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Monitoring iCCM referral systems: Bugoye Integrated Community Case Management Initiative (BIMI) in Uganda

Overview of attention for article published in Malaria Journal, April 2016
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Title
Monitoring iCCM referral systems: Bugoye Integrated Community Case Management Initiative (BIMI) in Uganda
Published in
Malaria Journal, April 2016
DOI 10.1186/s12936-016-1300-z
Pubmed ID
Authors

Lacey English, James S. Miller, Rapheal Mbusa, Michael Matte, Jessica Kenney, Shem Bwambale, Moses Ntaro, Palka Patel, Edgar Mulogo, Geren S. Stone

Abstract

In Uganda, over half of under-five child mortality is attributed to three infectious diseases: malaria, pneumonia and diarrhoea. Integrated community case management (iCCM) trains village health workers (VHWs) to provide in-home diagnosis and treatment of these common childhood illnesses. For severely ill children, iCCM relies on a functioning referral system to ensure timely treatment at a health facility. However, referral completion rates vary widely among iCCM programmes and are difficult to monitor. The Bugoye Integrated Community Case Management Initiative (BIMI) is an iCCM programme operating in Bugoye sub-county, Uganda. This case study describes BIMI's experience with monitoring referral completion at Bugoye Health Centre III (BHC), and outlines improvements to be made within iCCM referral systems. This study triangulated multiple data sources to evaluate the strengths and gaps in the BIMI referral system. Three quantitative data sources were reviewed: (1) VHW report of referred patients, (2) referral forms found at BHC, and (3) BHC patient records. These data sources were collated and triangulated from January-December 2014. The goal was to determine if patients were completing their referrals and if referrals were adequately documented using routine data sources. From January-December 2014, there were 268 patients referred to BHC, as documented by VHWs. However, only 52 of these patients had referral forms stored at BHC. Of the 52 referral forms found, 22 of these patients were also found in BHC register books recorded by clinic staff. Thus, the study found a mismatch between VHW reports of patient referrals and the referral visits documented at BHC. This discrepancy may indicate several gaps: (1) referred patients may not be completing their referral, (2) referral forms may be getting lost at BHC, and, (3) referred patients may be going to other health facilities or drug shops, rather than BHC, for their referral. This study demonstrates the challenges of effectively monitoring iCCM referral completion, given identified limitations such as discordant data sources, incomplete record keeping and lack of unique identifiers. There is a need to innovate and improve the ways by which referral compliance is monitored using routine data, in order to improve the percentage of referrals completed. Through research and field experience, this study proposes programmatic and technological solutions to rectify these gaps within iCCM programmes facing similar challenges. With improved monitoring, VHWs will be empowered to increase referral completion, allowing critically ill children to access needed health services.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 76 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 1%
Unknown 75 99%

Demographic breakdown

Readers by professional status Count As %
Researcher 17 22%
Student > Master 14 18%
Student > Bachelor 10 13%
Student > Postgraduate 9 12%
Student > Ph. D. Student 5 7%
Other 11 14%
Unknown 10 13%
Readers by discipline Count As %
Medicine and Dentistry 28 37%
Nursing and Health Professions 13 17%
Social Sciences 5 7%
Agricultural and Biological Sciences 3 4%
Business, Management and Accounting 2 3%
Other 9 12%
Unknown 16 21%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 04 May 2016.
All research outputs
#5,787,613
of 7,651,252 outputs
Outputs from Malaria Journal
#2,109
of 2,579 outputs
Outputs of similar age
#186,519
of 266,284 outputs
Outputs of similar age from Malaria Journal
#141
of 153 outputs
Altmetric has tracked 7,651,252 research outputs across all sources so far. This one is in the 13th percentile – i.e., 13% of other outputs scored the same or lower than it.
So far Altmetric has tracked 2,579 research outputs from this source. They receive a mean Attention Score of 4.8. This one is in the 10th percentile – i.e., 10% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 266,284 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 16th percentile – i.e., 16% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 153 others from the same source and published within six weeks on either side of this one. This one is in the 3rd percentile – i.e., 3% of its contemporaries scored the same or lower than it.