Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Sunil Parikh

Second Advisor

Daniel Ebbs

Abstract

Background: Northern Uganda faces persistent health challenges due to a legacy of armed conflict, poverty, and fragile health infrastructure. In Pader District, malaria remains the leading cause of under-five mortality, and rural communities face ongoing barriers to accessing timely care. Community health workers (CHWs) serve as critical intermediaries in care delivery, but their effectiveness is limited by structural and resource constraints.Methods: This study employed an exploratory sequential mixed-methods design informed by community-based participatory research (CBPR) principles. Qualitative data were collected through 11 semi-structured interviews and 6 focus group discussions with CHWs across six sub-counties in Pader District. Quantitative data were collected on 134 children under five years of age presenting with suspected malaria at the NUMEM Clinic from September 2024 to March 2025. Thematic analysis was used for qualitative data, and descriptive statistics and logistic regression were applied to the clinical dataset. Results: CHWs reported strong intrinsic motivation driven by service and community trust, but highlighted major challenges including frequent drug stockouts, lack of transportation, and gender-related barriers. They recommended increased material support, regular training, and inclusion in decision-making processes. Quantitative data revealed that 88.8% of children were classified with severe malaria, with high-grade fever emerging as a potential (though non-significant) predictor of severity. All children recovered following treatment. Conclusion: This study underscores the dual need to improve CHW support systems and address systemic barriers to malaria care. Strengthening supply chains, transportation access, and formal recognition of CHWs could enhance their role in early detection and referral. Investing in CHW programs may not only reduce malaria severity but also build more resilient and sustainable community-based health systems in rural Uganda.

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This is an Open Access Thesis.

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