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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Monica Olewe, MB ChB MPH1, Renu Garg, MD, MPH2, and Michael Deming, MD, MPH2. (1) Community Initiatives for Child Survival is Siaya Project, Siaya, Kenya, P.O. Box 88, Kisumu, Kenya, 254-3520010, monica@ksm.care.or.ke, (2) CSA/DPD/NCID/CDC, International Child Survival and Emerging Infections Program Support Activity, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341
To reduce childhood mortality rates in Siaya District, Kenya, CARE/Kenya trained and supervised community health workers (CHWs) to manage childhood illnesses and provide counseling on healthy behaviors. The prevalence of target behaviors was measured in a baseline (1996) and follow-up (1999) cluster-sample household survey. In 1998, 1999, and 2001, randomly selected CHWs were observed providing care to sick children who were then re-examined by a study clinician. Treatment was considered “adequate” if it included sulfadoxine-pyrimethamine, cotrimoxazole, oral rehydration solution, and referral, as indicated by the CHW clinical algorithm. The 1999 household survey showed that CHWs were consulted by 16.1%, 22.5%, and 28.8%, respectively, of children aged <2 years with “malaria” (caretaker-defined), rapid and difficult breathing, and diarrhea. Insecticide-treated bednet use by children in this age group remained rare (2.0% in 1996 and 3.0% in 1999). The proportion of children aged <5 years with a moderate illness classification receiving adequate treatment in CHW clinical evaluations increased from 27.7%, in 1998, to 74.3% in 2001, but the proportion of children with a severe illness classification receiving adequate treatment remained low (53.5% in 1998 and 41.3% in 2001). CHWs are an established but under-utilized source of care, and health promotion and treatment of severe illness remain major challenges for them. Changes being considered to address these challlenges include simplification of the clinical algorithm, use of a maternal-child register by CHWs as a monitoring tool and job aid for health promotion, and the sale and re-treatment of bednets by CHWs as a revenue-generating activity.
Learning Objectives:
Keywords: Community-Based Health Care, Child Health
Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employed by CARE/Kenya, the organization supporting the community health workers described in the abstract.