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首页> 美国卫生研究院文献>The American Journal of Tropical Medicine and Hygiene >Determinants of Utilization of Health Extension Workers in the Context of Scale-Up of Integrated Community Case Management of Childhood Illnesses in Ethiopia
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Determinants of Utilization of Health Extension Workers in the Context of Scale-Up of Integrated Community Case Management of Childhood Illnesses in Ethiopia

机译：埃塞俄比亚儿童疾病综合社区病例管理规模扩大的背景下使用卫生推广人员的决定因素

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Ethiopia has invested significant resources in integrated community case management (iCCM) of childhood illness. In Oromia Region, iCCM scale-up was phased in, allowing for comparisons between districts providing iCCM and routine services. We assessed the determinants of utilization of health extension workers (HEWs) delivering iCCM services at rural health posts by caregivers of sick, under-five children in a cross-sectional survey. We found low utilization of HEWs with only 9.3% of caregivers of a child sick with diarrhea, fever, and/or pneumonia in the previous 2 weeks taking their child to HEWs in both iCCM and routine areas. There was a higher likelihood of utilization of HEWs in iCCM areas (OR: 1.44; 95% CI: 0.97–2.12; P = 0.07), but this effect disappeared after accounting for confounders. In iCCM areas, maternal education, illness type, and distance were associated with utilization. Perceptions of illness severity and service quality were the primary reasons given for not utilizing the health post. Our findings suggest that though iCCM is reaching some vulnerable populations, there remain significant barriers to use of HEWs delivering iCCM services. Efforts for demand generation and minimization of remaining barriers are urgently needed for the sustained success of the iCCM strategy in Ethiopia.
机译：埃塞俄比亚在儿童疾病的综合社区病例管理（iCCM）中投入了大量资源。在奥罗米亚地区，逐步扩展了iCCM，从而可以在提供iCCM和常规服务的地区之间进行比较。在一项横断面调查中，我们评估了由生病，五岁以下儿童的保姆在农村卫生站提供iCCM服务的卫生保健扩展人员（HEW）的使用决定因素。我们发现，腹泻，发烧和/或肺炎患儿在前两周将孩子带到iCCM和常规地区的HEW时，只有9.3％的照料者对HEW利用率低。在iCCM地区使用HEW的可能性更高（或：1.44； 95％CI：0.97–2.12； P = 0.07），但考虑到混杂因素后，这种影响消失了。在iCCM区域，产妇教育，疾病类型和距离与利用率相关。疾病严重程度和服务质量的感知是未利用卫生站的主要原因。我们的研究结果表明，尽管iCCM正在覆盖一些弱势人群，但是使用提供iCCM服务的HEW仍然存在很大的障碍。为了使iCCM战略在埃塞俄比亚持续取得成功，迫切需要努力创造需求并最大程度地减少剩余障碍。

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