Evidence of Impact: iCCM as a strategy to save lives of children under five

Abstract

Background In 2013, the World Health Organization (WHO) launched the Rapid Access Expansion (RAcE) programme in the Democratic Republic of Congo, Malawi, Mozambique, Niger, and Nigeria to increase coverage of diagnostic, treatment, and referral services for malaria, pneumonia, and diarrhea among children ages 2-59 months. In 2017, a final evaluation of the six RAcE sites was conducted to determine whether the programme goal was reached. A key evaluation objective was to estimate the reduction in childhood mortality and the number of under-five lives saved over the project period in the RAcE project areas. Methods The Lives Saved Tool (LiST) was used to estimate reductions in all-cause child mortality due to changes in coverage of treatment for the integrated community case management (iCCM) illnesses – malaria, pneumonia, and diarrhea – while accounting for other changes in maternal and child health interventions in each RAcE project area. Data from RAcE baseline and endline household surveys, Demographic and Health Surveys, and routine health service data were used in each LiST model. The models yielded estimated change in under-five mortality rates, and estimated number of lives saved per year by malaria, pneumonia and diarrhea treatment. We adjusted the results to estimate the number of lives saved by community health worker (CHW)-provided treatment. Results The LiST model accounts for coverage changes in iCCM intervention coverage and other health trends in each project area to estimate mortality reduction and child lives saved. Under five mortality declined in all six RAcE sites, with an average decline of 10 percent. An estimated 6200 under-five lives were saved by malaria, pneumonia, and diarrhea treatment in the DRC, Malawi, Niger, and Nigeria, of which approximately 4940 (75 percent) were saved by treatment provided by CHWs. This total excludes Mozambique, where there were no estimated under-five lives saved likely due to widespread stockouts of key medications. In all other project areas, lives saved by CHW-provided treatment contributed substantially to the estimated decline in under-five mortality. Conclusions Our results suggest that iCCM is a strategy that can save lives and measurably decrease child mortality in settings where access to health facility services is low and adequate resources for iCCM implementation are provided for CHW services.

The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis

“…Recent reports from the Rapid Access Expansion (RACE) programs in Nigeria have shown that care-seeking for fever from an appropriate provider increased from 78% to 94% following implementation of iCCM and that coverage with artemisinin-based combination therapies (ACTs) within 1 day of symptom onset increased from 57% to 74% amongst malaria-confirmed cases [6]. Evidence from these iCCM programs have shown a reduction of overall clinical disease symptoms and all-cause child mortality after implementation [6,7]. These are consistent with findings from other studies, including cluster randomised trials of community health worker (CHW) programs, showing a decrease in overall mortality after increasing diagnosis and treatment coverage for malaria and other diseases [8][9][10].…”

The role of governance in implementing sustainable global health interventions: review of health system integration for integrated community case management (iCCM) of childhood illnesses

“… 44 This has improved recently with substantial increases in evaluations done to generate country specific, and sometimes district or village specific clarifications for programme successes and failures. 15 24 40 45–55 M&E of iCCM, and broader strategies influencing child health outcomes, improves adaptation of programme structure and service delivery for populations to achieve the greatest impact from programme potential. 6 18 21 28 30 32 56 Evaluations can provide revelations in programme effectiveness or the lack thereof.…”

Caregivers’ and Health Extension Workers’ Perceptions and Experiences of Outreach Management of Childhood Illnesses in Ethiopia: A Qualitative Study

“…Various strategies were employed by the global community to scale-up effective child health interventions [ 9 , 10 ]. The integrated Community Case Management is effective in reducing under-five mortality if implemented with sufficient coverage [ 9 ]. Community health workers are able to manage common childhood illnesses outside health facilities, which include identifying and treating sick children at their homes.…”