Performance of Community Based Agents In Home Based Care For Malaria in Under Fives in Jirapa and Lambussie Districts of the Upper West Region,Ghana

Abstract

Introduction:Home-based Management of Malaria (HMM) is a strategy to increase access to malaria treatment in Africa. In 2006, the strategy was launched in the Upper West Region (UWR) of Ghana. Community Based Agents (CBAs) were trained and equipped to provide home-based treatment to children aged 6-59 months with malaria. HMM was expected to reduce the number of children seen in health facilities with malaria. However, there has been a consistent increase in the burden of malaria since 2009 despite the role CBAs are expected to play in reducing the burden of malaria. This study was conducted to assess the knowledge and performance of CBAs on HMM, eight years after it‟s implementation and to assess the perception of community members and health workers about the services provided by CBAs in the region. Methods: A cross-sectional study was conducted in two purposive selected districts in the UWR.We interviewed 384 CBAs and 154 mothers/caregivers using a structured questionnaire.We conducted Key Informant Interviews (KII) with 13 community leaders and 15 health workers and held 2 Focus Group Discussions (FGDs) with mothers/caregivers. CBAs and health facility records were also reviewed and we observed the management practices of 37 CBAs offering services at the time of interviews. Variables obtained were age, sex, and indicators on knowledge and management practices. Data entry, cleaning and analysis was done using SPSS software version 18.0. Descriptive data analysis was done and categorical variables expressed as frequencies and relative frequencies. For bi-variate analysis, cross tabulation was undertaken to establish associations and results presented in tables. Significance level of 5% (0.05) was used. Qualitative data from KII and FGDs were translated and transcribed into English, coded and thereafter analysed and separated into the emerging themes. Results:The mean age of CBAs was 42.71(+/- 9.62) with 369(96%) being females. Majority of the CBAs 352 (91.7%) knew the cause of malaria and 318(82.8%) knew that, fever is the most common symptom of malaria. However, very few, 171(44.5%) knew the correct dosage of Artemisinin-based Combination Therapy (ACTs) for children aged 6-11 months. Out of the 37 CBAs observed, 86.5% (32/37), (95% CI: 74.2 –97.7) gave correct age appropriate dose, but only 10(27%) observed the children for danger signs. There was no significant association between formal education and knowledge of the correct dosage of ACTs for children aged 6-59 months. Residing in Jirapa was positively associated with knowledge on the correct dosage of ACTs for children 6-11 months old (P-value 0.00). Of the 12,128 children who reported with malaria in 2012, only 5,343 (44%) were seen by CBAs. This was lower than the target of 60% in the guidelines. Monthly reporting rate of CBAs ranged from 53% to 79% in Jirapa and 43% to 88% in Lambussie. Only196 (51%) of the CBAs had supervisory visits. Of the 154 mothers/caregivers interviewed, 116(75.3%) had utilized the services of CBAs. Among the 116 who utilized the services of CBAs; 95(81.9%) reported that CBAs took history, 86(74.1%) said their children were assessed before receiving treatment and 66(56.9%) were counseled on treatment compliance. Only 9(7.7%) were educated on malaria prevention in their communities. In all, 104(67.5%) of mothers/caregivers and 12(92.3%) of opinion leaders had good opinions about the role and performance of CBAs in the management of sick children. Mothers/caregivers at the FGDs were however of the view that CBAs are doing well in community education on malaria prevention. Conclusion: A high proportion of CBAs do not know the correct dosage of ACTs for children aged 6-11 months. Many CBAs were not supervised. Although most CBAs took history and examined children before giving treatment, observing for danger signs, client counseling and reporting on activities was not done regularly. We recommend re-training and regular supervision of all CBAs