Figure 1
Theory of change – iCCM contribution to reduction of under 5 morbidity and mortality.
Figure 2
Intervention timeline.
Table 1
Characteristics of the community health volunteers (CHVs; N = 58).
| Number | Percentage | |
|---|---|---|
| Gender | ||
| Female | 48 | 82.8 |
| Male | 10 | 17.2 |
| Education level | ||
| Primary school | 47 | 81.0 |
| High school | 11 | 19.0 |
| Age in years | ||
| 20–35 | 18 | 31.0 |
| 36–50 | 27 | 46.6 |
| 51–65 | 12 | 20.7 |
| 65+ | 1 | 1.7 |
| Years as Community Health Volunteer | ||
| <1 | 1 | 1.7 |
| 1–7 | 36 | 62.1 |
| 8–14 | 10 | 17.2 |
| 15–21 | 6 | 10.3 |
| 21+ | 5 | 8.6 |
| Previous training (multiple responses were allowed) | ||
| Family planning | 48 | 82.8 |
| HIV/prevention of mother-to-child transmission | 12 | 20.7 |
| Infant and young child feeding | 12 | 20.7 |
| Malaria case management/testing | 5 | 8.6 |
| Multidrug-resistant TB | 5 | 8.6 |
| Other training beyond the basic package: * home-based care, malaria prevention, neonatal case management, prevention for positive, † post abortion care, palliative care. | 40 | 69.0 |
[i] * Ministry of Health. Taking the Kenya Essential Package for Health to the community: a strategy for the delivery of level one services. Ministry of Health, Health Sector Reform Secretariat 2006. http://www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/community_strategy.pdf Accessed 28 Feb 2017.
† “Prevention for positive” refers to equipping HIV-positive individuals with knowledge/information to live a lifestyle that prevents them from re-infection.
Figure 3
Effect of six-day training in iCCM on community health workers’ knowledge.
Figure 4
Percentage of CHVs correctly performing steps of mRDT.
Table 2
CHV iCCM skills at baseline and after 6 months.
| Category of assessment | Baseline observations (N = 115)* | 6-month observations (N = 106)† | P-value‡ | ||
|---|---|---|---|---|---|
| Yes | % | Yes | % | ||
| CHV asked about symptoms | |||||
| Cough | 102 | 89% | 98 | 92% | 0.341 |
| Diarrhoea | 86 | 75% | 89 | 84% | 0.930 |
| Fever | 110 | 96% | 103 | 97% | 0.547 |
| Average | 87% | 91% | 0.344 | ||
| CHV looked for signs of illness | |||||
| Chest indrawing | 3 | 3% | 75 | 71% | 0.001 |
| Fast breathing by counting breaths in 1 minute | 0 | 0% | 61 | 58% | 0.001 |
| Unusually sleepy or lethargic or unconscious child | 4 | 3% | 72 | 68% | 0.001 |
| Malnutrition using the mid-upper arm circumference tape colour code | 11 | 10% | 95 | 90% | 0.001 |
| Malnutrition using the thumbs to press and demonstrate swelling of both feet | 2 | 2% | 88 | 83% | 0.001 |
| Average | 4% | 74% | 0.001 | ||
| Classifying danger signs and deciding to treat or refer | |||||
| CHV classified child as having any danger sign and decided for urgent referral | 15 | 9 | |||
| Assessor agreed with CHV classification of danger sign and decision to refer | 2/15 | 13% | 6/9 | 67% | 0.001 |
| CHV classified child as having no danger sign and decided for home treatment and advice to caregiver | 13 | 84 | |||
| Assessor agreed with CHV classification of no danger sign and decision for home treatment and advice to caregiver | 10/13 | 77% | 82/84 | 98% | 0.001 |
[i] * 58 CHVs were assessed for a total of 115 observations; average of two observations per CHV.
† Three CHVs had dropped out, so 55 were assessed for a total of 106 observations; average of two observations per CHV.
‡ Two-sample test of proportions p-value.