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首页> 外文期刊>BMC Health Services Research >Evaluating fidelity of community health worker roles in malaria prevention and control programs in Livingstone District, Zambia-A bottleneck analysis
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Evaluating fidelity of community health worker roles in malaria prevention and control programs in Livingstone District, Zambia-A bottleneck analysis

机译：赞美社区卫生工作人员角色的疟疾预防和控制方案中的疟疾区，赞比亚 - 一个瓶颈分析

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Community Health Workers (CHWs) are an important human resource in improving community malaria intervention coverages and success in reducing malaria incidence has been attributed to them. However, despite this attribution, malaria resurgence cases have been reported in various countries including Zambia. This study aims to evaluate the implementation fidelity of CHW roles in malaria prevention and control programs in Livingstone through performance and service quality assessment. A mixed method concurrent cross-sectional study based on quantitative and qualitative approaches was used to evaluate performance and service quality of the CHW roles for selected catchments areas in Livingstone district. For the quantitative approach, (34) CHWs were interviewed and a community survey was also done with 464 community participants. For qualitative approach, two focused group discussions with CHWs and three key informant interviews from the CHW supervisors were done. Overall implementation fidelity to the CHW roles was low with only 5(14.7%) of the CHWs having good performance and least good quality service while 29 (85.3%) performed poorly with substandard service. About 30% of house-holds reported having experienced malaria cases but CHWs had low coverage in testing with RDT (27%) for malaria index case service response with treatment at 14% coverage and provision of health education at 23%. For other households without malaria cases, only 27% had received malaria health education and 15% were screened for malaria. However, ITN distribution, sensitization for IRS were among other CHW services received by the community but were not documented in CHW registers for evaluation. Factors that shaped fidelity were being married, record for reports, supervision, and work experience as significant factors associated with performance. Lack of supplies, insufficient remuneration and lack of ownership by the supervising district were reported to hinder ideal implementation of the CHW strategy. Fidelity to the malaria CHW roles was low as performance and quality of service was poor. A systems approach for malaria CHW facilitation considering supervision, stock supply and recruiting more CHWs on a more standardized level of recognition and remuneration would render an effective quality implementation of the CHW roles in malaria.
机译：社区卫生工作者（CHWS）是改善社区疟疾干预覆盖范围的重要人物资源，减少疟疾发病率的成功已归因于他们。然而，尽管存在这种归因，但在包括赞比亚包括在内的各个国家均报告了疟疾复兴案件。本研究旨在通过绩效和服务质量评估来评估利用斯通中疟疾预防和控制计划中CHW作用的实施保真度。基于定量和定性方法的混合方法并发横截面研究用于评估Livingstone区选定集水区的CHW角色的性能和服务质量。对于定量方法，（34）采访了CHW，并使用464名社区参与者进行社区调查。对于定性方法，完成了与CHWS和三个关键信息传道人的重点组合讨论。 CHW角色的整体实施保真度低于5（14.7％）的CHW，具有良好的性能和最低优质的服务，而29（85.3％）与不合格的服务表现不佳。据报道，约有30％的房屋持有人经历过疟疾病例，但CHW在疟疾指数案例服务响应的RDT（27％）的测试中具有低覆盖率，以14％的覆盖率和23％的健康教育提供治疗。对于其他没有疟疾病例的家庭，只有27％的人获得疟疾健康教育，15％的疟疾筛查。但是，ITN分布，美国国税局的宣传是社区收到的其他CHW服务之外，但没有记录在CHW寄存器中进行评估。形状保真度的因素已婚，报告，监督和工作经验记录，作为与绩效相关的重要因素。据报道，缺乏供应，薪酬不足，缺乏监管区缺乏所有权，以阻碍CHW战略的理想实施。由于服务的性能和质量差，疟疾CHW角色的保真度很低。考虑监督，股票供应和招聘更多CHW的疟疾CHW促进的系统方法，以更加标准化的认可和报酬将提供有效的疟疾中CHW作用的质量实施。

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