title: Influence of community health volunteers on care seeking and treatment coverage for common childhood illnesses in the context of free health care in rural Sierra Leone.
abstract: OBJECTIVE
  To examine whether community health volunteers induced significant changes in care seeking and treatment of ill children under five 2 years after their deployment in two underserved districts of Sierra Leone.
  
  
  METHODS
  A pre-test-post-test study with intervention and comparison groups was used. A household cluster survey was conducted among caregivers of 5643 children at baseline and of 5259 children at endline.
  
  
  RESULTS
  In the intervention districts, treatments provided by community health volunteers increased from 0 to 14.3% for all three conditions combined (P < 0.001). Care seeking from an appropriate provider was not statistically significant (OR = 1.50, 95% CI: 0.88-2.54) between intervention and comparison districts and coverage of appropriate treatment increased in both study groups for all three illnesses. However, the presence of community health volunteers was associated with a 105% increase in appropriate treatment for pneumonia (OR = 2.05, 95% CI: 1.22-3.42) and a 55% drop in traditional treatment for diarrhoea (OR = 0.45, 95% CI: 0.21-0.96). Community health volunteers were also associated with fewer facility treatments for malaria (OR = 0.21, 95% CI: 0.07-0.62).
  
  
  CONCLUSIONS
  After implementing free care, coverage for treatment for all three illnesses in both study groups improved. Deployment of community health volunteers was associated with a reduced treatment burden at facilities and less reliance on traditional treatments.
authors.affiliation: Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Aisha I
authors.initials: AI
authors.lastname: Yansaneh
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Asha S
authors.initials: AS
authors.lastname: George
authors.forename: Sowmya R
authors.initials: SR
authors.lastname: Rao
authors.forename: Ngozi
authors.initials: N
authors.lastname: Kennedy
authors.forename: Peter
authors.initials: P
authors.lastname: Bangura
authors.forename: William R
authors.initials: WR
authors.lastname: Brieger
authors.forename: Augustin
authors.initials: A
authors.lastname: Kabano
authors.forename: Theresa
authors.initials: T
authors.lastname: Diaz
mesh_terms: D002675:Child, Preschool; D003150:Community Health Workers; D003625:Data Collection; D003967:Diarrhea / Q000628:therapy*; D005191:Family Characteristics; D005260:Female; D006268:Health Facilities; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000628:therapy*; D008297:Male; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D011014:Pneumonia / Q000628:therapy*; D011634:Public Health; D012424:Rural Population; D012807:Sierra Leone; D014838:Volunteers
keywords: agents/bénévoles de santé communautaires; búsqueda de cuidados sanitarios; community case management; community health workers/volunteers; health care seeking; manejo comunitario de casos; prise en charge communautaire des cas; recherche de soins de santé; voluntarios de salud comunitaria