Changes in care-seeking for common childhood illnesses in the context of Integrated Community Case Management (iCCM) program implementation in Benishangul Gumuz region of Ethiopia

Abstract

Background Integrated Community Case Management (iCCM) is a strategy for promoting access of under-served populations to lifesaving treatments through extending case management of common childhood illnesses to trained frontline health workers. In Ethiopia iCCM is provided by health extension workers (HEWs) deployed at health posts. We evaluated the association between the implementation of iCCM program in Assosa Zuria zone, Benishangul Gumuz region and changes in care-seeking for common childhood illnesses. Methods We conducted a pre-post study without control arm to evaluate the association of interest. The iCCM program that incorporated training, mentoring and supportive supervision of HEWs with community-based demand creation activities was implemented for two years (2017–18). Baseline, midline and endline surveys were completed approximately one year apart. Across the surveys, children aged 2–59 months (n = 1,848) who recently had cough, fever or diarrhea were included. Data were analysed using mixed-effects logistic regression model. Results Over the two-year period, care-seeking from any health facility and from health posts significantly increased by 10.7 and 17.4 percentage points (PP) from baseline levels of 64.5 and 34.1%, respectively (p<0.001). Care sought from health centres (p = 0.420) and public hospitals (p = 0.129) did not meaningfully change while proportion of caregivers who approached private (p = 0.003) and informal providers (p<0.001) declined. Caregivers who visited health posts for the treatment of diarrhea (19.2 PP, p<0.001), fever (15.5 PP, p<0.001), cough (17.8 PP, p<0.001) and cough with respiratory difficulty (17.3 PP, p = 0.038) significantly increased. After accounting for extraneous variables, we observed that care-seeking from iCCM providers was almost doubled (adjusted odds ratio = 2.32: 95% confidence interval; 1.88–2.86) over the period. Conclusion iCCM implementation was associated with a meaningful shift in care-seeking to health posts.

Integrated Community Case Management Utilization Status and Associated Factors Among Caretakers of Sick Children Under the Age of 5 Years in West Shewa, Ethiopia

“…There is evidence that ICCM has improved access to appropriate case management, which leads to earlier treatment, fewer severe cases, improved recovery, fewer referrals, and a reduced burden on health service deliveries ( 4 ). Similarly, studies have shown that ICCM can increase coverage of appropriate treatment for childhood illnesses among the poor and can lead to substantial reductions in child mortality ( 7 – 10 ).…”

Effective coverage of curative child health services in Ethiopia: analysis of the Demographic and Health Survey and Service Provision Assessment survey

“…This could be achieved by re-examining approaches to foster community engagement and empowerment, further decentralisation of curative child health services, intersectoral collaboration and strong leadership. 47 48 Although the Ethiopian PHC model provides a package of basic preventive and curative child health services to rural households, 49 our study found that the coverage of child health services is low and uneven. We also found that curative child health services may not be available in rural facilities, even though they are mandated to provide child health to rural communities.…”

Baseline malaria prevalence and care-seeking behaviours in rural Madagascar prior to a trial to expand malaria community case management to all ages

“…The ability to modify existing health-seeking behaviours through expansion of mCCM is not well established. There are several examples of improvement of care-seeking rates following the introduction of iCCM to naïve populations where it was previously effectively non-existent [ 2 , 3 ]. However, recent publications from Malawi [ 22 ] and Rwanda [ 6 ] underscore the difficulty in increasing care-seeking behaviour through support or expansion of established community case management programs.…”