Factors affecting the effectiveness of integrated community case management of malaria, pneumonia, and diarrhea by VHTS

Abstract

Background: Despite of being easily preventable and treatable, malaria, pneumonia, and diarrhea continue to be the major killers in Napak district therefore recent years have seen a development of a new generation of programs which in Uganda is called Integrated Community Case management of fever, pneumonia and diarrhea recommended by W.H.O and UNICEF to address the inequitable gap of accessing effective treatment for the above mentioned conditions. ICCM program was rolled out in Napak district in 2010 in which 440 VHTs were selected, trained and supported with supplies and medicines to treat children less than five years in the community. Main aim: To establish the factors that contributes to the success of ICCM program in Napak district and the limitations. Methodology: This was a cross sectional study of 166 VHTs and employed both quantitative and qualitative methods of data collection. Data collection used both quantitative and qualitative methods and analysis was by SPSS. Results: There was high (96.4%) retention of VHTs in Napak district due to the community involvement in the selection of VHTs and the appropriate attributes of persons selected however a good number (66,9%) had never gone to school where a correlation test revealed younger illiterate ( below 40 years) VHTs performed better than older VHTs. The program has challenges in maintaining adequate stocks of supplies and medicines where it was found VHTs did not have tracer medicines; ACTs, amoxicillin, ORs Zinc and rectal artesunate on the day of the visit. The VHTs performance was not equal in assessment, classification, and treatment of malaria, pneumonia, and diarrhea. A significant number had gaps in knowledge and competence where only 59 percent of the VHTs had adequate knowledge and lower number (43.4%) had adequate competences in assessment, classification and treatment of sick children. The main area of weakness was in counting respiratory rate of which (30.7%) could not count respiratory breaths within three breaths of those counted by the qualified research assistants that reveal a gap in classification and treatment of pneumonia putting pressure on use of medicines. Conclusion and recommendation: community involvement in the selection of VHTs has played positive role but VHTs should be supported with continued training, adequate supervision, regular monthly meetings and optimum provision of medicines, diagnostic aids and other supplies.