Utilization of community health workers for malaria treatment: results from a three-year panel study in the districts of Kaya and Zorgho, Burkina Faso

Malaria Journal

Research

Seni Kouanda¹  Antarou Ly¹  Valéry Ridde²  Thomas Druetz³  Slim Haddad⁴  Souleymane Diabaté⁵ 

[1] Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé, 03 BP 7192, Ouagadougou, Burkina Faso;School of Public Health, University of Montreal, 7101 avenue du Parc, H3N 1X9, Montreal, QC, Canada;School of Public Health, University of Montreal, 7101 avenue du Parc, H3N 1X9, Montreal, QC, Canada;University of Montreal Hospital Research Centre, 850 rue Saint-Denis, H2X 0A9, Montreal, QC, Canada;School of Public Health, University of Montreal, 7101 avenue du Parc, H3N 1X9, Montreal, QC, Canada;University of Montreal Hospital Research Centre, 850 rue Saint-Denis, H2X 0A9, Montreal, QC, Canada;Faculty of Medicine, Laval University, 1050 avenue de la Médecine, G1V 0A6, Québec, QC, Canada;Laval University Medical Research Center (CHUQ), Saint-Sacrement Hospital, 1050, chemin Sainte-Foy, G1S 4L8, Québec, QC, Canada;University of Montreal Hospital Research Centre, 850 rue Saint-Denis, H2X 0A9, Montreal, QC, Canada;

关键词: Community case management;    Community health worker;    Malaria;    Health-seeking behavior;    Burkina Faso;    Sub-Saharan Africa;    Panel study;    Evaluation;   

DOI  :  10.1186/s12936-015-0591-9

 received in 2014-07-09, accepted in 2015-01-28,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundMalaria is holo-endemic in Burkina Faso and causes approximately 40,000 deaths every year. In 2010, health authorities scaled up community case management of malaria with artemisinin-based combination therapy. Previous trials and pilot project evaluations have shown that this strategy may be feasible, acceptable, and effective under controlled implementation conditions. However, little is known about its effectiveness or feasibility/acceptability under real-world conditions of implementation at national scale.MethodsA panel study was conducted in two health districts of Burkina Faso, Kaya and Zorgho. Three rounds of surveys were conducted during the peak malaria-transmission season (in August 2011, 2012 and 2013) in a panel of 2,232 randomly selected households. All sickness episodes in children under five and associated health-seeking practices were documented. Community health worker (CHW) treatment coverage was evaluated and the determinants of consulting a CHW were analysed using multi-level logistic regression.ResultsIn urban areas, less than 1% of sick children consulted a CHW, compared to 1%–9% in rural areas. Gaps remained between intentions and actual practices in treatment-seeking behaviour. In 2013, the most frequent reasons for not consulting the CHW were: the fact of not knowing him/her (78% in urban areas; 33% in rural areas); preferring the health centre (23% and 45%, respectively); and drug stock-outs (2% and 12%, respectively). The odds of visiting a CHW in rural areas significantly increased with the distance to the nearest health centre and if the household had been visited by a CHW during the previous three months.ConclusionsThis study shows that CHWs are rarely used in Burkina Faso to treat malaria in children. Issues of implementation fidelity, a lack of adaptation to the local context and problems of acceptability/feasibility might have undermined the effectiveness of community case management of malaria. While some suggest extending this strategy in urban areas, total absence of CHW services uptake in these areas suggest that caution is required. Even in rural areas, treatment coverage by CHWs was considerably less than that reported by previous trials and pilot projects. This study confirms the necessity of evaluating public health interventions under real-world conditions of implementation.

【 授权许可】

Unknown   
© Druetz et al.; licensee BioMed Central. 2015. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.