Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study
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 J...
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| Format: | Article |
| Language: | English |
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BMC
2018-02-01
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| Series: | Malaria Journal |
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| Online Access: | http://link.springer.com/article/10.1186/s12936-018-2241-5 |
| _version_ | 1831712112374710272 |
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| author | James S. Miller Lacey English Michael Matte Rapheal Mbusa Moses Ntaro Shem Bwambale Jessica Kenney Mark J. Siedner Raquel Reyes Patrick T. Lee Edgar Mulogo Geren S. Stone |
| author_facet | James S. Miller Lacey English Michael Matte Rapheal Mbusa Moses Ntaro Shem Bwambale Jessica Kenney Mark J. Siedner Raquel Reyes Patrick T. Lee Edgar Mulogo Geren S. Stone |
| author_sort | James S. Miller |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-20T23:15:17Z |
| format | Article |
| id | doaj.art-c8fba882d16b4e5d88305037926f6164 |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-20T23:15:17Z |
| publishDate | 2018-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-c8fba882d16b4e5d88305037926f61642022-12-21T19:23:39ZengBMCMalaria Journal1475-28752018-02-011711910.1186/s12936-018-2241-5Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational studyJames S. Miller0Lacey English1Michael Matte2Rapheal Mbusa3Moses Ntaro4Shem Bwambale5Jessica Kenney6Mark J. Siedner7Raquel Reyes8Patrick T. Lee9Edgar Mulogo10Geren S. Stone11Massachusetts General HospitalUniversity of North Carolina at Chapel Hill School of MedicineGlobal Health CollaborativeGlobal Health CollaborativeMbarara University of Science and TechnologyBugoye Health Centre, Bugoye Trading CentreMassachusetts General HospitalMassachusetts General HospitalUniversity of North Carolina at Chapel Hill School of MedicineLynn Community Health CentreMbarara University of Science and TechnologyMassachusetts General HospitalAbstract 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.http://link.springer.com/article/10.1186/s12936-018-2241-5Village health workersCommunity health workersIntegrated community case managementQuality of care |
| spellingShingle | James S. Miller Lacey English Michael Matte Rapheal Mbusa Moses Ntaro Shem Bwambale Jessica Kenney Mark J. Siedner Raquel Reyes Patrick T. Lee Edgar Mulogo Geren S. Stone Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study Malaria Journal Village health workers Community health workers Integrated community case management Quality of care |
| title | Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study |
| title_full | Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study |
| title_fullStr | Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study |
| title_full_unstemmed | Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study |
| title_short | Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study |
| title_sort | quality of care in integrated community case management services in bugoye uganda a retrospective observational study |
| topic | Village health workers Community health workers Integrated community case management Quality of care |
| url | http://link.springer.com/article/10.1186/s12936-018-2241-5 |
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