University of Michigan Medical School, Ann Arbor, Michigan, United States of America.
Department of Health Policy, Planning, and Management, School of Public Health, Makerere University, Kampala, Uganda.
PLoS One. 2021 Mar 26;16(3):e0244891. doi: 10.1371/journal.pone.0244891. eCollection 2021.
Although under-five (U5) mortality in Uganda has dropped over the past two decades, rates in urban slum neighborhoods remain high. As part of a broader verbal and social autopsy study of U5 deaths, this study explored the perspectives of volunteer community health workers, called Village Health Teams (VHTs), on why children under five in Kampala's informal settlements are still dying despite living in close proximity to nearby health facilities.
This exploratory, qualitative study took place between January and March 2020 in the Rubaga division of Kampala, Uganda. VHTs from the slums of Kawaala and Nankulabye parishes, both located near a large government health center, were interviewed by a trained local interviewer to determine their perceptions of barriers to care-seeking and attribution for U5 childhood deaths. All interviews were audiotaped, transcribed into English, imported into NVivo V 12.0 and thematically analyzed using the Attride-Stirling framework.
20 VHTs were interviewed, yielding two global themes, the first focusing on VHTs perceptions of their role in the community to promote positive health outcomes, and the second focusing on VHTs' perceptions of how prompt care-seeking is disincentivized. Within the latter theme, three inter-related sub-themes emerged: disincentives for care-seeking at the health system level, which can drive negative beliefs held by families about the health system, and in turn, drive incentives for alternative health behaviors, which manifest as "incentivized delays" to care-seeking.
This study illustrates VHT perspectives on the complex interactions between health system disincentives and the attitudes and behaviors of families with a sick child, as well as the reinforcing nature of these factors. Findings suggest a need for multi-pronged approaches that sensitize community members, engage community and health system leadership, and hold providers accountable for providing high-quality care. VHTs have enormous potential to foster improvement if given adequate resources, training, and support.
尽管乌干达在过去二十年中五岁以下儿童（U5）死亡率有所下降，但城市贫民窟地区的死亡率仍然很高。作为 U5 死亡广义口头和社会尸检研究的一部分，本研究探讨了志愿者社区卫生工作者（称为乡村卫生团队（VHT））对坎帕拉非正规住区 5 岁以下儿童尽管居住在附近卫生设施附近仍死亡的看法。
这项探索性的定性研究于 2020 年 1 月至 3 月在乌干达坎帕拉的 Rubaga 区进行。来自 Kawaala 和 Nankulabye 教区的贫民窟的 VHT 接受了一名经过培训的当地访谈者的访谈，以确定他们对寻求护理障碍的看法以及对 U5 儿童死亡的归因。所有访谈均进行录音、转录为英语、导入 NVivo V 12.0 并使用 Attride-Stirling 框架进行主题分析。
对 20 名 VHT 进行了访谈，得出了两个总体主题，第一个主题侧重于 VHT 对其在社区中促进积极健康结果的作用的看法，第二个主题侧重于 VHT 对寻求护理的激励因素如何受到抑制的看法。在后一主题中，出现了三个相互关联的子主题：卫生系统层面上的激励因素抑制了寻求护理的动机，这会导致家庭对卫生系统产生负面看法，进而激励寻求替代医疗行为，这表现为寻求护理的“激励性延迟”。
本研究说明了 VHT 对卫生系统激励因素与患病儿童家庭的态度和行为之间复杂相互作用的看法，以及这些因素的强化性质。研究结果表明，需要采取多管齐下的方法，使社区成员敏感化，使社区和卫生系统领导层参与，并追究提供者提供高质量护理的责任。如果给予 VHT 足够的资源、培训和支持，他们就有巨大的潜力来促进改进。
