title: Performance of community health workers managing malaria, pneumonia and diarrhoea under the community case management programme in central Uganda: a cross sectional study.
abstract: BACKGROUND
  Lay community health workers (CHWs) have been widely used to provide curative interventions in communities that have traditionally lacked access to health care. Optimal performance of CHWs managing children with malaria, pneumonia and diarrhoea in communities is desired if a reduction in childhood morbidity and mortality is to be achieved. This study assessed factors influencing performance of CHWs managing malaria, pneumonia and diarrhoea under the Integrated Community Case Management (iCCM) programme in Wakiso district, central Uganda.
  
  
  METHODS
  A cross sectional study was conducted among 336 CHWs. Data was collected using interviews and record reviews. Performance was measured using composite scores based on the core activities of CHWs under the iCCM programme. These core activities included: treating children under five years, referring severely sick children including newborns, home visits, counseling caregivers on home care, record keeping and community sensitization. Descriptive and inferential statistics using odds ratios were done to determine factors influencing performance of CHWs.
  
  
  RESULTS
  Of the 336 respondents, 242 (72%) were females and the overall level of good performance was 21.7% (95% CI, 17.3-26.1%). Factors significantly associated with performance were: sex (females) (AOR 2.65; 95% CI, 1.29 -5.43), community support (AOR 2.29; 95% CI, 1.27-4.14), receiving feedback from health facilities (AOR 4.90; 95% CI, 2.52-9.51) and having drugs in the previous three months (AOR 2.99; 95% CI, 1.64-5.42).
  
  
  CONCLUSIONS
  Only one in every five CHWs performed optimally under the iCCM programme. Strategies to improve drug supply, community support and feedback provision from the formal health system are necessary to improve the performance of CHWs.
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda. jbagonza@musph.ac.ug.
authors.forename: James
authors.initials: J
authors.lastname: Bagonza
authors.forename: Simon P S
authors.initials: SP
authors.lastname: Kibira
authors.forename: Elizeus
authors.initials: E
authors.lastname: Rutebemberwa
mesh_terms: D000328:Adult; D019090:Case Management / Q000458:organization & administration*; D003153:Community Health Services / Q000379:methods* / Q000458:organization & administration; D003150:Community Health Workers / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000628:therapy*; D005260:Female; D006801:Humans; D008288:Malaria / Q000628:therapy*; D008297:Male; D011014:Pneumonia / Q000628:therapy*; D015397:Program Evaluation; D014454:Uganda