Community Units Research Articles

Assessing the Influence of Behavioural Factors of Community Health Promoters on Use of Community Based Health Information Systems in Selected Counties, Kenya

Globally, health management information systems (HMIS) in strengthening health systems have gained recognition due to potential of technology to improve access to quality care in underserved communities. In Kenya, the functionality of Community based- Health Management Information System (CBHMIS) currently stands at 55% down from 64% in year 2015. The aim of this paper was to determine the influence of behavioral factors of community units personnel on CBHMIS. As a nested study, with a broader aimt to establish the operational status of CBHMIS and its use in selected counties in Kenya; The main objective of this research was: To establish whether behavioural factors of Community Health Promoters (CHPs) influence CBHMIS use in Kenya. A mixed method design. was adopted, Kiambu, Kajiado and Nairobi counties formed the study location, a target population of 156 active community units was considered to arrive at a total sample of 122 community units and out of 7800CHPs a sample of 366 respondents was drawn. Multistage sampling was used to identify the CUs, and systematic random sampling to identify 366 respondents. Quantitative data tools were semi-structured closed ended questionnaires. Qualitative data tools included observation checklist, Focus Group Discussion and Key Informant Interviews guides. Quantitative data was analyzed using SPSS to generate univariate and bivariate analysis at p<0.05 significance level; Qualitative data was analyzed using content analysis based on key themes generated from the objectives. Results were presented in form of graphs, tables, figures, and narration. This study showed that the use of Community based- Health Management Information System stood at 56.6%. Behavioural factors were found to significantly influence use of Community based- Health Management Information System. Further, of the total variations in the use of Community based- Health Management Information System, behavioral factor explains 13.7% (R<sup>2</sup> = .137). Results show that the model was valid (F<sub>(1, 363)</sub> = 58.579, <I>P </I>= .001) hence the explanatory variable (X<sub>2</sub>, Behavioral factors) is good in explaining total variations in Use of CbHMIS by community units. This implies that the use of CbHMIS by Community Units (CU) improves significantly when the community units have better behavioural factors. In conclusion, behavioural factors of CHPs have strong and significant influence on the CBHMIS use. Motivation of CHPs is key as a motivator to CBHMIS use, as well as. provision of material support including reporting tools and IEC materials and capacity development technical, computer and electronic reporting skills to enhamce CHP operations and processes.

Health systems strengthening: assessing the influence of organizational factors of community health volunteers on use of community based health information systems in selected counties, Kenya

Background: WHO places health information as a key pillar of an effective health system (HS). HS strengthening has become a key focus of many nations. A paradigm shift from being disease specific focus to holistic strengthening of pillars of a HS. Kenya’s functionality of CbHMIS (community based health information systems) stands at 55% down from 64% in year 2015, majorly contributed to by organization of community health volunteers (CHVs) work. The aim was to establish influence of organizational factors of CHVs on CbHMIS use in Kenya.Methods: A cross-sectional design which employed both quantitative and qualitative approaches was used. Kiambu, Kajiado and Nairobi counties formed the study location. A systematic random sample of 366 respondents was drawn. Multistage sampling was used to identify the community units (CUs). Ethical clearance was obtained from KEMU, ethics and research committee (SERC), national commission for science, technology and innovation (NACOSTI) gave a research permit. 3 FGDs and 6 KIIs were conducted. Quantitative data was analyzed using SPSS version 23 to generate univariate and bivariate analysis at p<0.05 significance level. Qualitative data was analyzed using content analysis. Results were presented in form of graphs, tables, figures and narration.Results: Use of CbHMIS stood at 56.6%. Organizational factor explains 39.9% (R2=0.399) of total variations in the use of CbHMIS. Organizational factors of the CHVs were found to positively and significantly influence use of CbHMIS.Conclusions: Organizational factors influences use of CbHMIS by CHV. Government/partners to build CUs capacity on sustainable resource mobilization strategies.

Evaluation of Implementation Level of Community Health Strategy and Its Influence on Uptake of Skilled Delivery in Lurambi Sub County-Kenya.

Background:Despite the widespread application of the community health strategy (CHS) in Kenya and evidence of its effectiveness in reducing health outcomes at the household level, data from Kakamega County, of which Lurambi sub-county is part of, still showed that skilled birth delivery was at 47% against the national estimateof 62% and a target of 90%. However, there was limited evidence on the level of CHS implementation and its association with the uptake of skilled delivery.Methods:The study employed a cross-sectional analytic design. A structured validated community unit (CU) scorecard and a household questionnaire were used to collect quantitative data from the CUs through Community Health Extension Workers (CHEWs) and at the household level through mothers with children below 1 year. A random sample of 436 mothers from all the 38 Community Units (CUs) was included. CU functionality was assessed using 17 binary indicators (scored as 1 for a positive response, 0 otherwise) and total scores were expressed as percentages. Fully functional CUs scored ≥80% and semi-functional CU scored >50 to <80%. No CU was non-functional (scored ≤50%). Data from the CUs were merged with data at the household level. Association between CU functionality and skilled delivery was assessed using multivariable binary logistic regression controlling for socio-demographic variables. Adjusted Odds Ratios (OR) and 95% Confidence Intervals (95%CI) are reported.Results:A total of 38 CUs were assessed and of these, 26(68.6%) were fully functional and 12(31.4%) were semi-functional, 18(47.4%) had both household registers (MOH 513) and service delivery logbooks (MOH 514). Overall, 387(80.0%) of mothers had skilled birth deliveries, 263(68%) were from functional CUs and 124(32%) were from semi-functional CUs. Pregnant women were more likely to have skilled deliveries in fully functional CUs than semi-functional CUs (OR=1.3; 95% CI=1.1-2.4; p-value<.001). Other factors significantly associated with uptake of skilled delivery included receiving health education(OR=2.9;95%CI =1.4-6.1, p=.005), being visited at least twice by Community Health Volunteers, CHVs(OR=1.9;95%CI=1.1-3.5, p=.045), attending antenatal care clinics, ANC (OR=3.4;95%CI=1.3-3.5, p=.012), receiving advice where to deliver (OR=4.1;95%CI=1.8-9.4, p=.001).Conclusion:2 out of 3 community units were fully functional, and functionality was associated with increased uptake of skilled delivery. In a fully functional CUs, Community Health Volunteers provided health education through regular visits and they were able to provide a referral to health facilities for the pregnant women. To achieve national targets for skilled deliveries and universal health coverage, there is a need to ensure CUs are fully functional

Integrated and simplified approaches to community management of acute malnutrition in rural Kenya: a cluster randomized trial protocol

BackgroundIn many low income countries, the majority of acutely malnourished children are either brought to the health facility late or never at all due to reasons related to distance and associated costs. Integrated community case management (iCCM) is an integrated approach addressing disease and malnutrition through use of community health volunteers (CHVs) in children under-5 years. Evidence on the potential impact and practical experiences on integrating community-based management of acute malnutrition as part of an iCCM package is not well documented. In this study, we aim to investigate the effectiveness and cost effectiveness of integrating management of acute malnutrition into iCCM.MethodsThis is a two arm parallel groups, non-inferiority cluster randomized community trial (CRT) employing mixed methods approach (both qualitative and quantitative approaches). Baseline and end line data will be collected from eligible (malnourished) mother/caregiver-child dyads. Ten community units (CUs) with a cluster size of 24 study subjects will be randomized to either an intervention (5 CUs) and a control arm (5 CUs). CHV in the control arm, will only screening and refer MAM/SAM cases to the nearby health facility for treatment by healthcare professionals. In the intervention arm, however; CHVs will be trained both to screen/diagnose and also treat moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) without complication. A paired-matching design where each control group will be matched with intervention group with similar characteristics will be matched to ensure balance between the two groups with respect to baseline characteristics. Qualitative data will be collected using key informant and in-depth interviews (KIIs) and focused group discussions (FGDs) to capture the views and experiences of stakeholders.DiscussionOur proposed intervention is based on an innovative approach of integrating and simplifying SAM and MAM management through CHWs bring the services closer to the community. The trial has received ethical approval from the Ethics Committee of AMREF Health Africa - Ethical and Scientific Review Committee (AMREF- ESRC), Nairobi, Kenya. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, and presented to local and international conferences.Trial registrationPACTR201811870943127; Pre-results. 26 November 2018.

The Fragile Balance of Community-Based Health Care: One Community's United Response When the HIV/AIDS Primary Care Safety Net Failed.

After more than 20 years of continuous service to people living with HIV (PLWH), the doors of St George's Clinic (St George's), an ambulatory facility in Jefferson County, Alabama, were irrevocably closed on December 31, 2012. Despite serving an indigent patient population of more than 800 P

Community unit performance: factors associated with childhood diarrhea and appropriate treatment in Nyanza Province, Kenya

BackgroundThe government of Kenya launched its community health strategy in 2006 to improve certain aspects of its community health program. Under the strategy, community units (CUs) were established as level one of the Kenyan health system. A core member at this level is the community health worker (CHW). The objective of this study was to assess the relationship among the performance of the CUs, the prevalence of childhood diarrhea and appropriate treatment for it by controlling individual and community-level factors.MethodsThe main dataset used in this study was the 2011 Nyanza Province county-based Multiple Indicator Cluster Survey (MICS). In addition, based on the list of community units in Nyanza Province, Kenya, we identified the area’s CUs and their performance. MICS data and data on CUs were merged using sub-location names. There were 17 individual and two community-level independent variables in this study. Bivariate analysis and a multilevel logistic regression were performed.ResultsFactors significantly associated with a lower prevalence of diarrhea among children under five were the child’s increasing age, middle-aged household heads, children who received more attention, water treatment and rural versus urban area residence, while male children and highly performing CUs were significantly associated with a higher prevalence of diarrhea. In addition, middle wealth index, severity of diarrhea and middle- and high-CU performance were significantly associated with appropriate treatment for childhood diarrhea.ConclusionsAlthough this study found that children living in areas of high CU performance were more likely to have diarrhea, these areas would have been identified as being more at risk for diarrhea prevalence and other health concerns, prioritized for the establishment of a CU and allocated more resources to improve the performance of CUs. A higher CU performance was significantly associated with the appropriate treatment. It was suggested that CHWs could have a positive effect on the community, as demonstrated and promoted by appropriate health-seeking behavior and treatment for childhood diarrhea.

Interrupting transmission of soil-transmitted helminths: a study protocol for cluster randomised trials evaluating alternative treatment strategies and delivery systems in Kenya

IntroductionIn recent years, an unprecedented emphasis has been given to the control of neglected tropical diseases, including soil-transmitted helminths (STHs). The mainstay of STH control is school-based deworming (SBD), but...