KNOWLEDGE, ATTITUDE AND PRACTICES OF PUBLIC AND PRIVATE FACILITY HEALTH WORKERS TOWARDS INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES IN HOIMA DISTRICT
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Introduction: Under-five mortality remains high in Sub-Saharan Africa at 78 deaths per 1000 live births in 2016. In Hoima district, it stands at 85 deaths per 1000 live births while the national rate is 64 deaths. Integrated management of childhood illnesses (IMCI) strategy was introduced to reduce child mortality and morbidity due to common childhood illnesses. The quality of care children receive depends on the health worker’s knowledge, attitude and practices towards IMCI case management. In this study, we compared knowledge and associated factors, attitude and practices towards IMCI case management amongst private and public facility health providers so as to identify opportunities for improving quality of child health care. Methods: This was a comparative study conducted in June, 2019 among 99 health workers from public health facilities and 97 health workers from private Not for profit/NGO facilities in Hoima district using a self-administered questionnaire and an observation checklist. Knowledge was measured using a knowledge test and the outcome dichotomized with good knowledge being a score of 70% and above. Data was analysed using STATA 13.0 SE with chi square tests at bivariate and a modified Poisson model at multivariate analysis. All factors with a p-value <0.05 were considered significant. Frequencies and proportions were obtained for aspects of attitude and practice with chi square tests used to compare public and private facility health workers. Results: A total of 99, public and 97, private facility health workers were interviewed and observed managing a sick child under five years of age. More than half of both the private; 57 (58.8) and public; 55 (55.6%) facility health workers were found to have good knowledge with no significant difference between private and public facility health workers. Among the private but not the public facility health workers, individuals with a history of IMCI training xi were found to be more knowledgeable than those without it; [PR (95% CI) = 2.83 (1.19 – 6.71)]. In the same group, doctors were found to be more knowledgeable than nurses [PR (95% CI) = 1.57 (1.01 – 2.43)] and middle aged (35 – 39 years) health workers were less knowledgeable than the younger (19 -34 years) ones; [PR (95% CI) = 0.47 (0.23 – 0.94)]. Majority of both private; 86 (88.7%) and public; 88 (88.9%) facility health workers agreed that IMCI is important for child health care but more public facility health workers 39 (39.8%) were observed to use the IMCI chart booklet while managing the sick child compared to their private; 4 (4.1%) counterparts. Conclusion & recommendations: Both public and private facility health workers generally had good knowledge about IMCI case management though knowledge was suboptimal regarding the IMCI main symptoms, the IMCI- addressed diseases and the IMCI- specific signs for diagnosing pneumonia. Knowledge of IMCI case management was associated with cadre, age and history of IMCI training among private but not the public facility health workers. General attitude of both public and private facility health workers towards IMCI case management was good with majority agreeing that it is important for child health care. Practice of IMCI case management, though suboptimal in both groups, was better among public facility health workers, with more of these found to ask for the three IMCI main symptoms and to use the IMCI chart booklet when managing sick children compared to the private facility health workers. Doctors who had better knowledge should take lead in training other health workers within private health facilities.