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The performance of community health workers in the management of multiple childhood infectious diseases in Lira, northern Uganda : a mixed methods cross-sectional study

机译：乌干达北部里拉社区卫生工作者在多种儿童传染病管理中的表现：混合方法横断面研究

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Background: Community health workers (CHWs) have the potential to reduce child mortality by improving access to care, especially in remote areas. Uganda has one of the highest child mortality rates globally. Moreover, rural areas bear the highest proportion of this burden. The optimal performance of CHWs is critical. In this study, we assess the performance of CHWs in managing malaria, pneumonia, and diarrhea in the rural district of Lira, in northern Uganda. Designs: A cross-sectional mixed methods study was undertaken to investigate the performance of 393 eligible CHWs in the Lira district of Uganda. Case scenarios were conducted with a medical officer observing CHWs in their management of children suspected of having malaria, pneumonia, or diarrhea. Performance data were collected using a pretested questionnaire with a checklist used by the medical officer to score the CHWs. The primary outcome, CHW performance, is defined as the ability to diagnose and treat malaria, diarrhea, and pneumonia appropriately. Participants were described using a three group performance score (good vs. moderate vs. poor). A binary measure of performance (good vs. poor) was used in multivariable logistic regression to show an association between good performance and a range of independent variables. The qualitative component comprised seven key informant interviews with experts who had informed knowledge with regard to the functionality of CHWs in Lira district. Results: Overall, 347 CHWs (88.3%) had poor scores in managing malaria, diarrhea, and pneumonia, 26 (6.6%) had moderate scores, and 20 (5.1%) had good scores. The factors that were positively associated with performance were secondary-level education (adjusted odds ratio [AOR] 2.72; 95% confidence interval [CI] 1.50-4.92) and meeting with supervisors in the previous month (AOR 2.52; 95% CI 1.12-5.70). Those factors negatively associated with CHW performance included: serving 100-200 households (AOR 0.24; 95% CI 0.12-0.50), serving more than 200 households (AOR 0.22; 95% CI 0.10-0.48), and an initial training duration lasting 2-3 days (AOR 0.13; 95% CI 0.04-0.41). The qualitative findings reinforced the quantitative results by indicating that refresher training, workload, and in-kind incentives were important determinants of performance. Conclusions: The performance of CHWs in Lira was inadequate. There is a need to consider pre-qualification testing before CHWs are appointed. Providing ongoing support and supervision, and ensuring that CHWs have at least secondary education can be helpful in improving their performance. Health system managers also need to ensure that the CHWs' workload is moderated as work overload will reduce performance. Finally, although short training programs are beneficial to some degree, they are not sufficient and should be followed up with regular refresher training.
机译：背景：社区卫生工作者（CHW）有潜力通过改善获得医疗服务的机会来降低儿童死亡率，尤其是在偏远地区。乌干达是全球儿童死亡率最高的国家之一。此外，农村地区承担的负担最大。 CHW的最佳性能至关重要。在这项研究中，我们评估了乌干达北部里拉农村地区的CHW在控制疟疾，肺炎和腹泻中的表现。设计：进行了一项横断面混合方法研究，以调查在乌干达里拉地区的393名合格CHW的表现。病例方案是由一名医务人员在对疑似患有疟疾，肺炎或腹泻的儿童进行CHW处理时进行的。使用预先测试的调查表收集绩效数据，该调查表带有医务人员用来对CHW进行评分的清单。 CHW表现是主要结局，定义为适当诊断和治疗疟疾，腹泻和肺炎的能力。使用三组绩效评分（好vs.中vs.差）描述参与者。在多变量logistic回归中使用绩效的二元测量（好与差）来显示好绩效与一系列自变量之间的关联。定性部分包括对专家的七次主要信息提供者访谈，这些专家对Lira地区的CHW的功能有一定的了解。结果：总体上，有347名CHW（88.3％）在控制疟疾，腹泻和肺炎方面的得分较差，有26名（6.6％）的得分为中度，有20名（5.1％）的得分为好。与绩效成正比的因素是中学程度的教育（调整后的优势比[AOR] 2.72； 95％的置信区间[CI] 1.50-4.92）和上个月与主管的会面（AOR 2.52； 95％CI 1.12-） 5.70）。与CHW表现负相关的那些因素包括：服务100-200户家庭（AOR 0.24; 95％CI 0.12-0.50），服务超过200户家庭（AOR 0.22; 95％CI 0.10-0.48）和初始培训持续时间2 -3天（AOR 0.13; 95％CI 0.04-0.41）。定性研究结果表明，进修培训，工作量和实物激励是绩效的重要决定因素，从而增强了定量结果。结论：里拉的CHWs表现不佳。在任命CHW之前，需要考虑资格预审。提供持续的支持和监督，并确保CHW至少接受过中学教育，可以帮助他们提高绩效。卫生系统管理人员还需要确保减轻社区卫生工作者的工作量，因为工作超负荷会降低绩效。最后，尽管短期培训课程在某种程度上是有益的，但还远远不够，应定期进行进修培训。

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