Performance, attitudes and beliefs of village health teams regarding management of severe malaria using rectal artesunate for children under five in Mpigi district, Uganda

Abstract

Introduction and background: Malaria is still a complex public health problem in the African region, where most cases and deaths are due to the disease occurrence (UNICEF, 2007). The study main objective was to assess the performance, attitudes and beliefs of VHTs regarding management of severe malaria using rectal artesunate for children under five. This is because mortality in Mpigi due to malaria is high despite the presence of VHTs providing first line treatment and pre-referral treatment for fever with danger signs. There is little documentation regarding performance, attitudes and beliefs of VHTs regarding management of severe malaria. The conceptual frame linking the dependent and independent variables is included as well as the literature review. Methodology: The study used a cross sectional design in triangulation with qualitative data and document reviews. The study used a sample size of 384 VHTs from the 634 VHTs trained in ICCM. Performance of VHTs was measured using composite scores from performing different steps (History taking, child assessment giving treatment, counseling for compliance and follow-up) conducted during management of severe malaria. Data was collected using questionnaires, and Focus group discussion. Data was analyzed using STATA version 11 and thematic content analysis. Results: A response rate of 322(84.0%) was obtained. Overall the level of performance was 146(45.3%), education was the only factor that was significantly associated with performance (x2=28.288, 95%, p<0.001). VHTs mentioned that they preferred to use of rectal artesunate (RA) in managing severe malaria and that they were comfortable inserting it. They believed RA was safe, fast acting and quickly reduces body temperature. Conclusions: The performance of VHTs was sub-optimal as only 4 in 10 of VHTs were good performers; VHTs had a positive attitude towards RA and believed it is appropriate in the management of severe malaria. Recommendations: Level of education should be considered during selection of VHTs, refresher trainings, should be conducted to maintain a high level of skills, knowledge and attitude among VHTs.