Evaluation of Community Case Management of Malaria in Kisumu County, Kenya

Abstract

Globally, community case management of malaria (CCMM) has proved to be effective in the management of malaria as the community as health workers as they provide the necessary outreach in getting to the household and capturing the cases in the community. The access to healthcare in Kenya is riddled with cases of affordability, acceptability and availability especially in regions with limited resources, rural regions and those which are further from the urban areas. However, through CCMM, majority of these concerns are neutralized as health services are taken closer to the community. In essence the CHVs can provide the necessary linkage amongst the community and the health facilities due to their increased interaction with members of the community. These services are offered at reduced costs and also save time that the community members would have used in getting to the health facility. The objective of the study was to assess the community satisfaction, CHVs adherence to testing and treatment procedures, and the barriers in the implementation process of CCMM. The study design was a descriptive cross-sectional design and the participants were selected through two stage cluster sampling. The required sample size obtained was 108 households. Quantitative data was collected using structured household questionnaire and an observation checklist while qualitative data was collected using focused group discussions and key informant interviews. Quantitative data was cleaned, coded and analyzed using the Statistical Package for Social Sciences computer software programme. Qualitative data was transcribed and the data was analyzed by coding into similar themes. Three quarters of the respondents were female (n=84, 77.6%) with majority the respondents (n=104, 99%) aware of the existence of CHVs and (n=97, 92.4%) having acquired health services from the CHVs. Majority of the households deemed the services offered by CHVs to be satisfactory (n=54, 56%). On adherence to testing and treatment procedures, history taking was done by (n=21,70%) while taking temperature not done by (n=26,87%) and explanation on duration of treatment not done by all CHVs. Barriers to the implementation of CCMM include negative perception by health care workers, inadequate commodity supply poor waste and poor reporting. There is good community coverage and utilization of CCMM. However a sizeable number of CHVs do not adhere to the guidelines. Capacity building of CHVs coupled with support supervision and adequate commodity supply are needed for effective implementation of community management of malaria.