Timeliness of Care-Seeking From Village Health Workers for Children Under Five Years During the COVID-19 Lockdown in Southwestern Uganda.

Background In Uganda, village health workers (VHWs) use the integrated community case management (iCCM) strategy to treat malaria, pneumonia, and diarrhea in the community. It is very important for children to get treatment within 24 hours of getting sick to lower their risk of death and illness. In March 2020, Uganda imposed nationwide COVID-19 lockdown measures, encompassing transport restrictions and curfews, potentially impacting healthcare accessibility. This study evaluated the impact of the lockdown on the timeliness of treatment-seeking from VHWs for children under five years in southwestern Uganda. Methods We conducted a retrospective review of VHW patient registers from 22 villages in Bugoye sub-county, Kasese district, for the time between December 1, 2019, and May 31, 2020. The time before the lockdown was from December 1, 2019, to March 22, 2020, and the time during the lockdown was from March 23 to May 31, 2020. There were 4,024 child records in total, and 3,822 of them were used in regression models because they had all the information needed. Timeliness was defined as seeking care within 24 hours of the onset of illness. We used logistic regression to find crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results Overall, a total of 2,428 out of 3,822 (63.5%) children sought care within 24 hours. In the pre-lockdown period, 823 out of 1,330 people (61.9%) sought care on time. During the lockdown, 1,605 out of 2,492 people (64.4%) (p = 0.131) sought care on time. In multivariable logistic regression, the lockdown period was not significantly associated with timely care-seeking (adjusted OR (aOR) = 1.13, 95% CI: 0.99-1.30; p = 0.079). Fever was independently correlated with increased likelihood of timely care-seeking (aOR = 1.18, 95% CI: 1.02-1.37; p = 0.023), and increasing age in months was similarly associated with slightly higher odds (aOR = 1.01 per month increase, 95% CI: 1.00-1.01; p = 0.024). There was no significant association between sex, rapid breathing, diarrhea, and danger signs and timeliness. Conclusion The nationwide COVID-19 lockdown period was associated with a modest but non-significant increase in timely care-seeking. These results indicate that community-based health services delivered by VHWs remained accessible and robust despite mobility restrictions. Improving VHW programs could help make sure that important child health services are still available during future public health emergencies.