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BMC Public Health

, 17:202

Global health


BackgroundThe government of Kenya launched its community health strategy in 2006 to improve certain aspects of its community health program. Under the strategy, community units CUs were established as level one of the Kenyan health system. A core member at this level is the community health worker CHW. The objective of this study was to assess the relationship among the performance of the CUs, the prevalence of childhood diarrhea and appropriate treatment for it by controlling individual and community-level factors.

MethodsThe main dataset used in this study was the 2011 Nyanza Province county-based Multiple Indicator Cluster Survey MICS. In addition, based on the list of community units in Nyanza Province, Kenya, we identified the area’s CUs and their performance. MICS data and data on CUs were merged using sub-location names. There were 17 individual and two community-level independent variables in this study. Bivariate analysis and a multilevel logistic regression were performed.

ResultsFactors significantly associated with a lower prevalence of diarrhea among children under five were the child’s increasing age, middle-aged household heads, children who received more attention, water treatment and rural versus urban area residence, while male children and highly performing CUs were significantly associated with a higher prevalence of diarrhea. In addition, middle wealth index, severity of diarrhea and middle- and high-CU performance were significantly associated with appropriate treatment for childhood diarrhea.

ConclusionsAlthough this study found that children living in areas of high CU performance were more likely to have diarrhea, these areas would have been identified as being more at risk for diarrhea prevalence and other health concerns, prioritized for the establishment of a CU and allocated more resources to improve the performance of CUs. A higher CU performance was significantly associated with the appropriate treatment. It was suggested that CHWs could have a positive effect on the community, as demonstrated and promoted by appropriate health-seeking behavior and treatment for childhood diarrhea.

KeywordsCommunity health worker Infectious disease Diarrhea Health-seeking behavior Multi-level analysis Kenya AbbreviationsCHCCommunity health committee

CHEWCommunity health extension worker

CHISCommunity health information system

CHSCommunity health strategy

CHWsCommunity health workers

CUCommunity unit

EAsEnumeration areas

KDHSKenya demographic health survey

KNBSKenya National Bureau of Statistics

MICSMultiple indicator cluster survey

MoHMinistry of health

MoPHSMinistry of public health and sanitation

NHPP IINational health sector strategic plan 2005–2010

PPSProbability proportional to size

Autor: Yoshito Kawakatsu - Junichi Tanaka - Kazuya Ogawa - Kenneth Ogendo - Sumihisa Honda


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