Abstract
BackgroundGhana has developed two community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia, and to improve household and family practices: integrated Community Case Management (iCCM) and Community-based Health Planning and Services (CHPS). The objective of the study was to assess the effectiveness of iCCM and CHPS on disease knowledge and health behaviour regarding malaria, diarrhoea and pneumonia.MethodsA household survey was conducted two and eight years after implementation of iCCM in the Volta and Northern Regions of Ghana respectively, and more than ten years of CHPS implementation in both regions. The study population included 1356 carers of children under- five years of age who had fever, diarrhoea and/or cough in the two weeks prior to the interview. Disease knowledge was assessed based on the knowledge of causes and identification of signs of severe disease and its association with the sources of health education messages received. Health behaviour was assessed based on reported prompt care seeking behaviour, adherence to treatment regime, utilization of mosquito nets and having improved sanitation facilities, and its association with the sources of health education messages received.ResultsHealth education messages from community-based agents (CBAs) in the Northern Region were associated with the identification of at least two signs of severe malaria (adjusted Odds Ratio (OR) 1.8, 95%CI 1.0, 3.3, p = 0.04), two practices that can cause diarrhoea (adjusted OR 4.7, 95%CI 1.4, 15.5, p = 0.02) 0and two signs of severe pneumonia (adjusted OR 7.7, 95%CI2.2, 26.5, p = 0.01)-the later also associated with prompt care seeking behaviour (p = 0.04). In the Volta Region, receiving messages on diarrhoea from CHPS was associated with the identification of at least two signs of severe diarrhoea (adjusted OR 3.6, 95%CI 1.4, 9.0), p = 0.02). iCCM was associated with prompt care seeking behaviour in the Volta Region and CHPS with prompt care seeking behaviour in the Northern Region (p < 0.5).ConclusionsBoth iCCM and CHPS were associated with disease knowledge and health behaviour, but this was more pronounced for iCCM and in the Northern Region. HBC should continue to be considered as the strategy through which community-IMCI is implemented.
Highlights
Ghana has developed two community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia, and to improve household and family practices: integrated Community Case Management and Community-based Health Planning and Services (CHPS)
Escribano-Ferrer et al BMC Public Health (2017) 17:948 (Continued from previous page). Both Integrated community case management (iCCM) and CHPS were associated with disease knowledge and health behaviour, but this was more pronounced for iCCM and in the Northern Region
Home-based care (HBC) should continue to be considered as the strategy through which community-integrated management of childhood illness (IMCI) is implemented
Summary
Ghana has developed two community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia, and to improve household and family practices: integrated Community Case Management (iCCM) and Community-based Health Planning and Services (CHPS). In the 1990s the World Health Organisation (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) developed the integrated management of childhood illness (IMCI) to reduce the morbidity and mortality of children under- five [1]. Integrated community case management (iCCM) involves treating sick children with pre-packaged drugs dispensed by individuals selected by the community and trained by health care providers, thereby enhancing the potential to reduce inequities in access to quality drugs. Ghana adopted the IMCI and iCCM strategies and implements two main community-based strategies to reduce morbidity and mortality of children underfive: the community-based health planning services (CHPS) and the iCCM
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