MBARARA UNIVERSITY OF SCIENCE AND TECHNOLOGY REPORT OF HEALTHY CHILD UGANDA FACULTY RESEARCH GRANT ABOUT ASSESSMENT OF ACTIVITIES AND IMPACT OF COMMUNITY OWNED RESOURCE PERSONS (CORPs) ON FAMILIES AND COMMUNITIES IN HEALTHY CHILD UGANDA (HCU) BWIZIBWERA PROJECT AREA. JANUARY 2010 Research team SN. Name Faculty Department Job Title 1 Basil Tibanyendera Science Education Lecturer 2 Fortunate Atwiine Medicine Nursing Teaching Asst. 3 Esther Beebwa Medicine Nursing Teaching Asst. 4 Francis Mugabi, Dr. Medicine Medicine Project Co-ord. 5 Milton A Wesuta Medicine Biochemistry Lecturer 6 Stephens Twesigye Hospital Nursing Comm. Nurse DEDICATION This piece of work is dedicated to all children under five years of age in Bwizibwera. ACKNOWLEDGEMENT Our acknowledgements go to all those individuals who contributed to the successful completion of the study. First, we deeply thank all those respondents in Bwizibwera for sparing their precious time to participate in our data collection exercise. Acknowledgement also goes to Faidha Adrama, Albina Twebaze and Shadrack Muhoozi, all of Bwiziwera Health Centre IV, and all local leaders in Bwizibwera for taking us around the communities. Thanks go to Nicholas Matsiko for the statistical analysis of our research findings. We would lastly thank the Health Child Uganda project for initially training the investigators and for financially supporting the research project. TABLE OF CONTENTS TITLE PAGE Dedication........................................................................................................................................i Acknowledgement ………………………………………………………………………………..ii Table of Contents ………………………………………………………………………………...iii List of Tables ……………………………………………………………………………………..v List of Charts and Figures ………………………………………………………………………..vi List of acronyms and abbreviations ……………………………………………………………..vii Abstract …………………………………………………………………………………………viii CHAPTER ONE INTRODUCTION ………………………………………………..............1 1.1 Background ……………………………………………………………………………….1 1.2 Statement of the problem .………………………………………………………………...3 1.3 Purpose of the study ………………………………………………………………………3 1.4 General objective of the study ……………………………………………………………4 1.4.1 General objective …………………………………………………………………………4 1.4.2 Specific objectives ………………………………………………………………………..4 1.5 Significance of the study ……………………………………………………………….....4 1.6 Scope of the study ………………………………………………………………………...4 CHAPTER TWO METHODOLOGY ……………………………………………................6 2.1 Study Area ………………………………………………………………………………..6 2.2 Study Design ……………………………………………………………………………...6 2.3 Sampling Method ………………………………………………………………………....6 2.4 Study Population ……………………………………………………………………….....7 2.5 Data Collection methods…………………………………………………………………..8 2.5.1 Quantitative survey………………………………………………………………………..8 2.5.2 Qualitative survey…………………………………………………………………………9 2.5.3 Quality Assurance…………………………………………………………………………9 2.6. Methods of Analysis ……………………………………………………………………..9 2.7 Ethical considerations……………………………………………………………………..9 2.8 Challenges during the study……………………………………………………………...10 CHAPTER THREE RESULTS……………………………………………………….11 3.0 Study Results ……………………………………………………………………………11 3.1 Socio-demographic Profile of Respondents……………………………………………..11 3.1.1 Availability and access to health services in the area…………………………………….13 3.2.0 Respondents’ Knowledge of the CORPs and their Activities……………………………14 3.2.1 Respondents’ Knowledge of the CORPs…………………………………………………14 3.2.2 Respondents’ Knowledge of the activities of CORPs……………………………………15 3.3.0 Respondents’ Knowledge about Immunization…………………………………………..16 3.3.1 Respondents’ Source of Information about Immunization……………………………….16 3.3.2 Knowledge of the Immunizable diseases…………………………………………………17 3.3.3 Knowledge of the Ages of Immunization against different diseases……………………..18 3.4.0 Immunization Status of Children and Keeping of Immunization Records……………….18 3.4.1 Immunization Record Keeping at Household Level……………………………………...18 3.4.2 Immunization Status of Children in visited homes……………………………………….20 3.4.3 Immunization levels in Bwizibwera before and after start of the HCU project………….21 CHAPTER FOUR DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS……………………………..23 4.1 DISCUSSION……………………………………………………………………………….23 4.2 CONCLUSIONS…………………………………………………………………………….24 4.3 RECOMMENDATIONS ……………………………………………………………………25 REFERENCES ....................................................................................................................26 APPENDICES ....................................................................................................................27 LIST OF TABLES Table 2.1 Population distribution per village………………………………………………...6 Table 2.2 Actual sample size per village as calculated from the population distribution……8 Table 3.1 Number of households surveyed in each village………………………………...11 Table 3.2 Marital Status of Respondents…………………………………………………..12 Table 3.3 Distances to the nearest health center……………………………………………13 Table 3.4 Respondents’ Knowledge of the CORPs………………………………………..14 Table 3.5 Respondents’ Knowledge of the Activities of CORPs………………………….15 Table 3.6 Respondents’ Source of information and communication about immunization…17 Table 3.7 Respondents’ Knowledge of the ages of Immunization…………………………18 Table 3.8 Availability of Child Health Cards………………………………………………18 Table 3.9 Accessibility of Child Health Cards……………………………………………..19 Table 3.10 Physical state of Child Health Cards…………………………………………….20 Table 3.11 Percentage Level of immunization………………………………………………21 Table 3.12 Immunization levels against three major diseases in Bwizibwera before and after start of HCU project……………………………………………………….22 LIST OF CHARTS AND FIGURES Chart 1 Households visited in each village, percent...........................................................12 Chart 2 Marital status of respondents, percent...................................................................13 Chart 3 Distance to the nearest Health Centre, percent......................................................14 Chart 4 Respondents’ knowledge of the CORPs, percent..................................................15 Chart 5 Availability of Child Health Cards, percent..........................................................19 Chart 6 Accessibility of Child Health Cards, percent........................................................19 Chart 7 Physical state of Child Health Cards, percent.......................................................20 Figure 1 1998 Health belief model modified to suit this study of immunization in children under five years in Bwizibwera…………………………………………..4 Figure 2 Respondents’ knowledge of the Activities of CORPs, Percent………………….16 Figure 3 Respondents’ source of information and communication about immunization, Percent……………………………………………………………17 LIST OF ACRONYMS AND ABBREVIATIONS BCG Bacillus Calmette – Guérin CORPs Community Owned Resource Persons FREC Faculty of Medicine Research Ethhical Committee HC Health Centre HCU Healthy Child Uganda Hib Haemophilus Influenzae Type b IEC Information, Education and Communication IMR Infant Mortality Rate LC Local Council MUST Mbarara University of Science and Technology NGO Non – Governmental Organisation Polio Poliomyelitis TB Tuberculosis UDHS Uganda Demographic Health Survey U5MR Under-five mortality rate ABSTRACT The infant and under-five mortality rates in Uganda are still high. In the 2006 Demographic Health Survey (UDHS) Report, the infant mortality rate (IMR) was 76 per 1000 live births, while the under-five mortality rate (U5MR) was 137 per 1000, compared to the 2001 UDHS IMR figures of 88 per 1000 and U5MR figures of 147 per 1000. These rates are still high, making the country’s children still vulnerable. Healthy Child Uganda (HCU) project set out to address this problem in Southwestern Uganda through Community Owned Resource Persons (CORPs). One of the HCU project areas is Bwizibwera in Mbarara District. HCU operates in immunization, nutrition and sanitation. This study was designed to assess the activities and impact of the CORPs in the aspect of immunization. It was of the descriptive cross – sectional design, done in six villages in the sub – counties of Kashari and Rwanyamahembe. The sample size was 70 households which were randomly selected. Data were collected using a pretested questionnaire and focus group discussions. From the study findings, respondents had adequate knowledge about activities of the CORPs and they are the main source of information about immunization. However respondents had limited knowledge about immunisable diseases and ages of immunization against such diseases. Generally there has been an increase in the immunization levels among children under 5 years of age in the operational areas of CORPs and hence a considerable reduction in incidences of immunisable diseases among the children in Bwizibwera HCU project area. CHAPTER ONE INTRODUCTION 1.1 Background The infant and under-five mortality rates in Uganda are still high. In the 2006 Demographic Health Survey (UDHS) Report, the infant mortality rate (IMR) was 76 per 1000 live births, while the under-five mortality rate (U5MR) was 137 per 1000, compared to the 2001 UDHS IMR figures of 88 per 1000 and U5MR figures of 147 per 1000. Although this demonstrated only a modest drop in both IMR and U5MR over the 5 year period, the two types of rates are still quite high, making the country’s children still vulnerable. Healthy Child Uganda, a community-based health education partnership between the universities of Calgary and Dalhousie,