| dc.description.abstract | 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
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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. | en_US |
