Variation in the quality and out-of-pocket cost of treatment for childhood malaria, diarrhoea, and pneumonia: Community and facility based care in rural Uganda

被引:14
作者
Soremekun, Seyi [1 ]
Kasteng, Frida [2 ,3 ]
Lingam, Raghu [1 ,4 ]
Vassall, Anna [2 ]
Kertho, Edmound [5 ]
Settumba, Stella [5 ,6 ]
Etou, Patrick L.
Nanyonjo, Agnes [5 ,7 ]
ten Asbroek, Guus [1 ,8 ]
Kallander, Karin [3 ,9 ]
Kirkwood, Betty [1 ]
机构
[1] London Sch Hyg & Trop Med, Dept Populat Hlth, London, England
[2] London Sch Hyg & Trop Med, Dept Global Hlth & Dev, London, England
[3] Karolinska Inst, Div Global Hlth, Dept Publ Hlth Sci, Stockholm, Sweden
[4] Newcastle Univ, Inst Hlth & Soc, Newcastle, NSW, Australia
[5] Malaria Consortium, Kampala, Uganda
[6] Univ New South Wales, Natl Perinatal Epidemiol & Stat Unit, Sydney, BC, Australia
[7] African Populat Hlth Res Ctr, Nairobi, Kenya
[8] Acad Med Ctr, Dept Global Hlth, Amsterdam, Netherlands
[9] Malaria Consortium, London, England
来源
PLOS ONE | 2018年 / 13卷 / 11期
关键词
CASE-MANAGEMENT; HEALTH WORKERS; COVERAGE; CHILDREN; MORBIDITY; MORTALITY; MOTIVATION; RETENTION; ILLNESS; AFRICA;
D O I
10.1371/journal.pone.0200543
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background A key barrier to appropriate treatment for malaria, diarrhoea, and pneumonia (MDP) in children under 5 years of age in low income rural settings is the lack of access to quality health care. The WHO and UNICEF have therefore called for the scale-up of integrated community case management (iCCM) using community health workers (CHWs). The current study assessed access to treatment, out-of-pocket expenditure and the quality of treatment provided in the public and private sectors compared to national guidelines, using data collected in a large representative survey of caregivers of children in 205 villages with iCCM-trained CHWs in mid-Western Uganda. Results The prevalence of suspected malaria, diarrhoea and suspected pneumonia in the preceding two weeks in 6501 children in the study sample were 45%, 11% and 24% respectively. Twenty percent of children were first taken to a CHW, 56% to a health facility, 14% to other providers and no care was sought for 11%. The CHW was more likely to provide appropriate treatment compared to any other provider or to those not seeking care for children with MDP (RR 1.51, 95% CI 1.42-1.61, p<0.001). Seeking care from a CHW had the lowest cost outlay (median $0.00, IQR $0.00-$1.80), whilst seeking care to a private doctor or clinic the highest (median $2.80, IQR $1.20-$6.00). We modelled the expected increase in overall treatment coverage if children currently treated in the private sector or not seeking care were taken to the CHW instead. In this scenario, coverage of appropriate treatment for MDP could increase in total from the current rate of 47% up to 64%. Conclusion Scale-up of iCCM-trained CHW programmes is key to the provision of affordable, high quality treatment for sick children, and can thus significantly contribute to closing the gap in coverage of appropriate treatment.
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页数:24
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