Abstract
IntroductionPneumonia and diarrhoea disproportionately affect children in resource-poor settings. Integrated community case management (iCCM) involves community health workers treating diarrhoea, pneumonia and malaria. Studies on impact of iCCM on appropriate treatment and its effects on equity in access to the same are limited. The objective of this study was to measure the impact of integrated community case management (iCCM) as the first point of care on uptake of appropriate treatment for children with a classification of pneumonia (cough and fast breathing) and/or diarrhoea and to measure the magnitude and distribution of socioeconomic status related inequality in use of iCCM.MethodsFollowing introduction of iCCM, data from cross-sectional household surveys were examined for socioeconomic inequalities in uptake of treatment and use of iCCM among children with a classification of pneumonia or diarrhoea using the Erreygers’ corrected concentration index (CCI). Propensity score matching methods were used to estimate the average treatment effects on the treated (ATT) for children treated under the iCCM programme with recommended antibiotics for pneumonia, and ORS plus or minus zinc for diarrhoea.FindingsOverall, more children treated under iCCM received appropriate antibiotics for pneumonia (ATT = 34.7 %, p < 0.001) and ORS for diarrhoea (ATT = 41.2 %, p < 0.001) compared to children not attending iCCM. No such increase was observed for children receiving ORS-zinc combination (ATT = -0.145, p < 0.05).There were no obvious inequalities in the uptake of appropriate treatment for pneumonia among the poorest and least poor (CCI = -0.070; SE = 0.083). Receiving ORS for diarrhoea was more prevalent among the least poor groups (CCI = 0.199; SE = 0.118). The use of iCCM for pneumonia was more prevalent among the poorest groups (CCI = -0.099; SE = 0.073). The use of iCCM for diarrhoea was not significantly different among the poorest and least poor (CCI = -0.073; SE = 0.085).ConclusioniCCM is a potentially equitable strategy that significantly increased the uptake of appropriate antibiotic treatment for pneumonia and ORS for diarrhoea, but not the uptake of zinc for diarrhoea. For maximum impact, interventions increasing zinc uptake should be considered when scaling up iCCM programmes.
Highlights
Pneumonia and diarrhoea disproportionately affect children in resource-poor settings
Conclusion: integrated community case management (iCCM) is a potentially equitable strategy that significantly increased the uptake of appropriate antibiotic treatment for pneumonia and oral rehydration salts (ORS) for diarrhoea, but not the uptake of zinc for diarrhoea
As a vehicle to increase coverage of lifesaving treatment for children suffering from these three child killers, a joint statement was produced by the World Health Organisation (WHO) and United Nations Children's Fund (UNICEF) in 2004 calling for integrated community case management of pneumonia and diarrhoea in addition to malaria in countries where these diseases are common [9]
Summary
Pneumonia and diarrhoea disproportionately affect children in resource-poor settings. As a vehicle to increase coverage of lifesaving treatment for children suffering from these three child killers, a joint statement was produced by the World Health Organisation (WHO) and United Nations Children's Fund (UNICEF) in 2004 calling for integrated community case management (iCCM) of pneumonia and diarrhoea in addition to malaria in countries where these diseases are common [9]. It is postulated that CCM for pneumonia may lower drug resistance through improved social inclusion and rational drug use using the WHO approved classification and treatment algorithm [10, 11] Despite these postulations, the introduction of antibiotics at the community level in African contexts has been criticised in some literature [12]
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