Perceived quality of care for common childhood illnesses: facility versus community based providers in Uganda.
OBJECTIVE
To compare caretakers' perceived quality of care (PQC) for under-fives treated for malaria, pneumonia and diarrhoea by community health workers (CHWs) and primary health facility workers (PHFWs).


METHODS
Caretaker rated PQC for children aged (2-59) months treated by either CHWs or PHFWs for a bought of malaria, pneumonia or diarrhoea was cross-sectionally compared in quality domains of accessibility, continuity, comprehensiveness, integration, clinical interaction, interpersonal treatment and trust. Child samples were randomly drawn from CHW (419) and clinic (399) records from eight Midwestern Uganda districts. An overall PQC score was predicted through factor analysis. PQC scores were compared for CHWs and PHFWs using Wilcoxon rank-sum test. Multinomial logistic regression models were used to specify the association between categorized PQC and service providers for each quality domain. Finally, overall PQC was dichotomized into "high" and "low" based on median score and relative risks (RR) for PQC-service provider association were modeled in a "modified" Poisson regression model.


RESULTS
Mean (SD) overall PQC was significantly higher for CHWs 0.58 (0 .66) compared to PHFWs -0.58 (0.94), p<0.0001. In "modified" Poisson regression, the proportion of caretakers reporting high PQC was higher for CHWS compared to PHFWs, RR=3.1, 95%CI(2.5-3.8). In multinomial models PQC was significantly higher for CHWs compared to PHFWs in all domains except for continuity.


CONCLUSIONS
PQC was significantly higher for CHWs compared to PHFWs in this resource constrained setting. CHWs should be tapped human resources for universal health coverage while scaling up basic child intervention as PQC might improve intervention utilization.
Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden ; Malaria Consortium, Kampala, Uganda.
Agnes
A
Nanyonjo
Fredrick
F
Makumbi
Patrick
P
Etou
Göran
G
Tomson
Karin
K
Källander
D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D003150:Community Health Workers / Q000523:psychology*; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008288:Malaria / Q000628:therapy; D008297:Male; D010564:Personnel, Hospital / Q000523:psychology*; D011014:Pneumonia / Q000628:therapy; D011320:Primary Health Care; D011787:Quality of Health Care; D012107:Research Design; D012424:Rural Population; D012938:Social Perception; D018709:Statistics, Nonparametric; D014454:Uganda; D000078329:Workforce