{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T22:17:48Z","timestamp":1789769868757,"version":"4.0.1"},"reference-count":33,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T00:00:00Z","timestamp":1650585600000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Massachusetts General Hospital Department of Medicine"},{"name":"Mooney-Reed Charitable Foundation"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,4,3]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Integrated community case management (iCCM) of childhood illness in Uganda involves protocol-based care of malaria, pneumonia and diarrhoea for children under 5 years old. This study assessed volunteer village health workers\u2019 (VHW) ability to provide correct iCCM care according to the national protocol and change in their performance over time since initial training.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>VHWs affiliated with the Ugandan national programme provide community-based care in eight villages in Bugoye Subcounty, a rural area in Kasese District. The first cohort of VHWs began providing iCCM care in March 2013, the second cohort in July 2016.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>All children receiving iCCM care in 18 430 clinical encounters occurring between April 2014 and December 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The descriptive primary outcome measure was the proportion of patients receiving overall correct care, defined as adherence to the iCCM protocol for the presenting condition (hereafter quality of care). The analytic primary outcome was change in the odds of receiving correct care over time, assessed using logistic regression models with generalised estimating equations. Secondary outcome measures included a set of binary measures of adherence to specific elements of the iCCM protocol. Preplanned and final measures were the same.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, VHWs provided correct care in 74% of clinical encounters. For the first cohort of VHWs, regression modelling demonstrated a modest increase in quality of care until approximately 3 years after their initial iCCM training (OR 1.022 per month elapsed, 95% CI 1.005 to 1.038), followed by a modest decrease thereafter (OR 0.978 per month, 95% CI 0.970 to 0.986). For the second cohort, quality of care was essentially constant over time (OR 1.007 per month, 95% CI 0.989 to 1.025).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Quality of care was relatively constant over time, though the trend towards decreasing quality of care after 3 years of providing iCCM care requires further monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-051015","type":"journal-article","created":{"date-parts":[[2022,5,17]],"date-time":"2022-05-17T08:05:43Z","timestamp":1652774743000},"page":"e051015","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Long-term quality of integrated community case management care for children in Bugoye Subcounty, Uganda: a retrospective observational study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9987-479X","authenticated-orcid":false,"given":"James S","family":"Miller","sequence":"first","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar Mugema","family":"Mulogo","sequence":"additional","affiliation":[{"name":"Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda"},{"name":"Bugoye Community Health Collaboration, Bugoye, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew Christopher","family":"Wesuta","sequence":"additional","affiliation":[{"name":"Bugoye Community Health Collaboration, Bugoye, Uganda"},{"name":"Global Health Collaborative\u2014MUST Uganda, Mbarara, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobert","family":"Mumbere","sequence":"additional","affiliation":[{"name":"Bugoye Community Health Collaboration, Bugoye, Uganda"},{"name":"Global Health Collaborative\u2014MUST Uganda, Mbarara, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackson","family":"Mbaju","sequence":"additional","affiliation":[{"name":"Bugoye Community Health Collaboration, Bugoye, Uganda"},{"name":"Global Health Collaborative\u2014MUST Uganda, Mbarara, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Matte","sequence":"additional","affiliation":[{"name":"Bugoye Community Health Collaboration, Bugoye, Uganda"},{"name":"Global Health Collaborative\u2014MUST Uganda, Mbarara, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses","family":"Ntaro","sequence":"additional","affiliation":[{"name":"Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda"},{"name":"Bugoye Community Health Collaboration, Bugoye, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A","family":"Guiles","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Palka R","family":"Patel","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shem","family":"Bwambale","sequence":"additional","affiliation":[{"name":"Bugoye Community Health Collaboration, Bugoye, Uganda"},{"name":"Bugoye Health Center, Bugoye, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Kenney","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Bugoye Community Health Collaboration, Bugoye, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Reyes","sequence":"additional","affiliation":[{"name":"Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geren S","family":"Stone","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,4,22]]},"reference":[{"key":"2025121403211977000_12.4.e051015.1","unstructured":"World Health Organization, UNICEF . WHO\/UNICEF joint statement: integrated community case management (iCCM), 2012. https:\/\/www.who.int\/maternal_child_adolescent\/documents\/statement_child_services_access_whounicef.pdf"},{"key":"2025121403211977000_12.4.e051015.2","unstructured":"Republic of Uganda Ministry of Health . Village health team strategy and operational guidelines, 2010. Available: http:\/\/library.health.go.ug\/publications\/health-education\/village-health-team-strategy-and-operational-guidelines [Accessed 12 Sep 2020]."},{"key":"2025121403211977000_12.4.e051015.3","unstructured":"Republic of Uganda Ministry of Health . National village health teams (VHT) assessment in Uganda, 2015. Available: http:\/\/library.health.go.ug\/publications\/health-education\/national-village-health-teamsvht-assessment-uganda [Accessed 12 Sep 2020]."},{"key":"2025121403211977000_12.4.e051015.4","unstructured":"The Republic of Uganda Ministry of Health . Integrated community case management of childhood malaria, pneumonia and diarrhoea: implementation guidelines, 2010. 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