Factors associated with utilization of community health workers in improving access to malaria treatment among children in Kenya

James Kisia,Andrew Nyandigisi,Willis Akhwale,Salim Sohani,Kendra Siekmans,Florence Nelima,Kioko Kiilu,David Odhiambo Otieno,Wamalwa Emmanuel

doi:10.1186/1475-2875-11-248

Abstract

BackgroundThe success of community case management in improving access to effective malaria treatment for young children relies on broad utilization of community health workers (CHWs) to diagnose and treat fever cases. A better understanding of the factors associated with CHW utilization is crucial in informing national malaria control policy and strategy in Kenya. Specifically, little is known in Kenya on the extent to which CHWs are utilized, the characteristics of families who report utilizing CHWs and whether utilization is associated with improved access to prompt and effective malaria treatment. This paper examines factors associated with utilization of CHWs in improving access to malaria treatment among children under five years of age by women caregivers in two malaria endemic districts in Kenya.MethodsThis study was conducted in 113 hard-to-reach and poor villages in Malindi and Lamu districts in the coastal region classified as having endemic transmission of malaria. A cross-sectional household survey was conducted using a standardized malaria indicator questionnaire at baseline (n = 1,187) and one year later at endline assessment (n = 1,374) using two-stage cluster sampling.ResultsThere was an increase in reported utilization of CHWs as source of advice/treatment for child fevers from 2% at baseline to 35% at endline, accompanied by a decline in care-seeking from government facilities (from 67% to 48%) and other sources (26% to 2%) including shops. The most poor households and poor households reported higher utilization of CHWs at 39.4% and 37.9% respectively, compared to the least poor households (17.0%). Households in villages with less than 200 households reported higher CHWs utilization as compared to households in villages having >200 households. Prompt access to timely and effective treatment was 5.7 times higher (95% CI 3.4-9.7) when CHWs were the source of care sought. Adherence was high regardless of whether source was CHWs (73.1%) or public health facility (66.7%).ConclusionsThe potential for utilization of CHWs in improving access to malaria treatment at the community level is promising. This will not only enhance access to treatment by the poorest households but also provide early and appropriate treatment to vulnerable individuals, especially those living in hard to reach areas.

Highlights

The success of community case management in improving access to effective malaria treatment for young children relies on broad utilization of community health workers (CHWs) to diagnose and treat fever cases
According to the World Health Organization (WHO), Community case management of malaria (CCM) is based on the evidence that well-trained and supervised community health workers can provide prompt and adequate treatment to fever cases within 24 hours to help reduce morbidity and mortalities associated with malaria among under-five children in Africa [2]
As part of an evaluation of a pilot CCM project in Kenya, this study examines the extent to which CHWs were utilized, the characteristics of the families who reported utilizing CHWs and whether utilization was associated with improved access to prompt and effective malaria treatment

Summary

Introduction

The success of community case management in improving access to effective malaria treatment for young children relies on broad utilization of community health workers (CHWs) to diagnose and treat fever cases. A better understanding of the factors associated with CHW utilization is crucial in informing national malaria control policy and strategy in Kenya. This paper examines factors associated with utilization of CHWs in improving access to malaria treatment among children under five years of age by women caregivers in two malaria endemic districts in Kenya. According to the World Health Organization (WHO), CCM is based on the evidence that well-trained and supervised community health workers can provide prompt and adequate treatment to fever cases within 24 hours to help reduce morbidity and mortalities associated with malaria among under-five children in Africa [2]. CHWs provide the link between the health facilities and community members and are given responsibility for health promotion, disease prevention as well as treatment of specific diseases, such as uncomplicated malaria [4]

Methods

Results

Conclusion