Developing and implementing appropriate health communication messages for community based

216 Pages·2015·6.44 MB·English

by  Mercy Abbey

Developing and implementing appropriate health
communication messages for community based
management of fevers
Citation for published version (APA):
Abbey, M. (2016). Developing and implementing appropriate health communication messages for
community based management of fevers: Improving access to care for children under five in the Dangme
West District, Ghana. [Doctoral Thesis, Maastricht University]. Datawyse / Universitaire Pers Maastricht.
https://doi.org/10.26481/dis.20161125ma
Document status and date:
Published: 01/01/2016
DOI:
10.26481/dis.20161125ma
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Developing and implementing appropriate
Developing and implementing appropriate
health communication messages for
health communication messages for
community based management of fevers
community based management of fevers
Improving access to care for children under five
Improving access to care for children under five
in the Dangme West District, Ghana
in the Dangme West District, Ghana
MERCY ABBEY
MERCY ABBEY

Developing and implementing appropriate health
communication messages for community based management
of fevers
Improving access to care for children under five in the Dangme
West District, Ghana
DISSERTATION
To obtain the degree of Doctor at Maastricht University,
on the authority of the Rector Magnificus, Prof. dr. Rianne M. Letschert,
in accordance with the decision of the Board of Deans,
to be defended in public on Friday 25th November 2016, at10:00 hours
By
Mercy Abbey
Developing and implementing appropriate health
communication messages for community based management
of fevers
Improving access to care for children under five in the Dangme
West District, Ghana
DISSERTATION
To obtain the degree of Doctor at Maastricht University,
on the authority of the Rector Magnificus, Prof. dr. Rianne M. Letschert,
in accordance with the decision of the Board of Deans,
to be defended in public on Friday 25th November 2016, at10:00 hours
By
Mercy Abbey
Promotor
Prof. dr. H.W. van den Borne
2nd Promotor
Prof.dr. L. K. Bartholomew-Eldredge (University of Texas, Houston, USA) (†)
Co- Promotor
Dr. Matilda Pappoe (University of Ghana)
Assessment Committee
Prof. dr. N.K. de Vries (chair)
Dr. A. Krumeich
Prof. dr. G. Parcel (University of Texas, Houston, USA)
Prof. dr. R. Ruiter
Dr. M. van Vugt (University of Amsterdam)
Printed By: Datawyse | Universitaire Pers Maastricht
ISBN: 978 94 6159 637 6
Copyright: Mercy Abbey
All rights reserved. Any excerpts from this thesis may be used for scientific,
educational, policy or programming purposes provided the source is
acknowledged.
This dissertation has been prepared at the School for Public Health and
Primary Care: CAPHRI, Department of Health Promotion, Maastricht
University. CAPHRI participates in the Netherlands School of Primary Care
Research (CaRe).
ii
Contents
Preface iv
Chapter 1 General Introduction 1
Chapter 2 Community perceptions and practices of treatment
seeking for childhood pneumonia: A mixed methods
study in a Rural District, Ghana 17
Chapter 3 Salient beliefs of primary care givers about prompt care
seeking from Community Health Workers for a child with
fever: An elicitation study in a rural district in Ghana 39
Chapter 4 Development of theory and evidence based program to
promote community treatment of fevers in children under
five in a rural district in Southern Ghana: An Intervention
Mapping Approach 57
Chapter 5 Assessment of the adherence of Community Health Workers
to dosing and referral guidelines for the management of
fever in children under five years: a study in Dangme West
District, Ghana 81
Chapter 6 Factors related to retention of Community Health Workers
in a community based management of fevers in children
under- five years in the Dangme West District of Ghana 103
Chapter 7 Treating fever in children under five: Care giver perceptions
of Community Health Worker Services in Dangme West
District, Ghana 123
Chapter 8 General Discussion and Conclusions 147
Valorization 163
Summary 169
References 175
Acknowledgements 195
Curriculum Vitae 201
iii
Preface
In response to the call by the World Health Organization (WHO) and the
United Nations Children’s Fund (UNICEF) to integrate pneumonia treatment
at the community level, a cluster randomized controlled trial on treating
malaria and pneumonia in children under five was implemented in the
Dangme West District in Ghana between 2006 and 2009. The trial was
implemented within the framework of a programme titled: “Improving
access and quality of the management of malaria and pneumonia in Ghana”
that was funded by the UNDP/WHO/Special programme for Tropical Diseases
Research (TDR) and the Knowledge Enriches Programme of the Netherlands
Foundation for the Advancement of Tropical Research (WOTRO). The
programme comprised three projects:
1. Developing and implementing appropriate health communication
messages for home and community management of fever in children
under five in southern Ghana.
2. Home management of fevers (malaria and pneumonia) in children
under five: A cluster randomized controlled trial in southern Ghana.
3. A cost analysis, and cost effectiveness study of home management
of fevers in children under five in southern Ghana.
The present thesis is about project 1: Developing and implementing
appropriate health communication messages for community based
management of fever in children under five in the Dangme west district of
Ghana. Projects 2 and 3 are topics of two other theses.
In brief, for the main trial, 660 persons, averaging two per community or
village were selected by their communities and trained by professional health
staff to manage fever in children aged 2 months to 59 months. The trained
persons were referred to as Community Health Workers (CHWs). They
worked in their homes, treated fever and referred the severely ill children to
iv
the nearest health facility. In addition CHWs counseled care givers on
medication administration and referral compliance (where necessary).
Medicines provided were free of cost to the sick children.
To promote the use of the CHW services, project 1 designed and implemented
a health communication program that served as the platform for awareness
creation and demand generation to drive appropriate uptake of the CHW
services by the community. Our intervention methods included audio taped
recorded messages and a role model story in the form of drama recorded on
video. The communications program was implemented in all communities
served by the CHWs in the district. The messages were targeted at household
care givers/parents of children under five and other stakeholders. Key
messages delivered covered the rationale for the trial, the availability of
trained CHWs in the communities, the need for prompt and appropriate
treatment seeking for fevers in children under five and the expected role of
the different target audiences.
The Video:
The video tape was a 30 minute drama made up of short scenes acted by
community members in the local dialect Dangme. Each scene ended with
lessons and morals based on the expected role of the target groups. Some of
the key characteristics of scenarios acted out were: Children are dying of
many illnesses especially fever, the importance of going to CHW immediately
if the child has fever, the need for husbands to support their wives in seeking
treatment for the sick child and free medications offered by CHWs for treating
the sick children.
The Audio Tape
Two audio cassettes were produced with recorded messages in the local
dialect. The first provided information on the overview of the project;
informing community members about the job of the CHWs, the role of the
community members and urging them to use the services of the CHWs. The
second audio tape message provided information on drugs and the need for
compliance.
v
Terms and Definitions
Integrated Management of Childhood illness (IMCI)
A holistic approach to management of common childhood illnesses,
developed by WHO and UNICEF in 1995. The approach aims at improving
health worker skills, strengthening health systems and engaging and
improving community and family practices to deal with the main causes of
mortality and morbidity in children under 5 in resource constrained settings.
IMCI strategy includes interventions that promote child growth and
development, prevent illness and allow illness proper management when it
appears. These interventions should take place at facility level or at home at
community and family level. There are 2 levels where IMCI should be
implemented: Health facilities level (facility IMCI) and community level
(Community IMCI or Community Case management).
Integrated Community Case Management (iCCM)
Integrated community case management (iCCM) is a health service delivery
approach in which trained community health workers provide basic
diagnostic and treatment services for a subset of common childhood illnesses
at the community level. Community IMCI activities focus on improving
availability and quality of health education, community-based services, and
essential commodities to treat conditions like malaria, Acute respiratory
illnesses (ARI), and diarrhea.
Pneumonia
Pneumonia is a severe acute respiratory infection, a condition where fluids fill
the lungs and disrupt how oxygen is absorbed. Breathing can become very
difficult, especially for young children. Other symptoms can include intense
coughing, a high fever, and chills. As pneumonia progresses, children can
experience convulsions, unconsciousness, feeding problems, and without
timely treatment, often death from respiratory failure.
vi