Factors influencing community integrated management to childhood illness in rural areas

[摘要] ENGLISH ABSTRACT: Child mortality is a worldwide problem and, according to the World Health Organization (WHO), 8,1 million children under the age of five years die each year. The Millennium Development Goals focus on the worldwide reduction in child mortality by two-thirds between 2000 and 2015. Several studies show that worldwide Community Integrated Management of Childhood Illness (CIMCI) interventions by community care workers (CCWs) have a positive effect on child health.The goal of this study was to determine the factors influencing CIMCI in the rural areas of the West Coast District in the Western Cape of South Africa.The objectives for this study were to determine the factors influencing CIMCI carried out in rural areas by the CCWs, which were identified as:• having working hours that are adequate for such a comprehensive service package;• being adequately trained;• having adequate knowledge of the '16 Key Family Practices of CIMCI;• having equipment that is adequate for the execution of their daily duties;• being able to cope with the challenges of working in rural and remote areas; and• receiving adequate supervision and support related to CIMCI.A descriptive, non-experimental exploratory research design with a quantitative approach was applied. The target population (N = 270) consisted of CCWs who are funded by the Provincial Government of the Western Cape (PGWC) in the West Coast District. For this study a response rate of 257 (95,18%) was obtained.Data was collected personally by the researcher with a self-administered questionnaire.The data was analysed with the assistance of a statistician and are presented in histograms and frequency tables. The participants were tested on their knowledge of CIMCI, and more than half of them achieved an average score that was not satisfactory. Statistically significant correlations were found between the participants' total score achieved and highest school grade passed (p < 0. 01); their level of Expanded Public Works Programme (EPWP) training (p < 0.01); their attendance of the CIMCI five-day course (p < 0.00); and if they had done a refresher course on CIMCI (p < 0.00). The total score was also shown by the Mann-Whitney U test (p < 0.01) to have a direct relationship with whether they had received any health-related training after school. The conclusion that can be drawn is that the higher the level of education of the CCWs, the better their knowledge of CIMCI. This could also improve their work performance.The recommendations arising from this study include that CIMCI training should be standardised to ensure that the CCWs have adequate knowledge. The current policy on community-based services (CBS) of the Provincial Government Western Cape Department of Health should also be standardised to ensure adequate working hours, training, equipment and supervision, and to take into consideration the challenges of working in rural areas.In conclusion, should these recommendations be implemented, CIMCI will have a huge, positive impact on child morbidity and mortality. CCWs will be ensured adequate working hours in relation to their workload, and will receive adequate training, equipment and supervision. This will reduce the challenges CCWs face and strengthen their services in rural areas.

[发布机构] Stellenbosch University