Browsing by Author "Wesuta, Andrew Christopher"

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    Long-term quality of integrated community case management care for children in Bugoye Subcounty, Uganda: a retrospective observational study
    (BMJ, 2022-04) Miller, James S.; Mulogo, Edgar Mugema; Wesuta, Andrew Christopher; Mumbere, Nobert; Mbaju, Jackson; Matte, Michael; Ntaro, Moses; Guiles , Daniel A.; Patel, Palka R.; Bwambale, Shem; Kenney, Jessica; Reyes, Raquel; Stone, Geren S.; Medicine, School of Medicine
    Objective Integrated community case management (iCCM) of childhood illness in Uganda involves protocol-based care of malaria, pneumonia and diarrhoea for children under 5 years old. This study assessed volunteer village health workers’ (VHW) ability to provide correct iCCM care according to the national protocol and change in their performance over time since initial training. Setting VHWs affiliated with the Ugandan national programme provide community-based care in eight villages in Bugoye Subcounty, a rural area in Kasese District. The first cohort of VHWs began providing iCCM care in March 2013, the second cohort in July 2016. Participants All children receiving iCCM care in 18 430 clinical encounters occurring between April 2014 and December 2018. Primary and secondary outcome measures The descriptive primary outcome measure was the proportion of patients receiving overall correct care, defined as adherence to the iCCM protocol for the presenting condition (hereafter quality of care). The analytic primary outcome was change in the odds of receiving correct care over time, assessed using logistic regression models with generalised estimating equations. Secondary outcome measures included a set of binary measures of adherence to specific elements of the iCCM protocol. Preplanned and final measures were the same. Results Overall, VHWs provided correct care in 74% of clinical encounters. For the first cohort of VHWs, regression modelling demonstrated a modest increase in quality of care until approximately 3 years after their initial iCCM training (OR 1.022 per month elapsed, 95% CI 1.005 to 1.038), followed by a modest decrease thereafter (OR 0.978 per month, 95% CI 0.970 to 0.986). For the second cohort, quality of care was essentially constant over time (OR 1.007 per month, 95% CI 0.989 to 1.025). Conclusion Quality of care was relatively constant over time, though the trend towards decreasing quality of care after 3 years of providing iCCM care requires further monitoring.
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    Management of children with danger signs in integrated community case management care in rural southwestern Uganda (2014-2018)
    (Oxford University Press, 2024) Matte, Michael; Ntaro, Moses; Kenney, Jessica; Patel, Palka; Wesuta, Andrew Christopher; Kawungezi, Peter Chris; Bwambale, Shem; Ayebare, David; Baguma, Stephen; Bagenda, Fred; Miller, James S.; Stone, Geren; Mulogo, Edgar Mugema; Medicine, School of Medicine
    Background: In integrated community case management (iCCM) care, community health workers (CHWs) provide home-based management of fever, diarrhea and fast breathing for children aged <5 y. The iCCM protocol recommends that children with danger signs for severe illness are referred by CHWs to health facilities within their catchment area. This study examines the management of danger signs by CHWs implementing iCCM in a rural context. Methods: A retrospective observational study that examined clinical records for all patients with danger signs evaluated by CHWs from March 2014 to December 2018 was conducted. Results: In total, 229 children aged <5 y had been recorded as having a danger sign during 2014-2018. Of these children, 56% were males with a mean age of 25 (SD 16.9) mo, among whom 78% were referred by the CHWs as per the iCCM protocol. The age category of 12 to 35 mo had the highest numbers of prereferred and referred cases (54% and 46%, respectively). Conclusions: CHWs play a key role in early symptomatic detection, prereferral treatment and early referral of children aged <5 y. Danger signs among children aged <5 y, if left untreated, can result in death. A high proportion of the children with danger signs were referred as per the iCCM protocol. Continuous CHW training is emphasized to reduce the number of referral cases that are missed. More studies need to focus on children aged 12-35 mo and why they are the most referred category. Policymakers should occasionally revise iCCM guidelines to detail the types of danger signs and how CHWs can address these.
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    Usage of and satisfaction with Integrated Community Case Management care in western Uganda: a cross-sectional survey
    (Springer Nature, 2021-01-30) Miller, James S.; Patel, Palka; Mian‑McCarthy, Sara; Wesuta, Andrew Christopher; Matte, Michael; Ntaro, Moses; Bwambale, Shem; Kenney, Jessica; Stone, Geren S.; Mulogo, Edgar Mugema; Medicine, School of Medicine
    Background: In some areas of Uganda, village health workers (VHW) deliver Integrated Community Case Management (iCCM) care, providing initial assessment of children under 5 years of age as well as protocol-based treatment of malaria, pneumonia, and diarrhoea for eligible patients. Little is known about community perspectives on or satisfaction with iCCM care. This study examines usage of and satisfaction with iCCM care as well as potential associations between these outcomes and time required to travel to the household's preferred health facility. Methods: A cross-sectional household survey was administered in a rural subcounty in western Uganda during December 2016, using a stratified random sampling approach in villages where iCCM care was available. Households were eligible if the household contained one or more children under 5 years of age. Results: A total of 271 households across 8 villages were included in the final sample. Of these, 39% reported that it took over an hour to reach their preferred health facility, and 73% reported walking to the health facility; 92% stated they had seen a VHW for iCCM care in the past, and 55% had seen a VHW in the month prior to the survey. Of respondents whose households had sought iCCM care, 60% rated their overall experience as "very good" or "excellent," 97% stated they would seek iCCM care in the future, and 92% stated they were "confident" or "very confident" in the VHW's overall abilities. Longer travel time to the household's preferred health facility did not appear to be associated with higher propensity to seek iCCM care or higher overall satisfaction with iCCM care. Conclusions: In this setting, community usage of and satisfaction with iCCM care for malaria, pneumonia, and diarrhoea appears high overall. Ease of access to facility-based care did not appear to impact the choice to access iCCM care or satisfaction with iCCM care.