Abstract
BackgroundThis paper describes the development and implementation of a program to promote prompt and appropriate care seeking for fever in children under the age of five. Designed as a multicomponent program, the intervention comprises elements to influence the behavior of caregivers of children, Community Health Workers, professional health care providers and the wider community.MethodsFollowing the six fundamental steps of the Intervention Mapping protocol, we involved relevant stakeholders from the commencement of planning to program end. The IM protocol also recommends various behavior change methods to guide intervention development.ResultsThe intervention components implemented were successful in achieving program goals. For example, the intervention resulted in the primary outcome of reductions in all-cause mortality of 30% and 44%, among children treated with an antimalarial and those treated with the antimalarial plus an antibiotic respectively.Most Community Health Workers were retained on the program, with an attrition rate of 21.2% over a period of 30 months and the Community Health Workers rate of adherence to performance guidelines was high at 94.6%.ConclusionWe were able to systematically develop a theory- and evidence-based health promotion program based on the Intervention Mapping protocol. This article contributes to the response to recent calls for a more detailed description of the development of interventions and trials. The intervention mapping approach can serve as a guide for others interested in developing community- based health interventions in similar settings.
Highlights
This paper describes the development and implementation of a program to promote prompt and appropriate care seeking for fever in children under the age of five
It is estimated that a 70% reduction in under-five mortality could be achieved if all cases of childhood pneumonia were managed at the community level [6]
Factors contributing to this lack of appropriate response to fevers were found to be inadequate understanding by parents that fever can be related to either malaria or pneumonia and that both need urgent care
Summary
This paper describes the development and implementation of a program to promote prompt and appropriate care seeking for fever in children under the age of five. Mortality in children less than five years of age, remains an important public health problem especially in SubSaharan Africa (SSA) where almost half of the 7.7 million child deaths recorded globally occur each year [1,2,3]. It is estimated that a 70% reduction in under-five mortality could be achieved if all cases of childhood pneumonia were managed at the community level [6]. Most developing countries with high mortality rates, have limited access to prompt and appropriate care for potentially deadly childhood diseases especially in rural areas [8]. Other reasons for delays in care seeking include geographic and financial barriers to access to health care facilities, poor knowledge and practice of caregivers and caregiver’s perceptions that health care providers have poor attitudes towards them [10,11,12,13]
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