Abstract
IntroductionCommunity Health Workers (CHWs) have been utilised for various primary health care activities in different settings especially in developing countries. Usually when utilised in well defined terms, they have a positive impact. To support Kenya's policy on engagement of CHWs for tuberculosis (TB) control, there is need to demonstrate effects of utilising them.ObjectivesThis study assessed TB treatment adherence among patients who utilised CHWs in management of their illness in comparison to those who did not in urban and rural settings.MethodsA retrospective cohort study was conducted in selected health facilities using standard clinical records for each TB patient registered for treatment between 2005 to 2011. Qualitative data was collected from CHWs and health care providers.ResultsThe study assessed 2778 tuberculosis patients and among them 1499 (54%) utilized CHWs for their TB treatment. The urban setting in comparison with the rural setting contributed 70% of patients utilising the CHWs (p<0.001). Overall treatment adherence of the cohort was 79%. Categorizing by use of CHWs, adherence among patients who had utilized CHWs was 83% versus 68% among those that had not (p<0.001). In comparison between the rural and urban settings adherence was 76% and 81.5% (p<0.001) respectively and when categorized by use of CHWs it was 73% and 90% (p<0.001) for the rural and urban set ups respectively. Utilisation of CHWs remained significant in enhancing treatment adherence in the cohort with unadjusted and adjusted ORs; OR 2.25, (95% 1.86–2.73) p<0.001 and OR 1.98 (95% 1.51–2.5) p<0.001 respectively. It was most effective in the urban set-up, OR 2.65 (95% 2.02–3.48, p<0.001) in comparison to the rural set up, OR 0.74 (95% 0.56–0.97) p = 0.032.ConclusionUtilisation of CHWs enhanced TB treatment adherence and the best effects were in the urban set-up.
Highlights
Community Health Workers (CHWs) have been utilised for various primary health care activities in different settings especially in developing countries
There was a significantly higher proportion of pulmonary smear negative (PSN) patients (56%) utilizing CHWs for their treatment compared to pulmonary smear positive (PSP) 19% (p,0.001)
Results from qualitative data A majority of the CHWs who participated in the Focus group discussions (FGDs) were between the ages of 25–30 yrs and at least 75% were female
Summary
Community Health Workers (CHWs) have been utilised for various primary health care activities in different settings especially in developing countries. The term ‘‘Community Health Worker’’ encompasses a variety of health assistants who are recruited by respective ministries in-charge of health They are trained and work with communities in which they live. To ensure the sustainability and effectiveness of CHWs, it has been realised that they require some form of incentive [6,10,12] To emphasise this need, the rising incidence of poverty in many sub-Saharan African countries has resulted in the dying spirit of volunteerism because people have to use their time to get an earning. When the success by CHWs is minimal, the principal reason is usually failure of the health system to provide them with the necessary support This was demonstrated in the Phillipines where CHWs had inadequate training, insufficient logistics support, poorly motivated schemes and lack of community support resulting to below optimal contribution from them [1]. The challenge in utilizing them is how to determine the best effective way to implement and manage this type of public health intervention [10]
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