1921
Volume 99, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Different health-care management guidelines by the World Health Organization exist to help health workers in resource-limited settings treat patients. However, for children with unclassified fever and no danger signs, management guidelines are less clear and follow-up recommendations differ. Both a “universal follow-up” for all children, irrespective of health status, and a “conditional follow-up” only for children whose fever persists are recommended in different guidelines. It is unclear how feasible and acceptable these two different follow-up guidelines are among community health workers and caregivers of the sick child. This qualitative study was conducted in Ethiopia and was nested within a cluster-randomized controlled trial (cRCT). It aimed to determine health extension workers’ (HEWs’) and caregivers’ experiences of the management of febrile children and their perceptions of universal versus conditional follow-up recommendations. Seventeen HEWs and 20 caregivers were interviewed. The interviews revealed that HEWs’ understanding of how to handle an unclassified fever diagnosis increased with the implementation of the cRCT in both study arms (universal versus conditional follow-up). This enabled HEWs to withhold medicines from children with this condition and avoid referral to health centers. Both follow-up recommendations had perceived advantages, while the universal follow-up provided an opportunity to see the child’s health progress, the conditional follow-up advice allowed saving time and costs. The findings suggest that improved awareness of the unclassified fever condition can make HEWs feel more comfortable in managing these febrile children themselves and omitting unnecessary medication. Future community-level management guidelines should provide clearer instructions on managing fever where no malaria, pneumonia, diarrhea, or danger signs are present.

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References

  1. WHO, UNICEF, 2012. WHO/UNICEF JOINT STATEMENT Integrated Community Case Management (iCCM). An Equity-Focused Strategy to Improve Access to Essential Treatment Services for Children. Geneva, Switzerland/New York, NY: Word Health Organization and The United Nations Children’s Fund.
  2. Wharton-Smith A, Counihan H, Strachan C, , 2014. Implementing Integrated Community Case Management: Stakeholder Experience and Lessons Learned in Three African Countries. London, United Kingdom: Malaria Consortium. Available at: http://www.malariaconsortium.org/learningpapers. Accessed August 2, 2017.
  3. WHO, UNICEF, 2005. Handbook IMCI: Integrated Management of Childhood Illness. Geneva, Switzerland: World Health Organization.
  4. Dagan R, Sofer S, Phillip M, Shachak E, , 1988. Ambulatory care of febrile infants younger than 2 months of age classified as being at low risk for having serious bacterial infections. J Pediatr 112: 355360. [Google Scholar]
  5. Avner JR, , 2009. Acute fever. Pediatr Rev 30: 5. [Google Scholar]
  6. Elfving K, Shakely D, Andersson M, Baltzell K, Ali AS, Bachelard M, Falk KI, Ljung A, Msellem MI, Omar RS, , 2016. Acute uncomplicated febrile illness in children aged 2–59 months in Zanzibar–aetiologies, antibiotic treatment and outcome. PLoS One 11: e0146054. [Google Scholar]
  7. D’Acremont V, Kilowoko M, Kyungu E, Philipina S, Sangu W, Kahama-Maro J, Lengeler C, Cherpillod P, Kaiser L, Genton B, , 2014. Beyond malaria—causes of fever in outpatient Tanzanian children. N Engl J Med 370: 809817. [Google Scholar]
  8. WHO, UNICEF, 2011. Caring for the Sick Child. Caring for Newborns and Children in the Community—A Training Course for Community Health Workers. Geneva, Switzerland.
  9. Ethiopia Ministry of Health, 2011. Integrated Management of Newborn and Childhood Illness, Part 1. Addis Ababa, Ethiopia: Ethiopia Federal Ministry of Health. Available at: http://www.open.edu/openlearncreate/pluginfile.php/71990/mod_resource/content/2/IMNCI_Part_1_Final_Print-ready_March_2011_.pdf.
  10. World Health Organization, 2009. Caring for the Sick Child in the Community: Participant’s Manual. Geneva, Switzerland: World Health Organization. Available at: http://apps.who.int/iris/bitstream/10665/44398/1/9789241548045_Manual_eng.pdf.
  11. Tong A, Sainsbury P, Craig J, , 2007. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19: 349357. [Google Scholar]
  12. Al-Almaie SM, , 1999. The reliability of mothers to assess the presence of fever in their children. Saudi Med J 20: 696698. [Google Scholar]
  13. Verhoef H, Hodgins E, West CE, Carter JY, Kok FJ, , 1998. Diagnosis of fever in Africa. Lancet 351: 372373. [Google Scholar]
  14. Källander K, Alfvén T, Abebe A, Hailemariam A, Petzold M, Getachew D, Barat L, Steinhardt LC, Gutman JR, , 2018. Universal versus conditional 3-day follow-up visit for children with unclassified fever at the community level in Ethiopia: study protocol for a cluster randomized controlled non-inferiority trial. JMIR Res Protoc 7: e99. [Google Scholar]
  15. Källander K, Alfvén T, Funk T, Abebe A, Hailemariam A, Petzold M, Getachew D, Steinhardt LC, Gutman JR, , 2018. Universal versus conditional 3-day follow-up for children with non-severe unclassified fever at the community level in Ethiopia: a cluster randomised, noninferiority trial. PLoS Med 15: e1002553. [Google Scholar]
  16. Bilal NK, Herbst CH, Zhao F, Soucat A, Lemiere C, , 2011. Health extension workers in Ethiopia: improved access and coverage for the rural poor. Chuhan-Pole P, Angwafo M, eds. Yes Africa Can: Success Stories from a Dynamic Continent. Washington, DC: The World Bank, 433–443.
  17. Legesse H, Degefie T, Hiluf M, Sime K, Tesfaye C, Abebe H, Kebede H, Pearson L, Kassaye A, Taylor M, , 2014. National scale-up of integrated community case management in rural Ethiopia: implementation and early lessons learned. Ethiop Med J 52: 1526. [Google Scholar]
  18. Elo S, Kyngäs H, , 2008. The qualitative content analysis process. J Adv Nurs 62: 107115. [Google Scholar]
  19. Ansah EK, Reynolds J, Akanpigbiam S, Whitty CJ, Chandler CI, , 2013. “Even if the test result is negative, they should be able to tell us what is wrong with us”: a qualitative study of patient expectations of rapid diagnostic tests for malaria. Malar J 12: 258. [Google Scholar]
  20. Altaras R, Nuwa A, Agaba B, Streat E, Tibenderana JK, Martin S, Strachan CE, , 2016. How do patients and health workers interact around malaria rapid diagnostic testing, and how are the tests experienced by patients in practice? A qualitative study in western Uganda. PLoS One 11: e0159525. [Google Scholar]
  21. World Health Organization, 2010. Guidelines for the Treatment of Malaria. Geneva, Switzerland: WHO.
  22. Manyando C, Njunju EM, Chileshe J, Siziya S, Shiff C, , 2014. Rapid diagnostic tests for malaria and health workers’ adherence to test results at health facilities in Zambia. Malar J 13: 18. [Google Scholar]
  23. Mubi M, Kakoko D, Ngasala B, Premji Z, Peterson S, Björkman A, Mårtensson A, , 2013. Malaria diagnosis and treatment practices following introduction of rapid diagnostic tests in Kibaha district, coast region, Tanzania. Malar J 12: 18. [Google Scholar]
  24. Johansson EW, , 2016. Beyond “test and treat”: malaria diagnosis for improved pediatric fever management in sub-Saharan Africa. Glob Health Action 9: 31744. [Google Scholar]
  25. Johansson EW, Kitutu FE, Mayora C, Awor P, Peterson SS, Wamani H, Hildenwall H, , 2016. It could be viral but you don’t know, you have not diagnosed it: health worker challenges in managing non-malaria paediatric fevers in the low transmission area of Mbarara district, Uganda. Malar J 15: 1. [Google Scholar]
  26. Hertz JT, Munishi OM, Sharp JP, Reddy EA, Crump JA, , 2013. Comparing actual and perceived causes of fever among community members in a low malaria transmission setting in northern Tanzania. Trop Med Int Health 18: 14061415. [Google Scholar]
  27. Baltzell K, Elfving K, Shakely D, Ali AS, Msellem M, Gulati S, Mårtensson A, , 2013. Febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers’ practices in Zanzibar. Malar J 12: 1. [Google Scholar]
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  • Received : 06 Oct 2017
  • Accepted : 31 Jul 2018
  • Published online : 17 Sep 2018

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