Independent Evaluation of the integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design.

Agbessi Amouzou,Spy Munthali,Cesar G Victora,Rebecca Heidkamp,Tiope Mleme,Elizabeth Hazel,Benjamin Banda,Mercy Kanyuka,Jamie Perin,Lawrence H Moulton,Kenneth Hill,Jennifer Bryce,Robert E Black,Andrew Marsh,Lois Park

doi:10.4269/ajtmh.15-0584

Abstract

We evaluated the impact of integrated community case management of childhood illness (iCCM) on careseeking for childhood illness and child mortality in Malawi, using a National Evaluation Platform dose-response design with 27 districts as units of analysis. “Dose” variables included density of iCCM providers, drug availability, and supervision, measured through a cross-sectional cellular telephone survey of all iCCM-trained providers. “Response” variables were changes between 2010 and 2014 in careseeking and mortality in children aged 2–59 months, measured through household surveys. iCCM implementation strength was not associated with changes in careseeking or mortality. There were fewer than one iCCM-ready provider per 1,000 under-five children per district. About 70% of sick children were taken outside the home for care in both 2010 and 2014. Careseeking from iCCM providers increased over time from about 2% to 10%; careseeking from other providers fell by a similar amount. Likely contributors to the failure to find impact include low density of iCCM providers, geographic targeting of iCCM to “hard-to-reach” areas although women did not identify distance from a provider as a barrier to health care, and displacement of facility careseeking by iCCM careseeking. This suggests that targeting iCCM solely based on geographic barriers may need to be reconsidered.

Highlights

The Millennium Development Goals (MDGs) threw a spotlight on the need to accelerate progress of women and children’s health.[1]
We evaluated the impact of integrated community case management of childhood illness on careseeking for childhood illness and child mortality in Malawi, using a National Evaluation Platform dose-response design with 27 districts as units of analysis
One such strategy is the integrated Community Case Management. iCCM is endorsed by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF)[4,5,6] as a strategy to extend the provision of correct treatment of childhood pneumonia, diarrhea, and malaria beyond health facilities so that more children have access to lifesaving treatments.[7]

Summary

Introduction

The Millennium Development Goals (MDGs) threw a spotlight on the need to accelerate progress of women and children’s health.[1] The fourth MDG (MDG4) called for a reduction of two-thirds in child mortality between 1990 and 2015. ICCM is endorsed by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF)[4,5,6] as a strategy to extend the provision of correct treatment of childhood pneumonia, diarrhea, and malaria beyond health facilities so that more children have access to lifesaving treatments.[7] Despite important progress, these three infectious diseases still account for 31% of deaths in children under 5 years of age.[8] Many countries with high rates of under-five mortality have adopted iCCM as a policy, in sub-Saharan Africa.[9,10]

Methods

Results

Discussion

Conclusion