Community case management improves use of treatment for childhood diarrhea, malaria and pneumonia in a remote district of Ethiopia

Abstract

Background: Ethiopia's Health Extension Workers (HEW) deliver preventive interventions and treat childhood diarrhea and malaria, but not pneumonia. Most of Ethiopia's annual estimated 4 million childhood pneumonia cases go untreated. Objective: Evaluate the performance of volunteers in providing Community Case Management (CCM) for diarrhea, fever and pneumonia-in a pre-HEW setting in Liben Woreda, Oromiya Regional State. Methods: Save the Children supported Ministry of Health and communities to deliver child survival interventions from 1997-2006. We obtained permission in 2005 to train 45 volunteers from remote kebeles in CCM. We evaluated the strategy through reviewing registers and supervision records; examining CCM workers; focus group discussions; and three household surveys. Results: The CCM workers treated 4787 cases, mainly: malaria (36%), pneumonia (26%), conjunctivitis (14%), and watery diarrhea with some dehydration (12%). They saw 2.5 times more cases of childhood fever, pneumonia, and diarrhea than all the woreda's health facility staff combined. Quality of care was good. Conclusion: The availability, quality, demand, and use of CCM were high. These CCM workers were less educated and less trained than HEWs who perform complicated tasks (Rapid Diagnostic Tests) and dispense expensive antimalarial drugs like Coartem®. They should also treat pneumonia with inexpensive drugs like cotrimoxazole to help achieve Millennium Development Goal 4. [Ethiop.

Effectiveness of two community-based strategies on disease knowledge and health behaviour regarding malaria, diarrhoea and pneumonia in Ghana

“…Other iCCM studies that reported on carers’ disease knowledge in Mali [40], Uganda [41], Ghana [23], Burkina Faso [23], Ethiopia [23, 42] and Malawi [23] also found similar results. Carers’ in Mali in the iCCM intervention arm were significantly more likely to recognise fever lasting more than one day after treatment and convulsions as danger signs than carers in the control group.…”

“…Carers in Kumasi (Ghana), Lilongwe (Malawi) and Ougadougou (Burkina Faso) improved their knowledge on signs of severe malaria but not those in Bolgatanga (Ghana) and Jimma (Ethiopia) [23]. A longer study (9 years) conducted in Ethiopia showed an increase in the recognition of fast and difficulty in breathing as signs of suspected pneumonia and other childhood danger signs [42]. The contribution of iCCM to prompt treatment seeking behaviour was also found in other studies in Ghana and in Uganda [19, 43, 44].…”

Where there is no doctor: can volunteer community health workers in rural Uganda provide integrated community case management?

“…20 In a multi-methods Ethiopian study, volunteer CHWs treating diarrhoea, pneumonia, and fever and were highly accessed by community members 22 . Our study is complimentary suggesting multi-illness iCCM using CHWs with variable formal education is feasible, which is supportive of work in Eastern Uganda 23,[27][28][29][30] ; however, caution is needed to further understand quality of work, an issue highlighted by a recent study from Central Uganda.…”

“…16,17 African iCCM studies are few, 14,18 and less still have assessed health outputs and outcomes. 5,14,[19][20][21][22][23] National programs in sub-Saharan Africa are new and while early studies are demonstrating implementation feasibility and early positive outcomes 7,8 , more studies are needed to understand implementation in a variety of contexts including use of volunteer CHWs with limited formal education and short iCCM training.…”

World Health Organization/United Nations Children's Fund Joint Statement on Integrated Community Case Management: An Equity-Focused Strategy to Improve Access to Essential Treatment Services for Children

“…In Zambia, a CCM study on pneumonia and malaria found that 68% of children with pneumonia received early and appropriate treatment from community health workers, and that overtreatment of malaria significantly decreased 5. In Ethiopia, workers deployed in remote communities delivered two and a half times as many treatments for the three diseases than all the facility-based providers in the same district 18. The proportion of children receiving artemisinin-based combination therapy globally is also increasing, although significant gaps remain 14…”