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Original Articles
Open Access

Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation

Anne Langston, Jennifer Weiss, Justine Landegger, Thomas Pullum, Melanie Morrow, Melene Kabadege, Catherine Mugeni and Eric Sarriot
Global Health: Science and Practice August 2014, 2(3):342-354; https://doi.org/10.9745/GHSP-D-14-00067
Anne Langston
aInternational Rescue Committee, New York, NY., USA
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Jennifer Weiss
bConcern Worldwide, New York, NY., USA
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Justine Landegger
aInternational Rescue Committee, New York, NY., USA
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  • For correspondence: justine.landegger@rescue.org
Thomas Pullum
cICF International, The Demographic and Health Surveys Program, Rockville, MD., USA
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Melanie Morrow
cICF International, The Demographic and Health Surveys Program, Rockville, MD., USA
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Melene Kabadege
dWorld Relief, Baltimore, MD., USA
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Catherine Mugeni
eRwanda Ministry of Health, Kigali., Rwanda
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Eric Sarriot
fICF International, Center for Design and Research on Sustainability, Calverton, MD., USA
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Figures & Tables

Figures

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  • Figure1
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    The Bahomwana CHW Peer Support Group meets in Gasambu village, Rwanda, to exchange ideas and challenges in order to accomplish and improve their work.

  • Figure.
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    Figure.

    Care-Seeking From CHWs and Facilities for All iCCM Conditions in Children 0–59 Months, Kabeho Mwana Project vs. Non-Project Districts

    Abbreviations: CHWs, community health workers; iCCM, integrated community case management.

  • Figure3
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    A community health worker and member of a Peer Support Group on a routine home visit.

Tables

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    • View popup
    Table 1. Care-Seeking for Fever, Diarrhea, and ARI Symptoms and Other MCH Interventions for Kabeho Mwana and Non-Kabeho Mwana Project Districts in 2005 and 2010
    Non-KM Project DistrictsKM Project DistrictsDifference in the Differences
    20052010Change20052010Change
    N (%)N (%)%N (%)N (%)%%
    Care-Seeking From Any Trained Provider
     Diarrhea803 (16.2)808 (36.3)+20.0292 (8.4)308 (40.0)+31.6+11.6***
     Fever1,485 (31.5)1,003 (40.8)+9.3546 (20.3)332 (48.7)+28.4+19.1***
     ARI symptoms964 (30.5)233 (47.4)+16.9357 (20.9)85 (57.9)+37.0+20.0**
     All 3 conditions2,551 (26.0)1,570 (40.0)+14.0877 (16.3)541 (46.0)+29.7+15.7***
    Non-Project Specific Indicators
     At least 3 ANC visits in the most recent pregnancy4,269 (13.7)5,036 (36.2)+22.51,115 (12.0)1,274 (32.2)+20.2−2.3
     Child 12–23 months received DPT31,271 (87.0)1,262 (97.3)+10.3343 (88.5)330 (95.7)+7.2−3.1
     Child 6–59 months received vitamin A in past 6 months5,461 (83.7)6,168 (94.7)+11.11,394 (85.8)1,589 (85.6)−0.2−11.3
    • Abbreviations: ANC, antenatal care; ARI, acute respiratory infection; DPT3, diphteria, pertussis, and tetanus; KM, Kabeho Mwana; MCH, maternal and child health.

    • All of the tests are one-tailed. The tests in the last column of Table 1 correspond with the tests of the unadjusted odds ratios given in Table 2.

    • * P≤.05, ** P≤.01, *** P≤.001.

    • View popup
    Table 2. Odds Ratios for Care-Seeking for Sick Children in Kabeho Mwana Project Districts vs. Non-Project Districts After Controlling for 2005–2010 Gains in Both Types of Districts
    ConditionsUnadjusted OR (95% CI)Adjusted ORa (95% CI)
    Diarrhea2.47*** (1.47–4.15)2.56*** (1.47–4.46)
    Fever2.49*** (1.66–3.73)2.54*** (1.68–3.85)
    ARI symptoms2.53** (1.29–4.95)2.35** (1.20–4.62)
    All 3 conditions2.31*** (1.66–3.21)2.24*** (1.60–3.16)
    • Abbreviations: ARI, acute respiratory infection; CI, confidence interval; iCCM, integrated community case management; OR, odds ratio.

    • ↵a Adjusted to control for the duration of time since implementation of iCCM, the district (as a fixed categorical effect), and whether malaria was endemic in the district. All of the tests are one-tailed.

    • * P≤.05, ** P≤.01, *** P≤.001.

    • View popup
    Table 3. CHW Contribution to Care-Seeking, Kabeho Mwana Project Districts vs. Non-Project Districts, 2005 and 2010
    20052010
    Non-KM Project DistrictsKM Project DistrictsNon-KM Project DistrictsKM Project Districts
    Diarrhean = 1,103n = 1,132
    Any provider16.2 (13.3–19.1)8.4*** (5.6–11.3)36.2 (32.5–39.8)40.0 (34.0–46.0)
    CHW0.2 (−0.2–0.60)1.1 (0.1–2.1)9.5 (7.3–11.7)21.8*** (16.1–27.4)
    Facility16.2 (13.3–19.1)8.4*** (5.6–11.3)26.7 (23.0–30.3)18.2* (13.6–22.9)
    Fevern = 2,046n = 1,355
    Any provider31.5 (28.7–34.3)20.3*** (15.9–24.7)40.8 (37.2–44.4)48.7* (43.1–54.3)
    CHW0.4 (0.0–0.8)1.2 (0.0–2.4)12.1 (10.1–14.2)26.1*** (21.0–31.3)
    Facility31.1 (28.3–33.9)19.1*** (15.0–23.3)28.6 (25.4–31.9)22.5* (18.3–26.8)
    ARI Symptomsn = 1,332n = 322
    Any provider30.5 (27.2–33.8)20.9** (16.3–25.5)47.4 (39.2–55.7)57.9 (45.9–69.9)
    CHW0.5 (0.0–0.9)0.4 (−0.2–1.0)7.7 (4.4–11.0)27.5*** (16.6–38.3)
    Facility30.0 (26.8–33.2)20.5** (15.8–25.1)39.8 (31.8–47.7)30.4 (20.8–40.1)
    All 3 Conditionsan = 2,847n = 2,142
    Any provider26.4 (24.1–27.6)16.2*** (15.1–22.1)40.0 (37.1–42.9)46.0 (37.1–42.9)
    CHW0.6 (0.3–0.9)1.2* (0.3–2.0)4.9 (3.7–6.1)12.4*** (8.9–15.9)
    Facility25.8 (23.5–28.1)15.0*** (11.6–18.4)35.1 (32.–38.1)33.6 (29.3–38.0)
    • Abbreviations: ARI, acute respiratory infection; CHW, community health worker; KM, Kabeho Mwana.

    • ↵a Includes children presenting with multiple conditions.

    • All data are shown as % (95% CI).

    • P values given are for the difference between rates of care-seeking in KM and non-KM districts in the same year.

    • ↵ * P≤.05, ** P≤.01, *** P≤.001.

Additional Files

  • Figures
  • Tables
  • GHSP-D-14-00067 Supplementary Material

    Langston et al. doi: 10.9745/GHSP-D-14-00067. Listed in order below are Supplementary Table 1 (percent of women reporting serious problems in accessing health care); Supplementary Table 2 (basic district characteristics included in the regression); and Supplementary Table 3 (percent of under-5 children with a reported illness 2 weeks prior to the survey).

    Files in this Data Supplement:

    • Supplementary Material - Langston et al. doi: 10.9745/GHSP-D-14-00067
    • Supplementary Material - Langston et al. doi: 10.9745/GHSP-D-14-00067
    • Supplementary Material - Langston et al. doi: 10.9745/GHSP-D-14-00067
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Global Health: Science and Practice: 2 (3)
Global Health: Science and Practice
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August 01, 2014
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Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation
Anne Langston, Jennifer Weiss, Justine Landegger, Thomas Pullum, Melanie Morrow, Melene Kabadege, Catherine Mugeni, Eric Sarriot
Global Health: Science and Practice Aug 2014, 2 (3) 342-354; DOI: 10.9745/GHSP-D-14-00067

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Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation
Anne Langston, Jennifer Weiss, Justine Landegger, Thomas Pullum, Melanie Morrow, Melene Kabadege, Catherine Mugeni, Eric Sarriot
Global Health: Science and Practice Aug 2014, 2 (3) 342-354; DOI: 10.9745/GHSP-D-14-00067
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