Feasibility of engaging "Village Doctors" in the Community-based Integrated Management of Childhood Illness (C-IMCI): experience from rural Bangladesh

Sk Masum Billah, Dm Emdadul Hoque, Muntasirur Rahman, Aliki Christou, Ngatho Samuel Mugo, Khadija Begum, Tazeen Tahsina, Qazi Sadeq Ur Rahman, Enayet K. Chowdhury, Twaha Mansurun Haque, Rasheda Khanam, Ashraf Siddik, Jennifer Bryce, Robert E Black, Shams El Arifeen

Research output: Contribution to journalArticle

Abstract

Results: Village doctors' knowledge on the assessment and management of childhood illnesses improved significantly after training; knowledge of danger signs of pneumonia and severe pneumonia increased from 39% to 78% (P < 0.0001) and from 17% to 47% (P < 0.0001) respectively. Knowledge on the correct management of severe pneumonia increased from 62% to 84% (P < 0.0001), and diarrhoea management improved from 65% to 82% (P = 0.0005). Village doctors retained this knowledge over three years except for home management of pneumonia. No significant differences were observed in prescribing practices for diarrhoea and pneumonia management between trained and untrained village doctors. Village doctors were accessible to communities; 76% had cell phones; almost all attended home calls, and did not charge consultation fees. Nearly all (91%) received incentives from pharmaceutical representatives.

Conclusions: Village doctors have the capacity to learn and retain knowledge on the appropriate management of under-five illnesses. Training alone did not improve inappropriate antibiotic prescription practices. Intensive monitoring and efforts to target key actors including pharmaceutical companies, which influence village doctors dispensing practices, and implementation of mechanisms to track and regulate these providers are necessary for future engagement in management of under-five childhood illnesses.

Background: Informal health care providers particularly "village doctors" are the first point of care for under-five childhood illnesses in rural Bangladesh. We engaged village doctors as part of the Multi-Country Evaluation (MCE) of Integrated Management of Childhood Illness (IMCI) and assessed their management of sick under-five children before and after a modified IMCI training, supplemented with ongoing monitoring and supportive supervision.

Methods: In 2003-2004, 144 village doctors across 131 IMCI intervention villages in Matlab Bangladesh participated in a two-day IMCI training; 135 of which completed pre- and post-training evaluation tests. In 2007, 38 IMCI-trained village doctors completed an end-of-project knowledge retention test. Village doctor prescription practices for sick under-five children were examined through household surveys, and routine monitoring visits. In-depth interviews were done with mothers seeking care from village doctors.

Original languageEnglish (US)
Number of pages1
JournalJournal of Global Health
Volume8
Issue number2
DOIs
StatePublished - Dec 1 2018

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Bangladesh
Pneumonia
Diarrhea
Point-of-Care Systems
Inappropriate Prescribing
Cell Phones
Fees and Charges
Pharmaceutical Preparations
Health Personnel
Prescriptions
Motivation
Patient Care
Referral and Consultation
Mothers
Interviews
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Feasibility of engaging "Village Doctors" in the Community-based Integrated Management of Childhood Illness (C-IMCI) : experience from rural Bangladesh. / Billah, Sk Masum; Hoque, Dm Emdadul; Rahman, Muntasirur; Christou, Aliki; Mugo, Ngatho Samuel; Begum, Khadija; Tahsina, Tazeen; Rahman, Qazi Sadeq Ur; Chowdhury, Enayet K.; Haque, Twaha Mansurun; Khanam, Rasheda; Siddik, Ashraf; Bryce, Jennifer; Black, Robert E; El Arifeen, Shams.

In: Journal of Global Health, Vol. 8, No. 2, 01.12.2018.

Research output: Contribution to journalArticle

Billah, SM, Hoque, DE, Rahman, M, Christou, A, Mugo, NS, Begum, K, Tahsina, T, Rahman, QSU, Chowdhury, EK, Haque, TM, Khanam, R, Siddik, A, Bryce, J, Black, RE & El Arifeen, S 2018, 'Feasibility of engaging "Village Doctors" in the Community-based Integrated Management of Childhood Illness (C-IMCI): experience from rural Bangladesh', Journal of Global Health, vol. 8, no. 2. https://doi.org/10.7189/jogh.08.020413
Billah, Sk Masum ; Hoque, Dm Emdadul ; Rahman, Muntasirur ; Christou, Aliki ; Mugo, Ngatho Samuel ; Begum, Khadija ; Tahsina, Tazeen ; Rahman, Qazi Sadeq Ur ; Chowdhury, Enayet K. ; Haque, Twaha Mansurun ; Khanam, Rasheda ; Siddik, Ashraf ; Bryce, Jennifer ; Black, Robert E ; El Arifeen, Shams. / Feasibility of engaging "Village Doctors" in the Community-based Integrated Management of Childhood Illness (C-IMCI) : experience from rural Bangladesh. In: Journal of Global Health. 2018 ; Vol. 8, No. 2.
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AU - Billah, Sk Masum

AU - Hoque, Dm Emdadul

AU - Rahman, Muntasirur

AU - Christou, Aliki

AU - Mugo, Ngatho Samuel

AU - Begum, Khadija

AU - Tahsina, Tazeen

AU - Rahman, Qazi Sadeq Ur

AU - Chowdhury, Enayet K.

AU - Haque, Twaha Mansurun

AU - Khanam, Rasheda

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AU - Bryce, Jennifer

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AU - El Arifeen, Shams

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N2 - Results: Village doctors' knowledge on the assessment and management of childhood illnesses improved significantly after training; knowledge of danger signs of pneumonia and severe pneumonia increased from 39% to 78% (P < 0.0001) and from 17% to 47% (P < 0.0001) respectively. Knowledge on the correct management of severe pneumonia increased from 62% to 84% (P < 0.0001), and diarrhoea management improved from 65% to 82% (P = 0.0005). Village doctors retained this knowledge over three years except for home management of pneumonia. No significant differences were observed in prescribing practices for diarrhoea and pneumonia management between trained and untrained village doctors. Village doctors were accessible to communities; 76% had cell phones; almost all attended home calls, and did not charge consultation fees. Nearly all (91%) received incentives from pharmaceutical representatives.Conclusions: Village doctors have the capacity to learn and retain knowledge on the appropriate management of under-five illnesses. Training alone did not improve inappropriate antibiotic prescription practices. Intensive monitoring and efforts to target key actors including pharmaceutical companies, which influence village doctors dispensing practices, and implementation of mechanisms to track and regulate these providers are necessary for future engagement in management of under-five childhood illnesses.Background: Informal health care providers particularly "village doctors" are the first point of care for under-five childhood illnesses in rural Bangladesh. We engaged village doctors as part of the Multi-Country Evaluation (MCE) of Integrated Management of Childhood Illness (IMCI) and assessed their management of sick under-five children before and after a modified IMCI training, supplemented with ongoing monitoring and supportive supervision.Methods: In 2003-2004, 144 village doctors across 131 IMCI intervention villages in Matlab Bangladesh participated in a two-day IMCI training; 135 of which completed pre- and post-training evaluation tests. In 2007, 38 IMCI-trained village doctors completed an end-of-project knowledge retention test. Village doctor prescription practices for sick under-five children were examined through household surveys, and routine monitoring visits. In-depth interviews were done with mothers seeking care from village doctors.

AB - Results: Village doctors' knowledge on the assessment and management of childhood illnesses improved significantly after training; knowledge of danger signs of pneumonia and severe pneumonia increased from 39% to 78% (P < 0.0001) and from 17% to 47% (P < 0.0001) respectively. Knowledge on the correct management of severe pneumonia increased from 62% to 84% (P < 0.0001), and diarrhoea management improved from 65% to 82% (P = 0.0005). Village doctors retained this knowledge over three years except for home management of pneumonia. No significant differences were observed in prescribing practices for diarrhoea and pneumonia management between trained and untrained village doctors. Village doctors were accessible to communities; 76% had cell phones; almost all attended home calls, and did not charge consultation fees. Nearly all (91%) received incentives from pharmaceutical representatives.Conclusions: Village doctors have the capacity to learn and retain knowledge on the appropriate management of under-five illnesses. Training alone did not improve inappropriate antibiotic prescription practices. Intensive monitoring and efforts to target key actors including pharmaceutical companies, which influence village doctors dispensing practices, and implementation of mechanisms to track and regulate these providers are necessary for future engagement in management of under-five childhood illnesses.Background: Informal health care providers particularly "village doctors" are the first point of care for under-five childhood illnesses in rural Bangladesh. We engaged village doctors as part of the Multi-Country Evaluation (MCE) of Integrated Management of Childhood Illness (IMCI) and assessed their management of sick under-five children before and after a modified IMCI training, supplemented with ongoing monitoring and supportive supervision.Methods: In 2003-2004, 144 village doctors across 131 IMCI intervention villages in Matlab Bangladesh participated in a two-day IMCI training; 135 of which completed pre- and post-training evaluation tests. In 2007, 38 IMCI-trained village doctors completed an end-of-project knowledge retention test. Village doctor prescription practices for sick under-five children were examined through household surveys, and routine monitoring visits. In-depth interviews were done with mothers seeking care from village doctors.

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