The Effectiveness of Health Volunteers in Community Based Tuberculosis Care in Meru County, Kenya

Abstract

Background: Community Health Volunteers(CHVs) are an integral human resource in Health Care System specifically in resource limited settings.  Despite the adoption of the concept of Community Based Tuberculosis Care(CBTC) in 1994, lack of meaningful involvement of the affected communities using their own resource people in implementing all aspects of CBTC had often lead to unacceptable targets in Meru County community tuberculosis response [6].

Objectives: The general objective of the study was to assess the effectiveness of household visits by CHVs on Community Based Tuberculosis Care in Meru County, Kenya. That was a descriptive cross sectional study to collect quantitative data influencing Community Based Tuberculosis Care implementation for 3 months from March 2018 to May 2018.

Methodology: A semi - structured questionnaire was used to collect data from 345 sampled respondents in Meru County by research assistants, who were trained on the study objectives. Semi-structured questionnaire was used to collect data on demographic characteristic of respondents and the role of Community Health Volunteers which influenced the effectiveness of Community Based Tuberculosis Care. Data was analyzed using SPSS version 24.0 and STATA version 13.0 statistical packages. The study findings were presented in form of tables and figures. Majority of the 345 respondents who were included in the study were; male 267(77.4%) and female 78(22.6%). Most of the respondents 240(69.75%) resided in rural areas and 120(29.25%) resided in urban areas. Majority of the respondents were aged between 18-36 years 195(56.5%).

Results:  The number of respondents who were visited by the Community Health Volunteers after a month of initiation of treatment was  142(41.2%). The quality of health education offered by the CHVs was acceptable by majority of the respondents 334(96.8%). Most of them were  aware of Community Based Tuberculosis Care 233(67.5%) and the community was mainly engaged during National Tuberculosis day 207(88.9%). The association between Community Based Care and Community Outreach Services did not show a strong association (p-0.055). The effectiveness
of CBTC increased with the frequency of Outreach Services on monthly basis became more effective at OR-1.00 compared to quarterly and annually at OR -0.29,OR-0.21 respectively at a confidence interval of 95% (CI 0.04-1.90). Capacity building at the community level was to empower the  community with individual household taking responsibility of their own health.

Conclusion: Community based tuberculosis care can be more effective with increased frequency of outreach services at the community level.  Community Health Volunteers can help bridge the gap between community and health care systems. Training of more community health volunteers  on community based tuberculosis can help reach more households members to create awareness on tuberculosis.

Recommendation: Strategies of retention of Community Health Volunteers should be put in place to ensure sustainability. Training of CHVs involved in community activities on basic modules of community based tuberculosis care can improve effectiveness

Keywords: Community Health Volunteer, effectiveness, household visits.