Quality of Community-Based Essential Care for Children Under-Five in Mali's Koulikoro Region (Kati and Kangaba Districts): A Cross-sectional Analytical Study

Abstract

Aims: This study evaluated the quality of community-based essential care services provided to children aged 0–59 months by community health workers (CHWs) in Mali's Koulikoro region. It examined CHW performance, motivation, stakeholder satisfaction, and maternal practices. Study Design: A cross-sectional analytical study. Place and Duration of Study: Kati and Kangaba health districts, Koulikoro region, Mali, from September to December 2024. Methodology: Data were collected from 23 CHWs, 41 mothers of sick children, 36 mothers of newborns, 51 sick children aged 2–59 months, 36 newborns aged 0–2 months, 270 child health records, and 62 institutional stakeholders using structured questionnaires, observation checklists, and document reviews. Performance, motivation, and satisfaction were assessed using composite scores. Bivariate and multivariable analyses were performed using R software (version 4.2.1). Results: CHWs demonstrated satisfactory clinical competence, with task-completion rates exceeding 96% for fever assessment, danger-sign identification, treatment, and counselling. However, substantial gaps were identified in cough assessment (3.9%) and diarrhoea assessment (72.5%). Global motivation was low (mean score: 3.78/8; 47.3%). Financial incentives were reported by 13.0% of CHWs, while 73.9% reported receiving supervision. Maternal satisfaction was high among all surveyed mothers. Supervision was associated with CHW performance (OR = 1.89, 95% CI: 1.12–3.18, P = .017); however, given the small CHW sample (n = 23), this finding should be interpreted cautiously and regarded as exploratory. Good reception, appropriate counselling, and perceived care quality were the main reasons reported for maternal satisfaction. Newborn care showed 100% completion of danger-sign assessment; however, chlorhexidine application was observed in only 19.4% of cases. Cluster analysis identified three CHW profiles: high performers (35%), average performers (43%), and low performers (22%). Conclusion: Although CHWs demonstrated strong clinical skills and community trust, systemic challenges, including low motivation, inadequate supervision, material shortages, and inconsistent selected newborn-care practices, may constrain service quality. Strengthening supervision systems, establishing regular performance-based incentives, and providing targeted clinical training are needed to optimise community-based child health programmes.