title: Acceptability and Utilization of Community Health Workers after the Adoption of the Integrated Community Case Management Policy in Kabarole District in Uganda.
abstract: BACKGROUND
  Malaria, pneumonia and diarrhea remains to be the major causes of morbidity and mortality among children in Uganda. To address such challenges, the government adopted a national policy on Integrated Community Case Management (ICCM) for malaria, pneumonia and diarrhea in 2010. The aim of this study was to assess household access, utilization and acceptability of ICCM services in Kabarole District.
  
  
  METHODS
  The study was carried out between 22nd November to 4th December, 2014 in Rwimi sub-county, Kabarole district. A cross sectional household survey was conducted amongst caretakers of children below 5 years of age and a total of 384 respondents were interviewed about distance from nearest health facility and community health worker, socio-demographic characteristics, type of housing, history of fever, health-seeking behavior, perceptions of quality and utilization of ICCM services. Data was cleaned, coded and analysed using STATA 14.0 to produce results.
  
  
  RESULTS
  Most 53.1% of the studied children were males and their age ranged from 1-52 months. Nearly all the care takers, 97.1% (373/384) had utilized health services for their children in the three proceeding months to the study and of those, 0.5% (2/373) sought from a traditional healer, 8.6% (32/373) sought treatment at home, 27.3% (102/373) from community health worker, 27.3% (102/373) from government health unit and 36.2% (133/373) from non-government health units. The caretakers who stay near CHWs are more likely to utilize ICCM services than those staying near health facilities (P=0.001). The majority 65.6% of the caretakers stay near CHWs and use only 10 minutes to reach the CHWs. Trust in CHWs [AOR 0.85, 95%CI [0.641-1.135]], level of awareness [AOR 0.73, 95%CI [0.538-0.979]] and distance (≤1 km) to CHWs [AOR 1.65, 95%CI [1.075-2.522]] are positively associated with the utilisation of ICCM services.
  
  
  CONCLUSIONS
  The implementation of ICCM policy in kabarole has been an effective approach in increasing the utilization of malaria, diarrhea and pneumonia treatment services and hence increasing access to health services at community level. Trust in the CHWs, level of community awareness and distance to the CHWs are positively associated with the utilisation of ICCM services.
authors.affiliation: Makerere University College of Health Sciences, School of Public Health.
authors.forename: G
authors.initials: G
authors.lastname: Muhumuza
authors.affiliation: BNUR, Makerere University College of Health Sciences, School of Nursing, Uganda.
authors.forename: C
authors.initials: C
authors.lastname: Mutesi
authors.affiliation: MBCHB, Makerere University College of Health Sciences, School of Medicine, Uganda.
authors.forename: F
authors.initials: F
authors.lastname: Mutamba
authors.affiliation: BEHS, Makerere University College of Health Sciences, School of Public Health, Uganda.
authors.forename: P
authors.initials: P
authors.lastname: Ampuriire
authors.affiliation: BSB, Makerere University College of Health Sciences, School of Biomedical Sciences, Uganda.
authors.forename: C
authors.initials: C
authors.lastname: Nangai
keywords: Community health worker; Integrated community case management; Village health teams