TY - JOUR
T1 - Determinants of Utilization and Community Experiences with Community Health Volunteers for Treatment of Childhood Illnesses in Rural Sierra Leone
AU - Yansaneh, Aisha I.
AU - George, Asha S.
AU - Sharkey, Alyssa
AU - Brieger, William R.
AU - Moulton, Lawrence H.
AU - Yumkella, Fatu
AU - Bangura, Peter
AU - Kabano, Augustin
AU - Diaz, Theresa
N1 - Publisher Copyright:
© 2015, Springer Science+Business Media New York.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - In 2010, at the same time as the national roll out of the Free Health Care Initiative (FHCI), which removed user fees for facility based health care, trained community health volunteers (CHVs) were deployed to provide integrated community case management of diarrhea, malaria and pneumonia to children under 5 years of age (U5) in Kambia and Pujehun districts, Sierra Leone. After 2 years of implementation and in the context of FHCI, CHV utilization rate was 14.0 %. In this study, we examine the factors associated with this level of CHV utilization. A cross-sectional household-cluster survey of 1590 caregivers of 2279 children U5 was conducted in 2012; with CHV utilization assessed using a multiple logistic regression model. Focus groups and in-depth interviews were also conducted to understand communities’ experiences with CHVs. Children with diarrhea (OR = 3.17, 95 % CI: 1.17–8.60), from female-headed households (OR = 4.55, 95 % CI: 1.88–11.00), and whose caregivers reported poor quality of care as a barrier to facility care-seeking (OR = 8.53, 95 % CI: 3.13–23.16) were more likely to receive treatment from a CHV. Despite low utilization, caregivers were highly familiar and appreciative of CHVs, but were concerned about the lack of financial remuneration for CHVs. CHVs remained an important source of care for children from female-headed households and whose caregivers reported poor quality of care at health facilities. CHVs are an important strategy for certain populations even when facility utilization is high or when facility services are compromised, as has happened with the recent Ebola epidemic in Sierra Leone.
AB - In 2010, at the same time as the national roll out of the Free Health Care Initiative (FHCI), which removed user fees for facility based health care, trained community health volunteers (CHVs) were deployed to provide integrated community case management of diarrhea, malaria and pneumonia to children under 5 years of age (U5) in Kambia and Pujehun districts, Sierra Leone. After 2 years of implementation and in the context of FHCI, CHV utilization rate was 14.0 %. In this study, we examine the factors associated with this level of CHV utilization. A cross-sectional household-cluster survey of 1590 caregivers of 2279 children U5 was conducted in 2012; with CHV utilization assessed using a multiple logistic regression model. Focus groups and in-depth interviews were also conducted to understand communities’ experiences with CHVs. Children with diarrhea (OR = 3.17, 95 % CI: 1.17–8.60), from female-headed households (OR = 4.55, 95 % CI: 1.88–11.00), and whose caregivers reported poor quality of care as a barrier to facility care-seeking (OR = 8.53, 95 % CI: 3.13–23.16) were more likely to receive treatment from a CHV. Despite low utilization, caregivers were highly familiar and appreciative of CHVs, but were concerned about the lack of financial remuneration for CHVs. CHVs remained an important source of care for children from female-headed households and whose caregivers reported poor quality of care at health facilities. CHVs are an important strategy for certain populations even when facility utilization is high or when facility services are compromised, as has happened with the recent Ebola epidemic in Sierra Leone.
KW - Children under five
KW - Community health workers/volunteers
KW - Integrated community case management
KW - Sierra Leone
KW - Utilization
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U2 - 10.1007/s10900-015-0107-0
DO - 10.1007/s10900-015-0107-0
M3 - Article
C2 - 26507650
AN - SCOPUS:84959456418
SN - 0094-5145
VL - 41
SP - 376
EP - 386
JO - Journal of Community Health
JF - Journal of Community Health
IS - 2
ER -