Performance of community health workers in community based management of malaria, pneumonia and diarrhea among children under 5 years in Lira district
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Introduction: Many countries in Sub-Saharan Africa are failing to achieve their millennium development goal 4 of which Uganda is not an exception. Evidence shows that using the CHWs strategy can reduce child mortality by 24-40%. Despite this, existence of CHWs in Lira district has not led to a significant reduction in child mortality. This study sought to assess performance of CHWs in managing malaria, diarrhea and pneumonia and to understand the factors associated with their performance. Methods: In cross-sectional study, 393 eligible CHWs in Lira were recruited into the study between June and July 2015. From each of the four counties in Lira, one sub county was randomly selected and the required sample size from each sub county was got by proportionally dividing the overall sample size among the study sites. Data was entered using Epi-data and analyzed using STATA. Performance was measured by combining questionnaires that assessed knowledge and case scenarios that assessed practical skills. Performance was categorized into good and poor performance and odds ratios used as measure of association. Mixed methods were used to determine the factors associated with performance. Results: The response rate of 92.8% was attained. Overall only 6% of the respondents had good performance. Performance in pneumonia management was found to be poorest of all the three illnesses. The factors that were seen to independently affect performance included; managing only 2 extra illnesses CHWs (AOR 8.90 95% CI 1.30-50.24), having more than one financial incentive in previous month (AOR; 0.05 95% CI 0.01-0.38) and having an initial training of 3 days (AOR, 15.22 95% CI 2.3-100.6). The qualitative section further confirmed quantitative findings; the key determinants of performance here were: incentives, workload and training. Conclusion: The performance of CHWs in Lira in managing malaria, diarrhea and pneumonia is lacking. The factors that negatively influence performance are: the lack of regular refresher trainings and a high workload. The incentives given to CHWs by community members are seen to motivate them. The CHWs benefited from short-lived trainings lasting less than 5 days.