Accessibility to Integrated Community Case Management Services For Childhood Pneumonia among Caregivers in Kisii County, Kenya
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Date
2023-11
Authors
Mwambi, Dennis Oroo
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
Pneumonia contributes to the increased childhood deaths worldwide. Prompt diagnosis
and treatment with antibiotics has resulted in the reduction of pneumonia deaths. In
2014, Kisii County had a pneumonia prevalence of 10% among children under the age
of five years, which surpassed the 9% national average. Even though most caregivers
(71%) in Kisii sought advice from health facilities or provider, this did not translate to
treatment of the pneumonia cases, as only 41% of the cases were eventually provided
with antibiotics. Although Kisii County implemented iCCM for childhood illnesses,
including pneumonia, there are information gaps regarding accessibility, knowledge
and factors that could influence access to iCCM for childhood pneumonia. Therefore,
the main goal of this study was to ascertain whether caregivers in Kisii County had
access to iCCM services related to childhood pneumonia. A descriptive cross-sectional
research approach was used for this study. The research participants included 332
randomly sampled caregivers of children below 5 years in Bomachoge Borabu and
Bomachoge Chache sub-counties and 10 key informants from both the county and subcounty
levels. Data were collected using both structured and key informant interviews
(KIIs). The variables of interest were analysed using frequency-based descriptive
analysis, which was utilised to study quantitative data. Qualitative data were organised
and analysed thematically. Findings revealed that only 111 (34%) of the respondents
had access to iCCM for childhood pneumonia. Notably, the likelihood of access to
iCCM for childhood pneumonia reduced with caregiver age, with caregivers under 20
years being 1.5 times more likely to access iCCM. Separated or single caregivers were
six times as likely to access iCCM, while those ascribing to the Catholic faith increased
the likelihood of access by 1.7 times. Respondents engaged in business as their main
source of income increased the likelihood by 2.97 times, while employed caregivers
had a 1.4 times higher likelihood to access iCCM for childhood pneumonia. This study
showed a high knowledge of childhood pneumonia among the caregivers. Most
respondents, 232 (70.3%), mentioned at least one pneumonia symptom and nearly all
respondents, 326 (98.8%), identified at least one severe pneumonia symptom.
Additionally, 26 (7.9%) mentioned at least one of the three main causes of pneumonia
and 287 (87%) mentioned at least one approach to prevent pneumonia. Knowledge of
pneumonia symptoms (p 0.315, df 2), severe pneumonia symptoms (p 0.125, df 3),
cause of pneumonia (p 0.885, df 3) and pneumonia prevention approaches (p 0.575, df
2) were not significant predictors of access to iCCM for childhood pneumonia. Many
respondents, 160 (48.5%), sought help a CHV as their first point of contact when their
children started showing signs of pneumonia, with very few, 48 (15%), visiting
government health facilities, 3 (1%) visiting private clinics and 3 (1%) went to
chemists, while a small fraction, 4 (1.2%), visited traditional herbalists. Only 98
(29.7%) of sick children are taken through the MoH protocol for pneumonia diagnosis
and treatment at the community level, posing a potential risk of mismanagement of
children with pneumonia. The likelihood of access to iCCM for childhood pneumonia
increased by 3.03 times for caregivers who perceived pneumonia as a serious disease,
while it increased by 0.1 times for respondents who did not think pandemics affected
access to iCCM. The study recommends continuous access to timely diagnosis and
treatment for pneumonia among children under 5 years, investment in pneumonia
awareness creation programmes targeting caregivers of children under 5 years,
provision of routine support supervision to the CHVs and as such ensure compliance
with the MoH protocol on pneumonia case identification and management,
mechanisms for households to continue accessing health services.
Description
A Research Thesis Submitted In Fulfillment of the Award of the Degree of Master of Public Health (Monitoring And Evaluation) In The School Of Health Sciences Of Kenyatta University November, 2023
Keywords
Accessibility, Integrated Community, Case Management Services, Childhood Pneumonia, Caregivers, Kisii County, Kenya