Community perceptions and attitudes on malaria case management and the role of community health workers

Background Health workers’ compliance with outpatient malaria case-management guidelines has been improving in Africa. This study examined the factors associated with the improvements. Methods Data from 11 national, cross-sectional health facility surveys undertaken from 2010–2016 were analysed. Association between 31 determinants and improvement trends in five outpatient compliance outcomes were examined using interactions between each determinant and time in multilevel logistic regression models and reported as an adjusted odds ratio of annual trends (T-aOR). Results Among 9,173 febrile patients seen at 1,208 health facilities and by 1,538 health workers, a higher annual improvement trend in composite “test and treat” performance was associated with malaria endemicity-lake endemic (T-aOR = 1.67 annually; p<0.001) and highland epidemic (T-aOR = 1.35; p<0.001) zones compared to low-risk zone; with facilities stocking rapid diagnostic tests only (T-aOR = 1.49; p<0.001) compared to microscopy only services; with faith-based/non-governmental facilities compared to government-owned (T-aOR = 1.15; p = 0.036); with a daily caseload of >25 febrile patients (T-aOR = 1.46; p = 0.003); and with under-five children compared to older patients (T-aOR = 1.07; p = 0.013). Other factors associated with the improvement trends in the “test and treat” policy components and artemether-lumefantrine administration at the facility included the absence of previous RDT stock-outs, community health workers dispensing drugs, access to malaria case-management and Integrated Management of Childhood Illness (IMCI) guidelines, health workers’ gender, correct health workers’ knowledge about the targeted malaria treatment policy, and patients’ main complaint of fever. The odds of compliance at the baseline were variable for some of the factors. Conclusions Targeting of low malaria risk areas, low caseload facilities, male and government health workers, continuous availability of RDTs, improving health workers’ knowledge about the policy considering age and fever, and dissemination of guidelines might improve compliance with malaria guidelines. For prompt treatment and administration of the first artemether-lumefantrine dose at the facility, task-shifting duties to community health workers can be considered.

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Malaria case management by community health workers in the Central African Republic from 2009–2014: overcoming challenges of access and instability due to conflict

Malaria Journal ◽

10.1186/s12936-017-2005-7 ◽

2017 ◽

Vol 16 (1) ◽

Cited By ~ 12

Author(s):

Laura Ruckstuhl ◽

Christian Lengeler ◽

Jean Méthode Moyen ◽

Helle Garro ◽

Richard Allan

Keyword(s):

Case Management ◽

Community Health ◽

Community Health Workers ◽

Malaria Case ◽

Central African Republic ◽

Health Workers ◽

Malaria Case Management

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Introduction of mobile phones for use by volunteer community health workers in support of integrated community case management in Bushenyi District, Uganda: development and implementation process

BMC Health Services Research ◽

10.1186/1472-6963-14-s1-s2 ◽

2014 ◽

Vol 14 (Suppl 1) ◽

pp. S2 ◽

Cited By ~ 13

Author(s):

David Tumusiime ◽

Gad Agaba ◽

Teddy Kyomuhangi ◽

Jan Finch ◽

Jerome Kabakyenga ◽

...

Keyword(s):

Case Management ◽

Community Health ◽

Community Health Workers ◽

Mobile Phones ◽

Health Workers ◽

Implementation Process ◽

Community Case Management ◽

Integrated Community Case Management

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Exploring the Role of Community Health Workers in Providing Cancer Navigation: Perceptions of African American Older Adults

Oncology Nursing Forum ◽

10.1188/12.onf.e288-e298 ◽

2012 ◽

Vol 39 (3) ◽

pp. E288-E298 ◽

Cited By ~ 6

Author(s):

Jennifer Wenzel ◽

Randy Jones ◽

Rachel Klimmek ◽

Sarah Szanton ◽

Sharon Krumm

Keyword(s):

Older Adults ◽

African American ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

African American Older Adults

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Networking community health workers for service integration: role of social media

AIDS Care ◽

10.1080/09540121.2021.2019668 ◽

2022 ◽

pp. 1-7

Author(s):

Li Li ◽

Chunqing Lin ◽

Loc Quang Pham ◽

Diep Bich Nguyen ◽

Tuan Anh Le

Keyword(s):

Social Media ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Service Integration

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Contribution of community health workers to improving access to timely and appropriate case management of childhood fever in Mozambique

Journal of Global Health ◽

10.7189/jogh.07.010402 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 4

Author(s):

Tanya Guenther ◽

Salim Sadruddin ◽

Karen Finnegan ◽

Erica Wetzler ◽

Fatima Ibo ◽

...

Keyword(s):

Case Management ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Childhood Fever

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Trends in health workers’ compliance with outpatient malaria case-management guidelines across malaria epidemiological zones in Kenya, 2010–2016

Malaria Journal ◽

10.1186/s12936-020-03479-z ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Beatrice Amboko ◽

Kasia Stepniewska ◽

Peter M. Macharia ◽

Beatrice Machini ◽

Philip Bejon ◽

...

Keyword(s):

Case Management ◽

Malaria Case ◽

Health Workers ◽

Malaria Risk ◽

Low Risk ◽

Malaria Case Management ◽

Management Guidelines ◽

Seasonal Transmission ◽

Test And Treat ◽

Risk Areas

Abstract Background Health workers' compliance with outpatient malaria case-management guidelines has been improving, specifically regarding the universal testing of suspected cases and the use of artemisinin-based combination therapy (ACT) only for positive results (i.e., ‘test and treat’). Whether the improvements in compliance with ‘test and treat’ guidelines are consistent across different malaria endemicity areas has not been examined. Methods Data from 11 national, cross-sectional, outpatient malaria case-management surveys undertaken in Kenya from 2010 to 2016 were analysed. Four primary indicators (i.e., ‘test and treat’) and eight secondary indicators of artemether-lumefantrine (AL) dosing, dispensing, and counselling were measured. Mixed logistic regression models were used to analyse the annual trends in compliance with the indicators across the different malaria endemicity areas (i.e., from highest to lowest risk being lake endemic, coast endemic, highland epidemic, semi-arid seasonal transmission, and low risk). Results Compliance with all four ‘test and treat’ indicators significantly increased in the area with the highest malaria risk (i.e., lake endemic) as follows: testing of febrile patients (OR = 1.71 annually; 95% CI = 1.51–1.93), AL treatment for test-positive patients (OR = 1.56; 95% CI = 1.26–1.92), no anti-malarial for test-negative patients (OR = 2.04; 95% CI = 1.65–2.54), and composite ‘test and treat’ compliance (OR = 1.80; 95% CI = 1.61–2.01). In the low risk areas, only compliance with test-negative results significantly increased (OR = 2.27; 95% CI = 1.61–3.19) while testing of febrile patients showed declining trends (OR = 0.89; 95% CI = 0.79–1.01). Administration of the first AL dose at the facility significantly increased in the areas of lake endemic (OR = 2.33; 95% CI = 1.76–3.10), coast endemic (OR = 5.02; 95% CI = 2.77–9.09) and semi-arid seasonal transmission (OR = 1.44; 95% CI = 1.02–2.04). In areas of the lowest risk of transmission and highland epidemic zone, none of the AL dosing, dispensing, and counselling tasks significantly changed over time. Conclusions There is variability in health workers' compliance with outpatient malaria case-management guidelines across different malaria-risk areas in Kenya. Major improvements in areas of the highest risk have not been seen in low-risk areas. Interventions to improve practices should be targeted geographically.

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What are the roles of community health workers? Looking back at the philosophies of primary health care

Global Health Promotion ◽

10.1177/1757975918811087 ◽

2019 ◽

Vol 27 (2) ◽

pp. 117-120

Author(s):

Marietou Niang

Keyword(s):

Health Care ◽

Primary Health Care ◽

Community Development ◽

Health System ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Primary Health ◽

Looking Back

This commentary discusses the different roles of community health workers (CHWs), their challenges and limitations in a historical perspective of primary health care (PHC). We first try to show that the comprehensive philosophy of PHC promulgated in Alma-Ata proposed the role of CHWs as actors who work in community development. On the other hand, in the 1980s, with the emergence of the selective philosophy of PHC, CHWs’ role was more affiliated with the health system. We conclude our pitch about the balance that can exist between these different roles by suggesting that CHWs can work in continuity with the health system, but they should not be considered as affordable labor. Also, they must be supported in their activities to develop their communities, allowing them to participate effectively in programs and policies that concern them and their community.

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