Factors associated with management of Pneumonia among children by Village Health Teams in Abim District

Abstract

Background: Pneumonia is the 2nd leading cause of death in children under 5 years of age in Uganda. Pneumonia deaths could be prevented if Village Health Teams (VHTs) knew how to manage pneumonia correctly. The objective of the study was to determine factors associated with management of pneumonia among under-five year children by VHTs in Abim district. Methods: This was a cross sectional mixed methods study that investigated management of pneumonia by VHTs. Data was collected from 374 VHTs using a training video, questionnaires and case vignettes. The proportion of VHTs that correctly manage pneumonia was determined. Modified Poisson regression was used to investigate factors associated with management of pneumonia in children by VHTs. Four (4) key informants’ interviews with health workers (VHT focal persons) of health centres II, III and five focus group discussions with community members were conducted. Results: The study found that 15.51% of VHTs correctly manage children with pneumonia in the district as per the Sick Child Job Aid. In addition, the study reported that 73.8% of the VHTs could count within +/- 5 count of an expert. The study found that educational level [Adj. PR 2.06; 95% CI: (1.18-3.61) p-value 0.011], having a VHT register [Adj. PR 0.54; 95% CI (0.30- 0.98) p-value 0.041] and drug stock outs [Adj. PR 4.24; 95% CI (1.37-13.13) p-value 0.012] were significantly associated with management of pneumonia. The qualitative component identified refresher training, equipment and supplies and support supervision as main health facility factors influencing management of pneumonia among children by VHTs. Similarly community perception that VHTs cannot manage a child with pneumonia, drug stock outs, and trust were the community factors influencing VHT management of pneumonia. Conclusion: A low proportion of VHTs in the district manage children with pneumonia as per the Sick Child Job Aid. Strategies to improve provision of VHT registers and drugs, support supervision, refresher trainings and recruitment of educated individuals into the VHT structure are necessary to improve management of pneumonia. Communities should also be sensitised on roles and responsibilities of VHTs in management of pneumonia