Caregivers’ and Health Extension Workers’ Perceptions and Experiences of Outreach Management of Childhood Illnesses in Ethiopia: A Qualitative Study
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Study Areas
2.2. Sampling Procedure and Recruitment of the Study Participants
2.3. Data Collection
2.4. Data Management and Analysis
3. Results
3.1. Characteristics of the Participants
3.2. Themes Formation
3.2.1. Mothers’ Experiences and Perceptions of Outreach Services
Outreach Services Received
“The health extension worker teaches us based on the gaps we have. She teaches about how to feed our children. She tells us about antenatal care follow up, and if there is a problem that is beyond her capacity, she refers to the health centre. We take our children to the health post when we have a problem and if it is beyond her capacity then she refers us to the health centre…”(Mother, 26 years, FGD).
“The main reason for the house visits was to check that we are using a bed net. And to check our toilet and to make sure that we have a separate house for the animals…”(Mother, 34 years, FGD).
The health extension worker visits our houses and tell or teach us to keep our house organized, to clean our toilet, and to have proper waste disposal and about child feeding (how to prepare porridge)(Mother, 38 years, FGD).
Treating Sick Children at Home
“To be honest, we do not get treatment at home or community level, there is no such a thing as calling her [the health extension worker] and getting the treatment at the house”.(Mother, 31 years, FGD).
“How can she give medicine without evaluating and diagnosing the disease, what does she use to evaluate and diagnose the disease at the household level?”(Mother, 43 years, FGD).
“They can’t diagnose a disease with their naked eye. Let us say, my child got sick and how will I give him a medicine that they order at my house. You can only diagnose a disease by using different tests. If the child has fever and cough, he needs to be tested before prescribing a medicine…”(Mother, 34 years, FGD).
“It doesn’t matter whether we live far away or near the health post, we should still manage to come to the health post”(Mother, 29 years, FGD).
“I don’t trust their knowledge that much”(Mother, 34 years, FGD).
“…the health post should be well equipped for us to fully trust the medicines they prescribe. We wouldn’t go to the hospital if the health post was well equipped….”(Mother, 41 years, FGD).
“We don’t have phone and we can’t call them [the health extension workers] so we take the child to the health post instead”(Mother, 43 years, FGD).
3.2.2. Health Extension Workers’ Experiences and Perceptions of Outreach Services
Outreach Services Provided and Its Challenges
“The health post will not be closed at all times. If I am at the health post then my co-worker will be out in the field and vice versa… During the weekend (Sunday), we do awareness creation”(Health extension worker, interview).
“When we go house-to-house [for outreach services] … we bring everything necessary, including vitamin A, deworming, MUAC, and for children we take zinc, ORS, amoxicillin. If they are experiencing diarrhoea, we treat them with ORS and zinc…”(Health extension worker, interview).
We have separate registration for house-to-house services and we have a chart booklet. We used to take rapid diagnostic test and coartem (artemether-lumefantrine), amoxicillin and so on. So, we assess if a child has diarrhoea or vomiting, then we diagnose. We treat diarrhoea with zinc and ORS and we treat pneumonia with amoxicillin.(Health extension worker, interview).
“…In addition, we [health extension workers] also provide immunization for children as an outreach activity and at the health post. We have three outreach programs per month, so we provide immunization according to this schedule”(Health extension worker, interview).
“There are some kebeles far from the health post and it might take us more than 30 min to get to them. And by the time we get there, we might already be tired and exhausted…”(Health extension worker, interview).
“It can benefit all, but the question is whether we can provide this equally or not. We can treat sick children regardless of distance, it does not matter whether they are located near or far, if we come across them [sick children] we can still provide the treatment at home”(Health extension worker, interview).
“It has been a while since the integrated Community Case Management started but it was not strengthened, and we did not have all the necessary supply. But we were given a bag saying newborn as soon as this program was started, but ever since it was strengthened, we were given registration books to be used in the field…”(Health extension worker, interview).
Activities Needed to Improve Outreach Services
“…I think it would be better to hire nurses at the health post to provide quality services and it will help us to gain experience from them as well”(Health extension worker, interview).
“Even though there is an interruption currently, the three-months review meeting was good because it helped us to know our strengths and weaknesses so it would be good to do that regularly”(Health extension worker, interview).
“The community is aware about the services through women’s development army, 1 to 5 structure, and influential people. In addition, during the implementation of community-based projects, we gathered 150 people in the kebele and we [the health extension workers] created awareness so they [the community] know that we provide house-to-house treatment services …”(Health extension worker, interview).
“Motivation (salary and incentives) and further education…”(Health extension worker, interview).
“If we have a house near the health post, we will not be tired and we can provide the home-based care better…”(Health extension worker, interview).
4. Discussion
5. Strengths and Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviation
FGD | Focus Group Discussion |
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Defar, A.; Alemu, K.; Tigabu, Z.; Persson, L.Å.; Okwaraji, Y.B. Caregivers’ and Health Extension Workers’ Perceptions and Experiences of Outreach Management of Childhood Illnesses in Ethiopia: A Qualitative Study. Int. J. Environ. Res. Public Health 2021, 18, 3816. https://doi.org/10.3390/ijerph18073816
Defar A, Alemu K, Tigabu Z, Persson LÅ, Okwaraji YB. Caregivers’ and Health Extension Workers’ Perceptions and Experiences of Outreach Management of Childhood Illnesses in Ethiopia: A Qualitative Study. International Journal of Environmental Research and Public Health. 2021; 18(7):3816. https://doi.org/10.3390/ijerph18073816
Chicago/Turabian StyleDefar, Atkure, Kassahun Alemu, Zemene Tigabu, Lars Åke Persson, and Yemisrach B. Okwaraji. 2021. "Caregivers’ and Health Extension Workers’ Perceptions and Experiences of Outreach Management of Childhood Illnesses in Ethiopia: A Qualitative Study" International Journal of Environmental Research and Public Health 18, no. 7: 3816. https://doi.org/10.3390/ijerph18073816