Daily life and challenges faced by households with permanent childhood developmental disability in rural Tanzania: a qualitative study

Severe developmental disability in children affects the life of the child and entire household. We conducted a qualitative study to understand how caregivers manage severe developmental disabilities in children in rural Africa. Families and six children (out of 15 children) who had serious permanent sequelae from a cerebral infection in Handeni, Tanzania, were contacted and invited to a workshop to recount their experience living with severe developmental disabilities. After consent, individual interviews were conducted first through recording of individual digital stories and then through individual semi-structured interviews. Pre-determined key categories were used to analyse the data. Our results showed that developmental disabilities required constant care and reduced the autonomy of the children. Schooling had not been attempted or was halted because of learning problems or inability to meet specialized school costs. Parents were under constant physical, emotional and financial stress. Their occupational earnings decreased. Some families sold their assets to survive. Others began to rely on relatives. Understanding the consequences of developmental disability helps to identify where social support should be focused and improved

Quantifying and Valuing Community Health Worker Time in Improving Access to Malaria Diagnosis and Treatment

This work was supported by the UNICEF/UNDP/World Bank/WHO/Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland (project ID number A80553 [Burkina Faso]; A80550 [Nigeria]; and A80556 [Uganda]) through funds made available by the European Commission (FP7) for research to improve community access to health interventions in Africa

Impact of improving community-based access to malaria diagnosis and treatment on household costs

Background: Community health workers (CHWs) were trained in Burkina Faso, Nigeria and Uganda to diagnose febrile children using malaria rapid diagnostic tests (RDTs), treat positive malaria cases with artemisinin combination treatment (ACTs) and those who could not take oral medicines with rectal artesunate. We quantified the impact of this intervention on private household costs for childhood febrile illness. Methods: Households with recent febrile illness in a young child in previous two weeks were selected randomly before and during the intervention and data obtained on household costs for the illness episode. Household costs included consultation fees, registration costs, user fees, diagnosis, bed, drugs, food and transport costs. Private household costs per episode before and during the intervention were compared. The intervention’s impact on household costs per episode was calculated and projected to district-wide impacts on household costs. Results: Use of CHW increased from 35% of illness episodes before the intervention to 50% during the intervention (p<0.0001) and total household costs per episode decreased significantly in each country from 4.36 to 1.54 dollars in Burkina Faso, from 3.90 to 2.04 dollars in Nigeria and from 4.46 to 1.42 in dollars Uganda (all p<0.0001). There was no difference in the time used by the child’s caregiver to care for a sick child (59% before intervention vs. 51% during intervention spent 2 days or less). Using the most recent population figures for each study district, we estimate that the intervention could save households a total of 29,965, 254,268 and 303,467 dollars, respectively in the study districts in Burkina Faso, Nigeria and Uganda. Conclusions: Improving access to malaria diagnostics and treatments in malaria endemic areas substantially reduces private household costs. The key challenge is to develop and strengthen community human resources to deliver the intervention, and ensure adequate supplies of commodities and supervision. We demonstrate feasibility and benefit to populations living in difficult circumstances

Impact of Improving Community-Based Access to Malaria Diagnosis and Treatment on Household Costs

Financial support. This work was supported by UNICEF/UNDP/World Bank/WHO/Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland (project ID numbers A80553; [;Burkina Faso], A80550; [;Nigeria], and A80556; [Uganda]) through funds made available by the European Commission (FP7) for research to improved community access to health interventions in Africa. Supplement sponsorship. This article appears as part of the supplement “Malaria in Highly Endemic Areas: Improving Control Through Diagnosis, Artemisinin Combination Therapy, and Rectal Artesunate Treatment,” sponsored by the World Health Organization

Impact of improving community-based access to malaria diagnosis and treatment on household costs

Background: Community health workers (CHWs) were trained in Burkina Faso, Nigeria and Uganda to diagnose febrile children using malaria rapid diagnostic tests (RDTs), treat positive malaria cases with artemisinin combination treatment (ACTs) and those who could not take oral medicines with rectal artesunate. We quantified the impact of this intervention on private household costs for childhood febrile illness. Methods: Households with recent febrile illness in a young child in previous two weeks were selected randomly before and during the intervention and data obtained on household costs for the illness episode. Household costs included consultation fees, registration costs, user fees, diagnosis, bed, drugs, food and transport costs. Private household costs per episode before and during the intervention were compared. The intervention’s impact on household costs per episode was calculated and projected to district-wide impacts on household costs. Results: Use of CHW increased from 35% of illness episodes before the intervention to 50% during the intervention (p<0.0001) and total household costs per episode decreased significantly in each country from 4.36 to 1.54 dollars in Burkina Faso, from 3.90 to 2.04 dollars in Nigeria and from 4.46 to 1.42 in dollars Uganda (all p<0.0001). There was no difference in the time used by the child’s caregiver to care for a sick child (59% before intervention vs. 51% during intervention spent 2 days or less). Using the most recent population figures for each study district, we estimate that the intervention could save households a total of 29,965, 254,268 and 303,467 dollars, respectively in the study districts in Burkina Faso, Nigeria and Uganda. Conclusions: Improving access to malaria diagnostics and treatments in malaria endemic areas substantially reduces private household costs. The key challenge is to develop and strengthen community human resources to deliver the intervention, and ensure adequate supplies of commodities and supervision. We demonstrate feasibility and benefit to populations living in difficult circumstances