Acceptability and Utilization of Community Health Workers after the Adoption of the Integrated Community Case Management Policy in Kabarole District in Uganda.

BACKGROUND: Malaria, pneumonia and diarrhea remains to be the major causes of morbidity and mortality among children in Uganda. To address such challenges, the government adopted a national policy on Integrated Community Case Management (ICCM) for malaria, pneumonia and diarrhea in 2010. The aim of this study was to assess household access, utilization and acceptability of ICCM services in Kabarole District. METHODS: The study was carried out between 22nd November to 4th December, 2014 in Rwimi sub-county, Kabarole district. A cross sectional household survey was conducted amongst caretakers of children below 5 years of age and a total of 384 respondents were interviewed about distance from nearest health facility and community health worker, socio-demographic characteristics, type of housing, history of fever, health-seeking behavior, perceptions of quality and utilization of ICCM services. Data was cleaned, coded and analysed using STATA 14.0 to produce results. RESULTS: Most 53.1% of the studied children were males and their age ranged from 1-52 months. Nearly all the care takers, 97.1% (373/384) had utilized health services for their children in the three proceeding months to the study and of those, 0.5% (2/373) sought from a traditional healer, 8.6% (32/373) sought treatment at home, 27.3% (102/373) from community health worker, 27.3% (102/373) from government health unit and 36.2% (133/373) from non-government health units. The caretakers who stay near CHWs are more likely to utilize ICCM services than those staying near health facilities (P=0.001). The majority 65.6% of the caretakers stay near CHWs and use only 10 minutes to reach the CHWs. Trust in CHWs [AOR 0.85, 95%CI [0.641-1.135]], level of awareness [AOR 0.73, 95%CI [0.538-0.979]] and distance (≤1 km) to CHWs [AOR 1.65, 95%CI [1.075-2.522]] are positively associated with the utilisation of ICCM services. CONCLUSION: The implementation of ICCM policy in kabarole has been an effective approach in increasing the utilization of malaria, diarrhea and pneumonia treatment services and hence increasing access to health services at community level. Trust in the CHWs, level of community awareness and distance to the CHWs are positively associated with the utilisation of ICCM services.

Death of a wild chimpanzee community member: possible outcome of intense sexual competition.

Our observations strongly support the view that a lethal gang attack occurred against a young adult male within a wild chimpanzee (Pan troglodytes schweinfurthii) community. This is the first report of such an occurrence. At least three adult male chimpanzees are believed to have been involved in the attack. This case is unusual because the attack was fatal, involved directed group aggression within a community, and was not linked to the overthrow of the alpha male. During the period before the attack, the percentage of cycling females in the community was very low (15 males:17 females, a maximum of two regularly cycling). This fact, coupled with the presence of one female in full genital tumescence, may have incited and escalated the violence of the attack. The lethal attack is interpreted as an act of intra-community male sexual competition resulting in the complete exclusion of one male from estrous females.