Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
Malar J. 2013 Aug 23;12:292. doi: 10.1186/1475-2875-12-292.
Malaria and other communicable diseases remain major threats in developing countries. In Cambodia, village malaria workers (VMWs) have been providing malaria control services in remote villages to cope with the disease threats. In 2009, the VMW project integrated child health services into the original malaria control services. However, little has been studied about the utilization of VMWs' child health services. This study aimed to identify determinants of caregivers' VMW service utilization for childhood illness and caregivers' knowledge of malaria management.
A cross-sectional study was conducted in 36 VMW villages of Kampot and Kampong Thom provinces in July-September 2012. An equal number of VMW villages with malaria control services only (M) and those with malaria control plus child health services (M+C) were selected from each province. Using structured questionnaires, 800 caregivers of children under five and 36 VMWs, one of the two VMWs who was providing VMW services in each study village were interviewed.
Among the caregivers, 23% in M villages and 52% in M+C villages utilized VMW services for childhood illnesses. Determinants of caregivers' utilization of VMWs in M villages included their VMWs' length of experience (AOR = 11.80, 95% confidence interval [CI] = 4.46-31.19) and VMWs' service quality (AOR = 2.04, CI = 1.01-4.11). In M+C villages, VMWs' length of experience (AOR = 2.44, CI = 1.52-3.94) and caregivers' wealth index (AOR = 0.35, CI = 0.18-0.68) were associated with VMW service utilization. Meanwhile, better service quality of VMWs (AOR = 3.21, CI = 1.34-7.66) and caregivers' literacy (AOR = 9.91, CI = 4.66-21.05) were positively associated with caregivers' knowledge of malaria management.
VMWs' service quality and length of experience are important determinants of caregivers' utilization of VMWs' child health services and their knowledge of malaria management. Caregivers are seeking VMWs' support for childhood illnesses even if they are providing only malaria control services. This underlines the importance of scaling-up VMWs' capacity by adding child health services of good quality, which will result in improving child health status in remote Cambodia.
疟疾和其他传染病仍然是发展中国家的主要威胁。在柬埔寨，乡村疟疾工作者（VMW）一直在偏远村庄提供疟疾控制服务，以应对疾病威胁。2009 年，VMW 项目将儿童卫生服务纳入原有的疟疾控制服务。然而，对于 VMW 儿童卫生服务的利用情况，研究甚少。本研究旨在确定照料者利用 VMW 服务治疗儿童疾病的决定因素和照料者对疟疾管理的认识。
2012 年 7 月至 9 月，在柬埔寨贡布和磅通省的 36 个 VMW 村庄进行了一项横断面研究。从每个省各选择疟疾控制服务仅（M）和疟疾控制加儿童卫生服务（M+C）的同等数量的 VMW 村庄。使用结构化问卷，对 800 名 5 岁以下儿童的照料者和 36 名 VMW 进行了访谈，他们是每个研究村庄提供 VMW 服务的两名 VMW 中的一名。
在照料者中，M 村的 23%和 M+C 村的 52%利用 VMW 服务治疗儿童疾病。M 村照料者利用 VMW 的决定因素包括 VMW 的工作经验（OR = 11.80，95%置信区间[CI] = 4.46-31.19）和 VMW 的服务质量（OR = 2.04，CI = 1.01-4.11）。在 M+C 村，VMW 的工作经验（OR = 2.44，CI = 1.52-3.94）和照料者的财富指数（OR = 0.35，CI = 0.18-0.68）与 VMW 服务利用有关。同时，VMW 服务质量较好（OR = 3.21，CI = 1.34-7.66）和照料者识字率（OR = 9.91，CI = 4.66-21.05）与照料者对疟疾管理的认识呈正相关。
VMW 的服务质量和工作经验是照料者利用 VMW 儿童卫生服务和他们对疟疾管理认识的重要决定因素。即使只提供疟疾控制服务，照料者也在寻求 VMW 对儿童疾病的支持。这强调了通过增加高质量的儿童卫生服务来扩大 VMW 能力的重要性，这将有助于改善柬埔寨偏远地区的儿童健康状况。
