Treating fever in children under 5 years of age: caregiver perceptions of community health worker services in Dangme West district, Ghana.
BACKGROUND
Integrated community case management of childhood illnesses is a key strategy to help reduce mortality in children under 5 years; particularly those with difficult access to treatment. However, the success of such strategies depends on community utilization of services. This study assessed community utilization, perceptions and related factors of community health worker services.


METHODS
Data were gathered from a cross-sectional survey among 562 caregivers and focus group discussions among 84 caregivers. Factors related to utilization of community health workers (CHWs) for management of childhood fevers were analyzed using logistic regression and focus group discussions to explore caregiver perceptions of CHW activities.


RESULTS
Utilization of CHWs for management of fever in under-5s was 59.4%. Caregivers who were exposed to the communication intervention were about four times more likely to use the services of the CHWs compared to those who were not exposed (OR 3.79; 95% CI: 2.62-5.49; p<0.001). Farmers were 84% more likely to use CHW services for children sick with fever compared to those who were unemployed (OR 1.84; 95% CI: 1.00-3.39; p=0.05). Caregiver perceptions of the program were generally positive; most caregivers expressed satisfaction with the CHW services, citing prompt treatment, friendliness and free medicines. Male involvement in the CHW program was comparatively low.


CONCLUSIONS
Dissemination of information among priority groups can enhance utilization of CHW services. Exploring the perspective of both men and women to gain in-depth understanding on their views on male involvement will be useful for planning appropriate strategies to get more males involved in community-based child health programs.
Research and Development Division, Ghana Health Service, PM Bag 190 Accra, Ghana mercy.abbey@yahoo.com mercy.abbey@ghsmail.org.
Mercy
M
Abbey
School of Public Health, University of Texas Health Science Centre, 1200 Herman Pressler, Suite W238 Houston, Texas 77030, USA.
L Kay
LK
Bartholomew
School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13 Legon, Accra, Ghana.
Matilda
M
Pappoe
Department of Health Promotion, University of Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
Bart
B
van den Borne
D000328:Adult; D001364:Awareness; D017028:Caregivers / Q000523:psychology*; D002648:Child; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000628:therapy*; D017144:Focus Groups; D005869:Ghana; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012737:Sex Factors
Access; Children; Communication; Community health workers; Perceptions