Factors associated with management of pneumonia among children by Community Health Workers in Abim district, Uganda

Abstract

Introduction: Pneumonia is a leading cause of death among children under five years of age in Uganda. Community Health Workers (CHWs) can prevent pneumonia deaths if they know how to manage the disease correctly. We conducted a study to determine factors associated with management of pneumonia among under-five year children by CHWs in Abim district, Uganda. Methods: This was a cross sectional study. We obtained data from 374 CHWs using a training video, questionnaire, Sick Child Job Aid (SCJA) and case vignettes. We determined the proportion of CHWs that correctly managed pneumonia. Modified Poisson regression established factors associated with management of pneumonia in children by CHWs. We conducted four key informant interviews with CHWs focal persons, and five focus group discussions with community members. Results: We found that 15.5% of CHWs correctly managed pneumonia among children as per the SCJA. In addition, 73.8% of the CHWs respiratory rate counts were close to the respiratory count of the training video with +/- five range. Educational level (Adj. PR 2.06; 95% CI: (1.18-3.61) p-value 0.011), having a CHW register (Adj. PR 0.54; 95% CI (0.30-0.98) p-value 0.041) and drug stock outs (Adj. PR 4.24; 95% CI (1.37-13.13) p-value 0.012) were significantly associated with CHW management of pneumonia. Refresher training, availability of equipment and supplies, and support supervision were the main health facility factors influencing management of pneumonia. Perceptions that CHWs could not manage pneumonia among children, drug stock outs, and lack of trust were community factors influencing CHW management of pneumonia. Conclusion: A low proportion of CHWs correctly managed pneumonia among children. Strategies to improve provision of CHW registers, drugs, support supervision, refresher trainings, as well as recruiting CHWs with a minimum of secondary level of education are necessary to improve management of pneumonia among children. Communities also need to be sensitised on roles and responsibilities of CHWs in management of pneumonia.