Where there is no doctor: can volunteer community health workers in rural Uganda provide integrated community case management?

Jennifer L. Brenner, Celestine Barigye, Samuel Maling, Jerome Kabakyenga, Alberto Nettel-Aguirre, Denise Buchner1, Teddy Kyomuhangi, Carolyn Pim, Kathryn Wotton, Natukwatsa Amon, Nalini Singhal.

1. University of Calgary, Department of Paediatrics, Cumming School of Medicine
2. Ministry of Health Uganda,
3. Mbarara University of Science and Technology, Maternal, Newborn and Child Health Institute
4. Mbarara University of Science and Technology Faculty of Medicine, Community Health

Abstract
Introduction: Integrated community case management (iCCM) involves assessment and treatment of common childhood illnesses by community health workers (CHWs). Evaluation of a new Ugandan iCCM program is needed.

Objectives: The objectives of this study were to assess if iCCM by lay volunteer CHWs is feasible and if iCCM would increase,proportions of children treated for fever, pneumonia, and diarrhoea in rural Uganda.

Methods: This pre/post study used a quasi-experimental design and non-intervention comparison community. CHWs were selected, trained, and equipped to assess and treat children under five years with signs of the three illnesses. Evaluation included CHW-patient encounter record review plus analysis of pre/post household surveys.
Results: 196 iCCM-trained CHWs reported 6,276 sick child assessments (45% fever, 46% pneumonia, 9% diarrhoea). 93% of cases were managed according to algorithm recommendations. Absolute proportions of children receiving treatment significantly increased post-intervention: antimalarial for fever (+24% intervention versus +4% control) and oral rehydration salts/zinc for diarrhoea (+14% intervention versus +1% control).

Conclusion:In our limited-resource, rural Ugandan setting, iCCM involving lay CHWs was feasible and significantly increased the proportion of young children treated for malaria and diarrhoea.

Keywords: Uganda; maternal health; child health; community health worker; integrated community case management