Effectiveness of malaria case management in under-five children by community health workers in Thyolo and Chikwawa districts in Malawi from 2017 to 2021.
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Date
2024
Authors
Pendame, Mwayi Winstone
Journal Title
Journal ISSN
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Publisher
The University of Zambia
Abstract
Malaria is one of the infectious diseases that causes a lot of deaths in under-five children in sub Saharan African countries and continues to be a public health problem. Most of these deaths occur in under-five children residing in remote and hard-to-reach areas where access to healthcare is a challenge because of long distances to the health facilities. The use of community health workers (CHWs) was introduced to improve access to healthcare and to reduce the under-five children’s deaths due to malaria. However, there is limited information in terms of the effectiveness of CHWs in malaria case management in Malawi. The main objective of this study was to investigate the effectiveness of CHWs in malaria case management in Thyolo and Chikwawa districts of Malawi. This was a retrospective descriptive study design where eight (8) health centres were randomly selected within the catchment area and clusters in each of the selected districts where the CHWs are based. Malaria mortality trends and malaria admission trends were analysed before and after the introduction of malaria community case management. Analysis was done using SPSS, STATA, and R Studio. Tests used were independent t-tests, multiple linear regression, and time trend analysis tests such as Moving Average and Mann-Kendall Trend tests. The results from the years 2017 to 2021 showed that 53% of under-five malaria cases were seen in village clinics in Thyolo district and 38.5% in Chikwawa from the year 2017 to 2021. Further, there was a significant decline in the trends of malaria death rates over time (p = value 0.036). Thyolo district had a decline in mortality from 72.8 per 100,000 in 2013 to 24.7 per 100,000 in 2021, whereas Chikwawa district saw a decline from 99.4 per 100,000 to 36.2 per 100,000. Additionally, a significant mean difference (p = 0.035) was found between the two districts, with Chikwawa district having more cases (M = 9142) than Thyolo district (M = 2235). Admission trends also statistically declined (p = value: 0.034) after the community case malaria programme from 2017 to 2021. Country-wide study will help to establish the effectiveness of CHW for the whole of Malawi. The study recommends a need to continuously support the CHWs, more sensitisation meetings to the communities to continuously access the health services rendered by the CHWs and to consider increasing the age group accessing services by CHWs.
Description
Thesis of Master of Science in Tropical Infectious Diseases and Zoonosis