Department of Community Health, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda.
Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, Boston, MA 02114, USA.
Int Health. 2024 Mar 4;16(2):194-199. doi: 10.1093/inthealth/ihad039.
In integrated community case management (iCCM) care, community health workers (CHWs) provide home-based management of fever, diarrhea and fast breathing for children aged <5 y. The iCCM protocol recommends that children with danger signs for severe illness are referred by CHWs to health facilities within their catchment area. This study examines the management of danger signs by CHWs implementing iCCM in a rural context.
A retrospective observational study that examined clinical records for all patients with danger signs evaluated by CHWs from March 2014 to December 2018 was conducted.
In total, 229 children aged <5 y had been recorded as having a danger sign during 2014-2018. Of these children, 56% were males with a mean age of 25 (SD 16.9) mo, among whom 78% were referred by the CHWs as per the iCCM protocol. The age category of 12 to 35 mo had the highest numbers of prereferred and referred cases (54% and 46%, respectively).
CHWs play a key role in early symptomatic detection, prereferral treatment and early referral of children aged <5 y. Danger signs among children aged <5 y, if left untreated, can result in death. A high proportion of the children with danger signs were referred as per the iCCM protocol. Continuous CHW training is emphasized to reduce the number of referral cases that are missed. More studies need to focus on children aged 12-35 mo and why they are the most referred category. Policymakers should occasionally revise iCCM guidelines to detail the types of danger signs and how CHWs can address these.
在综合社区病例管理（iCCM）护理中，社区卫生工作者（CHW）为年龄<5 岁的儿童提供家庭管理发热、腹泻和呼吸急促。iCCM 方案建议，CHW 应将有严重疾病危险征象的儿童转介至其服务范围内的卫生机构。本研究在农村背景下考察了实施 iCCM 的 CHW 对危险征象的管理。
对 2014 年 3 月至 2018 年 12 月期间所有由 CHW 评估的有危险征象的患者的临床记录进行了回顾性观察研究。
在 2014-2018 年间，共有 229 名年龄<5 岁的儿童记录有危险征象。这些儿童中，56%为男性，平均年龄为 25（SD 16.9）个月，其中 78%按 iCCM 方案由 CHW 转介。12-35 个月的年龄组有最多的预转介和转介病例（分别为 54%和 46%）。
CHW 在早期症状检测、预转介治疗和<5 岁儿童的早期转介方面发挥着关键作用。<5 岁儿童的危险征象如果得不到治疗，可能导致死亡。按 iCCM 方案，有相当比例的有危险征象的儿童得到了转介。强调要对 CHW 进行持续培训，以减少漏诊的转介病例数。更多的研究需要关注 12-35 个月的儿童，以及为什么他们是最常被转介的类别。政策制定者应定期修订 iCCM 指南，详细说明危险征象的类型以及 CHW 如何处理这些征象。
