Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study

Malaria Journal

Shem Bwambale¹  Rapheal Mbusa²  Michael Matte²  Patrick T. Lee³  Jessica Kenney⁴  Mark J. Siedner⁴  Geren S. Stone⁴  James S. Miller⁴  Edgar Mulogo⁵  Moses Ntaro⁵  Raquel Reyes⁶  Lacey English⁶ 

[1] Bugoye Health Centre, Bugoye Trading Centre;Global Health Collaborative;Lynn Community Health Centre;Massachusetts General Hospital;Mbarara University of Science and Technology;University of North Carolina at Chapel Hill School of Medicine;

关键词: Village health workers;    Community health workers;    Integrated community case management;    Quality of care;   

DOI  :  10.1186/s12936-018-2241-5

来源: DOAJ

【 摘 要 】

Abstract Background Village health workers (VHWs) in five villages in Bugoye subcounty (Kasese District, Uganda) provide integrated community case management (iCCM) services, in which VHWs evaluate and treat malaria, pneumonia, and diarrhoea in children under 5 years of age. VHWs use a “Sick Child Job Aid” that guides them through the evaluation and treatment of these illnesses. A retrospective observational study was conducted to measure the quality of iCCM care provided by 23 VHWs in 5 villages in Bugoye subcounty over a 2-year period. Methods Patient characteristics and clinical services were summarized using existing aggregate programme data. Lot quality assurance sampling of individual patient records was used to estimate adherence to the iCCM algorithm, VHW-level quality (based on adherence to the iCCM protocol), and change over time in quality of care (using generalized estimating equations regression modelling). Results For each of 23 VHWs, 25 patient visits were randomly selected from a 2-year period after iCCM care initiation. In these visits, 97% (150) of patients with diarrhoea were treated with oral rehydration and zinc, 95% (216) of patients with pneumonia were treated with amoxicillin, and 94% (240) of patients with malaria were treated with artemisinin-based combination therapy or rectal artesunate. However, only 44% (44) of patients with a negative rapid test for malaria were appropriately referred to a health facility. Overall, 75% (434) of patients received all the correct evaluation and management steps. Only 9 (39%) of the 23 VHWs met the pre-determined LQAS threshold for high-quality care over the 2-year observation period. Quality of care increased significantly in the first 6 months after initiation of iCCM services (p = 0.003), and then plateaued during months 7–24. Conclusions Quality of care was high for uncomplicated malaria, pneumonia and diarrhoea. Overall quality of care was lower, in part because VHWs often did not follow the guidelines to refer patients with fever who tested negative for malaria. Quality of care appears to improve in the initial months after iCCM implementation, as VHWs gain initial experience in iCCM care.

【 授权许可】

Unknown