Improving access to appropriate case management for common childhood illnesses in hard-to-reach areas of Abia State, Nigeria

Abstract

Back Background ground Studies have demonstrated that trained community health workers can improve access to quality health services for under five children. Under the World Health Organization's Rapid Access Expansion Progamme, integrated community case management of childhood illnesses (iCCM) was introduced in Abia and Niger States, Nigeria in 2013. The objective of the program was to increase the number of children 2-59 months receiving quality life-saving treatment for malaria, pneumonia and diarrhoea by extending case management through community-oriented resource persons (CORPs). We present findings from household surveys comparing baseline and endline data to assess changes in sick child care-seeking, assessment, and treatment coverage provided over the project period in Abia State. Methods Methods A baseline household survey was conducted in May 2014 and an endline survey in February 2017. The surveys used multi-stage cluster sampling of primary caregivers of children aged 2-59 months who had been recently sick with diarrhoea, fever, or cough with difficult breathing. R Results esults Care-seeking from an appropriate provider improved significantly from 69% at baseline to 77% at endline (P<0.01). At baseline, patent and proprietary medicine vendors (PPMVs) (55%) and health centers (34%) were the main providers of care for iCCM services; by endline, CORPs became the main source (48%), followed by PPMVs (36%) and health centers (25%). C Conclusions onclusions Overall, the findings demonstrate improvements in care-seeking. Care-seeking practices shifted over the course of the project, with more caregivers seeking care from CORPs by the end of the project. The findings suggest that scaling up iCCM in Nigeria may improve access to appropriate treatment for under five children living in hard-to-reach areas.

Innovative, enhanced community management of non-hypoxaemic chest-indrawing pneumonia in 2–59-month-old children: a cluster-randomised trial in Africa and Asia

“…Reduction in mortality, increasing care seeking and treatment for pneumonia, malaria and diarrhoea through CLHWs was recently demonstrated by the WHO Rapid Access Expansion iCCM programmed in the Democratic Republic of Congo, Malawi, Niger and Nigeria. [26][27][28] High-quality data evaluating the management of chestindrawing pneumonia by the CLHWs from various countries are essential before the iCCM protocol can be updated to make it consistent with the IMCI protocol. As Box 1 Definition of enhanced integrated community case management (pneumonia component) in intervention clusters 29 and list of danger signs assessed in the study hypoxaemia can accompany pneumonia, including the use of pulse oximetry will assist in the identification of patients with a high risk of mortality.…”

Common childhood illnesses: a cross-sectional study of commodity stocking patterns and management knowledge among patent and proprietary medicine vendors in Nigeria

“…Their relative accessibility, affordability of health services and constant availability of medicines and commodities for managing childhood illnesses in their stores, compared to government and other private health facilities position them as a preferred source of care for these illnesses. Studies have shown that PPMVs, when exposed to adequate training, may be a reliable source of care for uncomplicated common childhood illnesses [ 7 , 10 ]. However, poor knowledge of appropriate diagnostic and treatment procedures for the common illnesses among under five children and poor referral practices exists among PPMVs, thereby contributing to poor treatment outcomes.…”

“…Interventions in African countries have reported its effectiveness in reducing under five mortality by as high as 15% [ 8 ]. Through the WHO supported iCCM intervention in Abia and Niger States of Nigeria, community health workers provided lifesaving treatments which contributed to 70% and 80% child lives respectively saved over the course of the intervention in the two states [ 8 , 10 ].…”

Case Management Knowledge and Commodity Stocking Pattern for Common Childhood Illnesses among Patent and Proprietary Medicine Vendors in Ebonyi and Kaduna States, Nigeria

“…8 Through the WHO supported iCCM intervention in Abia and Niger States of Nigeria, community health workers provided lifesaving treatments which contributed to 70% and 80% child lives respectively saved over the course of the intervention in the two states. 8,10 Patent and proprietary medicine vendors (PPMVs) are gradually becoming an integral part of the Nigerian health system especially for their role in the delivery of primary healthcare services and products. This is due to their presence even in hard-to-reach areas, long opening hours and consistency of service availability unlike government owned health facilities.…”