Strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya.

Autor:	Njeru RW; KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya. rita.njeru@st-annes.ox.ac.uk., Uddin MF; Nutrition and Clinical Services Division, icddr,b, GPO Box 128, Dhaka, 1000, Bangladesh., Zakayo SM; KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya., Sanga G; KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya., Charo A; KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya., Islam MA; Nutrition and Clinical Services Division, icddr,b, GPO Box 128, Dhaka, 1000, Bangladesh., Hossain MA; Nutrition and Clinical Services Division, icddr,b, GPO Box 128, Dhaka, 1000, Bangladesh., Kimani M; KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya., Mwadhi MK; KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya., Ogutu M; KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya., Chisti MJ; Nutrition and Clinical Services Division, icddr,b, GPO Box 128, Dhaka, 1000, Bangladesh., Ahmed T; Nutrition and Clinical Services Division, icddr,b, GPO Box 128, Dhaka, 1000, Bangladesh., Walson JL; Departments of Global Health, Medicine, Paediatrics and Epidemiology, University of Washington Seattle, Seattle, USA., Berkley JA; KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya.; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK., Jones C; KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya.; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK., Theobald S; Department of International Public Health, Liverpool School of Tropical medicine, Liverpool, UK., Muraya K; KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya., Sarma H; Departments of Global Health, Medicine, Paediatrics and Epidemiology, University of Washington Seattle, Seattle, USA.; Research School of Population Health, The Australian National University, Canberra ACT, Canberra, 0200, Australia., Molyneux S; KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya. SMolyneux@kemri-wellcome.org.; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK. SMolyneux@kemri-wellcome.org.
Jazyk:	angličtina
Zdroj:	BMC health services research [BMC Health Serv Res] 2021 Nov 15; Vol. 21 (1), pp. 1234. Date of Electronic Publication: 2021 Nov 15.
DOI:	10.1186/s12913-021-07209-2
Abstrakt:	Background: Undernourished children in low- and middle-income countries remain at elevated risk of death following hospital discharge, even when treated during hospitalisation using World Health Organisation recommended guidelines. The role of community health workers (CHWs) in supporting post-discharge recovery to improve outcomes has not been adequately explored. Methods: This paper draws on qualitative research conducted as part of the Childhood Acute Illnesses and Nutrition (CHAIN) Network in Bangladesh and Kenya. We interviewed family members of 64 acutely ill children admitted across four hospitals (a rural and urban hospital in each country). 27 children had severe wasting or kwashiorkor on admission. Family members were interviewed in their homes soon after discharge, and up to three further times over the following six to fourteen months. These data were supplemented by observations in facilities and homes, key informant interviews with CHWs and policy makers, and a review of relevant guidelines. Results: Guidelines suggest that CHWs could play a role in supporting recovery of undernourished children post-discharge, but the mechanisms to link CHWs into post-discharge support processes are not specified. Few families we interviewed reported any interactions with CHWs post-discharge, especially in Kenya, despite our data suggesting that opportunities for CHWs to assist families post-discharge include providing context sensitive information and education, identification of danger signs, and supporting linkages with community-based services and interventions. Although CHWs are generally present in communities, challenges they face in conducting their roles include unmanageable workloads, few incentives, lack of equipment and supplies and inadequate support from supervisors and some community members. Conclusion: A multi-pronged approach before or on discharge is needed to strengthen linkages between CHWs and children vulnerable to poor outcomes, supported by clear guidance. To encourage scale-ability and cost-effectiveness of interventions, the most vulnerable, high-risk children, should be targeted, including undernourished children. Intervention designs must also take into account existing health worker shortages and training levels, including for CHWs, and how any new tasks or personnel are incorporated into hospital and broader health system hierarchies and systems. Any such interventions will need to be evaluated in carefully designed studies, including tracking for unintended consequences. (© 2021. The Author(s).)
Databáze:	MEDLINE
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