs participated; 62% of CHVs offered quality services. There was a direct association between quality of services and stock-outs of artemether-lumefantrine (AL), stock-outs of malaria rapid diagnostic tests (RDT) and support supervision. CHVs who were supervised during the year preceding the assessment were four times more likely to perform better than those not supervised (uOR 4.2, 95% CI: 1.38-12.85). CHVs with reliable supplies of AL and RDT kits performed three times better than those who experienced stock outs (uOR = 3.2, 95% CI: 1.03-10.03 and 3.3, 95% CI: 1.63-6.59 respectively). Biosafety and documentation were the most poorly performed. The majority of CHVs offered quality CCMM services despite safety gaps. Safety, continuous supplies of RDT, AL and supervision are essential for quality performance by CHV in delivering CCMM.
Highlights
Kenya adopted the World Health Organization’s recommendation of community case management of malaria (CCMM) in 2012
Most community health volunteers (CHVs) had been in practice for 12 years; less than one quarter had less than one year of experience
Availability of AL and rapid diagnostic tests (RDT) were strongly associated with quality of service; the odds of providing a satisfactory score (≥ 75%) for service among CHV who had adequate stocks of AL and RDT were three times higher than those with stock outs. (Figures 1 and 2)
Summary
Kenya adopted the World Health Organization’s recommendation of community case management of malaria (CCMM) in 2012. According to a study conducted by the World Health Organization (WHO) and Ministry of Health (MoH) using the Service Availability Mapping tool, in 2007 there were nine health facilities per 100,000 of population in western Kenya where malaria is endemic [1]. Health facilities are inadequately staffed with high rates of provider absenteeism, shortages of drugs and poor quality of care [2, 3]. Given these constraints, self-treatment of suspected malaria is common using over-the-counter drugs, which may not be effective [3,4]
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