title: Female community health volunteers service utilization for childhood illness- improving quality of health services only is not enough: a cross-sectional study in mid-western region, Nepal.
abstract: BACKGROUND
  Female Community Health Volunteers (FCHVs) are considered service providers for major health problems at the community level in Nepal. However, few studies have been conducted about the roles of FCHVs from the users' perspective. This study sought to examine the current status of FCHV service utilization and identify the determinants of caregivers' utilization of FCHVs' health services in the mid-western region of Nepal.
  
  
  METHODS
  This cross-sectional study targeted 446 caregivers of children under five years of age and whose children had ever fallen ill in the study village development committees (VDCs) of three districts of Nepal. Caregivers were asked about their usual health practices for childhood illness, health service utilization for childhood illness, children's health condition, satisfaction with health services, and socio-demographic status. Descriptive statistics and multiple logistic regression were used for analysis.
  
  
  RESULTS
  Among 446 caregivers, 66.8% had never sought care from FCHVs for their children's illnesses in their lifetime, and more than 50% of them were unaware of FCHVs' services for acute respiratory infection and diarrhea. Among 316 caregivers whose child had an illness during the last seven months, 92.3% of them (n = 293) did not take their child to FCHVs. The main reasons were the lack of medicine available from them and their incompetency in providing care. Among the 446 caregivers, those who participated in a mothers' group (n = 82) were more likely to use FCHVs' services in their lifetime (AOR = 3.23, 95% CI =1.81-5.76).
  
  
  CONCLUSIONS
  Caregivers can gain benefit by using FCHV's health services, but a majority of the caregivers did not seek care from FCHVs due to its limited quality. Raising caregivers' awareness on FCHV is equally important at community level.
authors.forename: Moe
authors.initials: M
authors.lastname: Miyaguchi
authors.affiliation: Department of Community and Global Health, the University of Tokyo, Tokyo, Japan. jyasuoka@m.u-tokyo.ac.jp.
authors.forename: Junko
authors.initials: J
authors.lastname: Yasuoka
authors.forename: Amod Kumar
authors.initials: AK
authors.lastname: Poudyal
authors.forename: Ram Chandra
authors.initials: RC
authors.lastname: Silwal
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
mesh_terms: D000328:Adult; D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D009390:Nepal; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D014838:Volunteers; D000078329:Workforce; D055815:Young Adult