Health system strengthening through community referral in the management of febrile illness in Nigeria

A Poster Presentation at the 61st Annual Meeting of the American Society of Tropical Medicine and Hygiene, 11-15 November 2012, Atlanta

Bright C. Orji1, William R. Brieger2, Emmanuel Otolorin1, Jones Nwadike3, Edueno V. Bassey4, Mayen Nkanga5

1Jhpiego/Nigeria, Abuja, Nigeria, 2The Johns Hopkins University, Baltimore,MD, United States, 3Dunamis Medical Diagnostic Services, Lagos, Nigeria, 4Etebi Health Center, Etebi, Akwa Ibom State, Nigeria, 5Akwa Ibom State Ministry of Health, Uyo, Nigeria

Use of Community Health Workers (CHWs) in community case management of febrile illness can improve community-clinic continuum of care, health outcomes and referral system. The main objective of this study is to ascertain the level of home visitation carried out by the CHWs, compliance rate for referrals and treatment response. The authors carried out a record review of 12 months of community registers to ascertain the level of home visitation. To determine compliance to r eferral, all referral slips and clients’ cards at the six primary health care centers participating in the on-going Integrated Community case Management of Malaria were assessed. The CHWs made a cumulative overall home visits of 7,282 to pregnant women 4460 (61.2%) and children under-five years of age 2822 (38.8%).

nigeria-cdd-performs-rdt-in-upenekang-community-ibeno-lga-akwa-ibom-state-2.jpgThe median visitation for pregnant women was 406 compared to children under-five years of age 257. Overall referral was 578; pregnant women 332 (57.4%) while children under-five years of age 246 (42.6%). The overall median referral was 28; pregnant women (19) compared to children under-five years of age (9). Overall referral compliance rate was 79.1% (457/578) with pregnant women 73.2% (245/332) compared to children under-five years 86.2% (212/246).

Median number of days for pregnant women to comply with referral was 4 compared to children under-five years of age 1.5 days. Reasons for referral for pregnant women, ANC attendance topped the list 78.4 % (192/245); malaria treatment 30.6% (75/245) and reactions to medicines Sulfadoxine-pyrimethamine 2.8% (7/245) and Artemisinin Combination Therapy 3 (1.2%) while Children under-five years of age malaria treatment topped the list 60.8% (129/212); diarrhea treatment 23.6% (50/212); pneumonia treatment 14.6% (31/212) and reactions to ACT 0.94% (2/212).

All cases were treated same day at the health facility. In conclusion we found relatively high compliance in community referral, and care-givers of children under five years of age are more likely to comply with referral and very early too than pregnant women. Community health education on referral during pregnancy as a  component of case management of febrile illness is recommended for program managers and implementers.

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