Open Access
Poster presentation

Malaria Journal

, 11:P142

Factors associated with utilization of community health workers in improving access to malaria treatment among children in Kenya

Authors

  • James Kisia
    • Kenya Red Cross Society
  • Florence Nelima
    • University of Nairobi Institute of Tropical and Infectious Community Diseases (UNITID)
  • David Odhiambo Otieno
    • Kenya Red Cross Society
  • Kioko Kiilu
    • Kenya Red Cross Society
  • Emmanuel Wamalwa
    • Care International in Kenya
  • Salim Sohani
    • Canadian Red Cross
  • Kendra Siekmans
    • HealthBridge
  • Andrew Nyandigisi
    • Ministry of Public Health and Sanitation
  • Willis Akhwale
    • Ministry of Public Health and Sanitation

DOI: 10.1186/1475-2875-11-S1-P142

Background information

The success of community case management in improving access to effective malaria treatment for young children relies on broad utilization of community health workers (CHWs) to diagnose and treat fever cases. A better understanding of the factors associated with CHW utilization is crucial in informing national malaria control policy and strategy in Kenya. Specifically, little is known in Kenya on the extent to which CHWs are utilized, the characteristics of families who report utilizing CHWs and whether utilization is associated with improved access to prompt and effective malaria treatment. This paper examines factors associated with utilization of CHWs in improving access to malaria treatment among children under five years of age by women caregivers in two malaria endemic districts in Kenya

Methods

This study was conducted in 113 hard-to-reach and poor villages in Malindi and Lamu districts in the coastal region classified as having endemic transmission of malaria. A cross-sectional household survey was conducted using a standardized malaria indicator questionnaire at baseline (n = 1,187) and one year later at end-line assessment (n = 1,374) using two-stage cluster sampling.

Results

There was an increase in reported utilization of CHWs as source of advice/treatment for child fevers from 2% at baseline to 35% at end-line, accompanied by a decline in care-seeking from government facilities (from 67% to 48%) and other sources (26% to 2%) including shops. The most poor households and poor households reported higher utilization of CHWs at 39.4% and 37.9% respectively, compared to the least poor households (17.0%). Households in villages with less than 200 households reported higher CHWs utilization as compared to households in villages having >200 households. Prompt access to timely and effective treatment was 5.7 times higher (95% CI 3.4-9.7) when CHWs were the source of care sought. Adherence was high regardless of whether source was CHWs (73.1%) or public health facility (66.7%).

Table 1

Characteristic

BASELINE

ENDLINE

P-Values

Sample size (N)

269

345

 

Women caregiver education level

  

0.125

None

53.2 (143)

57.7 (199)

 

Primary

43.5 (117)

41.2 (142)

 

Secondary

3.4 (9)

1.2 (4)

 

Woman caregiver age category

  

0.332

<=20 y

21.2 (57)

15.7 (54)

 

21-30 y

44.6 (120)

47.1 (162)

 

31-50 y

26.7 (72)

29.4 (101)

 

51+ y

 

1.1 (4)

 

Unknown

7.4 (20)

6.7 (23)

 

Male household head

84.1 (216)

81.7 (282)

0.285

Household owns radio

40.9 (105)

32.8 (113)

0.041

Household owns bicycle

56.4 (145)

48.1 (166)

0.044

Household owns mosquito nets

81.3 (209)

89.3 (308)

0.006

Village size

  

0.531

<= 60 households

21.9 (59)

18.6 (64)

 

61 to 100 households

24.5 (66)

27.8 (96)

 

101 to 200 households

31.6 (85)

32.2 (111)

 

>200 households

21.9 (59)

21.5 (74)

 

Household wealth rank

  

0.335

Most poor

22.3 (60)

23.8 (82)

 

Poor

54.3 (146)

57.7 (199)

 

Least poor

23.4 (63)

18.6 (64)

 
Table 2

Source of advice/treatment for children with fever in past 2 weeks among those who reported seeking advice/treatment

Source of advice/treatment

Baseline

(N=235)

Endline

(N=298)1

 

n

%

n

%

CHW/Red Cross volunteer

5

2.1

103

34.6

Government health facilities

157

66.8

143

48.0

Private medical sector1

12

5.1

46

15.4

Other sources1

59

26.0

6

2.0

Table 3

Women caregiver, household and village characteristics associated with utilization of CHW services for child fever advice/treatment

Characteristic

CHW

(N=103)

Other

(N=195)

p-value

Women caregiver education

   

No formal education

57.3 (59)

56.4 (110)

0.885

Primary/secondary

42.7 (44)

43.6 (85)

 

Women caregiver age group

N=98

N=178

 

≤20 y

16.3 (16)

17.4 (31)

0.993

21-30 y

50.0 (49)

48.9 (87)

 

31-40 y

29.6 (29)

29.2 (52)

 

41+ y

4.1 (4)

4.5 (8)

 

Attended ANC during last pregnancy

N=100

69.0 (69)

N=193

65.8 (127)

0.581

IPT (2+ doses SP) during last pregnancy

N=56

82.1 (46)

N=111

84.7 (94)

0.674

Knowledge of AL as new anti-malarial drug

44.7 (46)

N=194

29.9 (58)

0.010

Identified sleeping under net as way to prevent malaria

84.5 (87)

78.0 (152)

0.179

Household wealth rank

Most poor

Poor

Least poor

27.2 (28)

64.1 (66)

8.7 (9)

22.1 (43)

55.4 (108)

22.6 (44)

0.012

Household size

N=102

N=194

 

2 to 4

22.6 (23)

24.7 (48)

0.425

5 to 7

41.2 (42)

46.4 (90)

 

8 or more

36.3 (37)

28.9 (56)

 

Village size

<60 households

22.3 (23)

17.4 (34)

0.008

61-100 households

33.0 (34)

24.6 (48)

 

101-200 households

34.0 (35)

30.3 (59)

 

>200 households

10.7 (11)

27.7 (54)

 

Visited by CHW in past 3 months

94.2 (97)

28.7 (56)

<0.001

Table 4

A cross tabulation of timely provision of AL and source of the antimalarial

Timing of AL treatment

CHW as source of advice/treatment

p-value

 

Yes

No

 

AL given within 24 hours

57.3 (59)

19.0 (37)

<0.001

AL given within 48 hours

79.6 (82)

36.4 (71)

<0.001

AL given at any time

90.3 (93)

45.1 (88)

<0.001

Conclusion

The results of this study provide evidence that use of trained and supervised community health workers in community case management improved management of uncomplicated child fever cases in hard to reach villages in Malindi and Lamu District in Coastal Province of Kenya. In addition to this, poverty seems to be closely linked to child caregivers seeking services of community-based service providers, highlighting the impediment of poverty towards accessibility of cost sharing services widely practiced in Kenyan public health facilities. Policy actions to address barriers to effective utilization of CHWs in healthcare delivery should be scaled up in such hard to reach communities. The government and partners should, therefore, invest more in mechanisms which support CHW utilization especially the roll out of the Community Health Strategy 2006 as part of successful control of malaria and other infectious diseases.

The potential for utilization of CHWs in improving access to malaria treatment at the community level is promising. This will not only enhance access to treatment by the poorest households but also provide early and appropriate treatment to vulnerable individuals, especially those living in hard to reach areas.

Copyright information

© Kisia et al; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.