Factors influencing community integrated management to childhood illness in rural areas

Van Zyl, Marjorie Alice (2013-03)

Thesis (MCurr)--Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: Child mortality is a worldwide problem and, according to the World Health Organization (WHO), 8,1 million children under the age of five years die each year. The Millennium Development Goals focus on the worldwide reduction in child mortality by two-thirds between 2000 and 2015. Several studies show that worldwide Community Integrated Management of Childhood Illness (CIMCI) interventions by community care workers (CCWs) have a positive effect on child health. The goal of this study was to determine the factors influencing CIMCI in the rural areas of the West Coast District in the Western Cape of South Africa. The objectives for this study were to determine the factors influencing CIMCI carried out in rural areas by the CCWs, which were identified as: • having working hours that are adequate for such a comprehensive service package; • being adequately trained; • having adequate knowledge of the “16 Key Family Practices” of CIMCI; • having equipment that is adequate for the execution of their daily duties; • being able to cope with the challenges of working in rural and remote areas; and • receiving adequate supervision and support related to CIMCI. A descriptive, non-experimental exploratory research design with a quantitative approach was applied. The target population (N = 270) consisted of CCWs who are funded by the Provincial Government of the Western Cape (PGWC) in the West Coast District. For this study a response rate of 257 (95,18%) was obtained. Data was collected personally by the researcher with a self-administered questionnaire. The data was analysed with the assistance of a statistician and are presented in histograms and frequency tables. The participants were tested on their knowledge of CIMCI, and more than half of them achieved an average score that was not satisfactory. Statistically significant correlations were found between the participants’ total score achieved and highest school grade passed (p < 0. 01); their level of Expanded Public Works Programme (EPWP) training (p < 0.01); their attendance of the CIMCI five-day course (p < 0.00); and if they had done a refresher course on CIMCI (p < 0.00). The total score was also shown by the Mann-Whitney U test (p < 0.01) to have a direct relationship with whether they had received any health-related training after school. The conclusion that can be drawn is that the higher the level of education of the CCWs, the better their knowledge of CIMCI. This could also improve their work performance. The recommendations arising from this study include that CIMCI training should be standardised to ensure that the CCWs have adequate knowledge. The current policy on community-based services (CBS) of the Provincial Government Western Cape Department of Health should also be standardised to ensure adequate working hours, training, equipment and supervision, and to take into consideration the challenges of working in rural areas. In conclusion, should these recommendations be implemented, CIMCI will have a huge, positive impact on child morbidity and mortality. CCWs will be ensured adequate working hours in relation to their workload, and will receive adequate training, equipment and supervision. This will reduce the challenges CCWs face and strengthen their services in rural areas.

AFRIKAANSE OPSOMMING: Kindersterftes is wêreldwyd ’n probleem en volgens die Wêreldgesondheidsorganisasie sterf 8,1 miljoen kinders onder die ouderdom van vyf jaar elke jaar. Die Millenniumontwikkelings-doelwitte fokus daarop om kindersterftes tussen 2000 en 2015 met twee-derdes te verminder. Verskeie studies toon dat intervensies deur middel van Gemeenskapsgeïntegreerde Bestuur van Kindersiektes deur gemeenskapsorgwerkers die wêreld oor ’n positiewe effek op kindergesondheid het. Die doel van hierdie studie was om die faktore te bepaal wat Gemeenskapsgeïntegreerde Bestuur van Kindersiektes in die landelike gebiede van die Weskusdistrik in die Wes-Kaap van Suid-Afrika beïnvloed. Die doelwitte vir hierdie studie was om die faktore te bepaal wat beïnvloed hoe Gemeenskapsgeïntegreerde Bestuur van Kindersiektes in die landelike gebiede deur gemeenskapsorgwerkers uitgevoer word, wat soos volg uiteengesit is: • werksure wat voldoende is vir die omvattende pakket dienste wat aangebied word; • dat hulle voldoende opgelei is; • dat hulle voldoende kennis het van die “16 Sleutel Familiepraktyke” van Gemeenskapsgeïntegreerde Bestuur van Kindersiektes; • dat hulle die nodige toerusting besit wat voldoende is vir die uitvoer van hulle daaglikse pligte; • dat hulle raad weet met die uitdagings van werk in landelike en afgeleë gebiede; en • dat hulle voldoende toesig en ondersteuning met betrekking tot Gemeenskapsgeïntegreerde Bestuur van Kindersiektes ontvang. ’n Beskrywende, nie-eksperimentele verkennende navorsingsontwerp met ’n kwantitatiewe benadering is gebruik. Die teikenbevolking (N = 270) het bestaan uit gemeenskapsorgwerkers wat deur die Provinsiale Regering van die Wes-Kaap in die Weskusdistrik befonds word. Vir hierdie studie is ’n responstempo van 257 (95,18%) verkry. Die data is persoonlik deur die navorser deur middel van ’n selftoepastoets ingesamel. Die data is met behulp van ’n statistikus geanaliseer en word deur middel van histogramme en frekwensietabelle voorgestel. Die deelnemers is getoets op grond van hulle kennis van Gemeenskapsgeïntegreerde Bestuur van Kindersiektes, en meer as die helfte het ’n gemiddelde telling behaal wat nie bevredigend is nie. Statisties beduidende korrelasies is verkry tussen die deelnemers se totale telling en die hoogste skoolgraad behaal (p < 0.01); hulle vlak van Expanded Public Works Programme (EPWP) opleiding (p < 0.01); hulle bywoning van die vyfdaagse Gemeenskapsgeïntegreerde Bestuur van Kindersiektes kursus (p < 0.00); en of hulle ’n opknappingskursus oor Gemeenskapsgeïntegreerde Bestuur van Kindersiektes gedoen het (p < 0.00). Die totale telling is deur die Mann-Whitney U-toets (p < 0.01) gewys om ’n direkte verwantskap te hê met of hulle enige gesondheidsverwante opleiding ná skool ondergaan het. Die gevolgtrekking is dat hoe hoër die gemeenskapsorgwerkers se vlak van opvoeding, hoe beter hulle kennis van Gemeenskapsgeïntegreerde Bestuur van Kindersiektes. Dit sou ook hulle werkverrigting kon verbeter. Die aanbevelings wat uit hierdie studie spruit, sluit in dat Gemeenskapsgeïntegreerde Bestuur van Kindersiektes-opleiding gestandaardiseer moet word om te verseker dat gemeenskapsorgwerkrs voldoende kennis het. Die huidige beleid van die Provinsiale Regering van die Wes-Kaap oor gemeenskapsgebaseerde dienste moet ook gestandaardiseer word om te verseker dat hulle toereikende werksure, opleiding, toerusting en toesig het, en om die uitdagings van werk in landelike gebiede in ag te neem. Ter afsluiting: sou hierdie aanbevelings geïmplementeer word, sal Gemeenskapsgeïntegreerde Bestuur van Kindersiektes ‘n groot, positiewe impak op kindermorbiditeit en kindersterftes hê. Gemeenskapsorgwerkers sal van voldoende werksure met betrekking tot hulle werklas verseker wees, en sal voldoende opleiding, toerusting en toesig ontvang. Dit sal die uitdagings verminder waarvoor hulle te staan kom en hulle dienste in landelike gebiede versterk.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/80383
This item appears in the following collections: