Evaluation of Integrated Community Case Management in Eight Districts of Central Uganda

Abstract

ObjectiveEvidence is limited on whether Integrated Community Case Management (iCCM) improves treatment coverage of the top causes of childhood mortality (acute respiratory illnesses (ARI), diarrhoea and malaria). The coverage impact of iCCM in Central Uganda was evaluated.MethodsBetween July 2010 and December 2012 a pre-post quasi-experimental study in eight districts with iCCM was conducted; 3 districts without iCCM served as controls. A two-stage household cluster survey at baseline (n = 1036 and 1042) and end line (n = 3890 and 3844) was done in the intervention and comparison groups respectively. Changes in treatment coverage and timeliness were assessed using difference in differences analysis (DID). Mortality impact was modelled using the Lives Saved Tool.Findings5,586 Village Health Team members delivered 1,907,746 treatments to children under age five. Use of oral rehydration solution (ORS) and zinc treatment of diarrhoea increased in the intervention area, while there was a decrease in the comparison area (DID = 22.9, p = 0.001). Due to national stock-outs of amoxicillin, there was a decrease in antibiotic treatment for ARI in both areas; however, the decrease was significantly greater in the comparison area (DID = 5.18; p<0.001). There was a greater increase in Artemisinin Combination Therapy treatment for fever in the intervention areas than in the comparison area but this was not significant (DID = 1.57, p = 0.105). In the intervention area, timeliness of treatments for fever and ARI increased significantly higher in the intervention area than in the comparison area (DID = 2.12, p = 0.029 and 7.95, p<0.001, respectively). An estimated 106 lives were saved in the intervention area while 611 lives were lost in the comparison area.ConclusioniCCM significantly increased treatment coverage for diarrhoea and fever, mitigated the effect of national stock outs of amoxicillin on ARI treatment, improved timeliness of treatments for fever and ARI and saved lives.

The Effects of an Integrated Community Case Management Strategy on the Appropriate Treatment of Children and Child Mortality in Kono District, Sierra Leone: A Program Evaluation

“…Overall, the proportions of appropriate treatment achieved for all conditions are comparable for fever and higher for other conditions than those seen in the iCCM-treatment group in a recent evaluation of iCCM in Central Uganda (64.3%, fever; 28.8%, pneumonia; 15.9% diarrhea). 32 …”

Proactive case detection of common childhood illnesses by community health workers: a systematic review

“…Many low-income and middle-income countries (LMICs) have implemented integrated Community Case Management (iCCM) of common childhood illnesses,1 2 a package of services delivered by CHWs to diagnose, treat and refer children under 5 with malaria, diarrhoea, pneumonia and malnutrition in the community setting 3. This strategy has shown an increase in access to care and reduced child mortality 4–12. However, the expected benefits have not been realised in all contexts 13–18.…”

Effectiveness of Peer-Supervision on Paediatric Fever Treatment Among Registered Private Drug Sellers in East-Central Uganda: An Interrupted Time Series Analysis

“…Evidence from different settings shows that even among trained community health workers, diagnosis and rightful classi cation of children with pneumonia symptoms remains a challenge [37][38][39]. As such, several studies emphasize the importance of supervision in improving appropriate treatment of acute respiratory tract infections which are associated with community pneumonia in children under ve years of age [40,41]. This further strengthens the importance of peer supervision among drug sellers in rural settings where supervision has been inadequate.…”

“…Considering results one month after introduction of peer supervision as well as post trend results, there was no statistically signi cant difference in appropriate treatment of uncomplicated malaria among drug sellers in the intervention and comparison districts. In Uganda, studies evaluating integrated community case management in eight districts of central Uganda also found no statistical difference in appropriate treatment of children between intervention and comparison districts [41]. This may be because malaria has affected the Ugandan population for a long time.…”