Strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya
Abstract Background Undernourished children in low- and middle-income countries remain at elevated risk of death following hospital discharge, even when treated during hospitalisation using World Health Organisation recommended guidelines. The role of community health workers (CHWs) in supporting po...
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2021
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oai:doaj.org-article:239087859392456ca3eec1a743a5de562021-11-21T12:06:06ZStrengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya10.1186/s12913-021-07209-21472-6963https://doaj.org/article/239087859392456ca3eec1a743a5de562021-11-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07209-2https://doaj.org/toc/1472-6963Abstract Background Undernourished children in low- and middle-income countries remain at elevated risk of death following hospital discharge, even when treated during hospitalisation using World Health Organisation recommended guidelines. The role of community health workers (CHWs) in supporting post-discharge recovery to improve outcomes has not been adequately explored. Methods This paper draws on qualitative research conducted as part of the Childhood Acute Illnesses and Nutrition (CHAIN) Network in Bangladesh and Kenya. We interviewed family members of 64 acutely ill children admitted across four hospitals (a rural and urban hospital in each country). 27 children had severe wasting or kwashiorkor on admission. Family members were interviewed in their homes soon after discharge, and up to three further times over the following six to fourteen months. These data were supplemented by observations in facilities and homes, key informant interviews with CHWs and policy makers, and a review of relevant guidelines. Results Guidelines suggest that CHWs could play a role in supporting recovery of undernourished children post-discharge, but the mechanisms to link CHWs into post-discharge support processes are not specified. Few families we interviewed reported any interactions with CHWs post-discharge, especially in Kenya, despite our data suggesting that opportunities for CHWs to assist families post-discharge include providing context sensitive information and education, identification of danger signs, and supporting linkages with community-based services and interventions. Although CHWs are generally present in communities, challenges they face in conducting their roles include unmanageable workloads, few incentives, lack of equipment and supplies and inadequate support from supervisors and some community members. Conclusion A multi-pronged approach before or on discharge is needed to strengthen linkages between CHWs and children vulnerable to poor outcomes, supported by clear guidance. To encourage scale-ability and cost-effectiveness of interventions, the most vulnerable, high-risk children, should be targeted, including undernourished children. Intervention designs must also take into account existing health worker shortages and training levels, including for CHWs, and how any new tasks or personnel are incorporated into hospital and broader health system hierarchies and systems. Any such interventions will need to be evaluated in carefully designed studies, including tracking for unintended consequences.Rita Wanjuki NjeruMd. Fakhar UddinScholastica Mutheu ZakayoGladys SangaAnderson CharoMd. Aminul IslamMd. Alamgir HossainMary KimaniMercy Kadzo MwadhiMichael OgutuMohammod Jobayer ChistiTahmeed AhmedJudd L. WalsonJames A. BerkleyCaroline JonesSally TheobaldKui MurayaHaribondhu SarmaSassy MolyneuxBMCarticleCommunity health workersUndernutritionPost-hospital dischargeChildrenAcute illnessPublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-14 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
Community health workers Undernutrition Post-hospital discharge Children Acute illness Public aspects of medicine RA1-1270 |
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Community health workers Undernutrition Post-hospital discharge Children Acute illness Public aspects of medicine RA1-1270 Rita Wanjuki Njeru Md. Fakhar Uddin Scholastica Mutheu Zakayo Gladys Sanga Anderson Charo Md. Aminul Islam Md. Alamgir Hossain Mary Kimani Mercy Kadzo Mwadhi Michael Ogutu Mohammod Jobayer Chisti Tahmeed Ahmed Judd L. Walson James A. Berkley Caroline Jones Sally Theobald Kui Muraya Haribondhu Sarma Sassy Molyneux Strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya |
| description |
Abstract Background Undernourished children in low- and middle-income countries remain at elevated risk of death following hospital discharge, even when treated during hospitalisation using World Health Organisation recommended guidelines. The role of community health workers (CHWs) in supporting post-discharge recovery to improve outcomes has not been adequately explored. Methods This paper draws on qualitative research conducted as part of the Childhood Acute Illnesses and Nutrition (CHAIN) Network in Bangladesh and Kenya. We interviewed family members of 64 acutely ill children admitted across four hospitals (a rural and urban hospital in each country). 27 children had severe wasting or kwashiorkor on admission. Family members were interviewed in their homes soon after discharge, and up to three further times over the following six to fourteen months. These data were supplemented by observations in facilities and homes, key informant interviews with CHWs and policy makers, and a review of relevant guidelines. Results Guidelines suggest that CHWs could play a role in supporting recovery of undernourished children post-discharge, but the mechanisms to link CHWs into post-discharge support processes are not specified. Few families we interviewed reported any interactions with CHWs post-discharge, especially in Kenya, despite our data suggesting that opportunities for CHWs to assist families post-discharge include providing context sensitive information and education, identification of danger signs, and supporting linkages with community-based services and interventions. Although CHWs are generally present in communities, challenges they face in conducting their roles include unmanageable workloads, few incentives, lack of equipment and supplies and inadequate support from supervisors and some community members. Conclusion A multi-pronged approach before or on discharge is needed to strengthen linkages between CHWs and children vulnerable to poor outcomes, supported by clear guidance. To encourage scale-ability and cost-effectiveness of interventions, the most vulnerable, high-risk children, should be targeted, including undernourished children. Intervention designs must also take into account existing health worker shortages and training levels, including for CHWs, and how any new tasks or personnel are incorporated into hospital and broader health system hierarchies and systems. Any such interventions will need to be evaluated in carefully designed studies, including tracking for unintended consequences. |
| format |
article |
| author |
Rita Wanjuki Njeru Md. Fakhar Uddin Scholastica Mutheu Zakayo Gladys Sanga Anderson Charo Md. Aminul Islam Md. Alamgir Hossain Mary Kimani Mercy Kadzo Mwadhi Michael Ogutu Mohammod Jobayer Chisti Tahmeed Ahmed Judd L. Walson James A. Berkley Caroline Jones Sally Theobald Kui Muraya Haribondhu Sarma Sassy Molyneux |
| author_facet |
Rita Wanjuki Njeru Md. Fakhar Uddin Scholastica Mutheu Zakayo Gladys Sanga Anderson Charo Md. Aminul Islam Md. Alamgir Hossain Mary Kimani Mercy Kadzo Mwadhi Michael Ogutu Mohammod Jobayer Chisti Tahmeed Ahmed Judd L. Walson James A. Berkley Caroline Jones Sally Theobald Kui Muraya Haribondhu Sarma Sassy Molyneux |
| author_sort |
Rita Wanjuki Njeru |
| title |
Strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya |
| title_short |
Strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya |
| title_full |
Strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya |
| title_fullStr |
Strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya |
| title_full_unstemmed |
Strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya |
| title_sort |
strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in bangladesh and kenya |
| publisher |
BMC |
| publishDate |
2021 |
| url |
https://doaj.org/article/239087859392456ca3eec1a743a5de56 |
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