Abstract
Community case management (CCM) is a strategy for training and supporting workers at the community level to provide treatment for the three major childhood diseases—diarrhea, fever (indicative of malaria), and pneumonia—as a complement to facility-based care. Many low- and middle-income countries are now implementing CCM and need to evaluate whether adoption of the strategy is associated with increases in treatment coverage. In this review, we assess the extent to which large-scale, national household surveys can serve as sources of baseline data for evaluating trends in community-based treatment coverage for childhood illnesses. Our examination of the questionnaires used in Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2005 and 2010 in five sub-Saharan African countries shows that questions on care seeking that included a locally adapted option for a community-based provider were present in all the DHS surveys and in some MICS surveys. Most of the surveys also assessed whether appropriate treatments were available, but only one survey collected information on the place of treatment for all three illnesses. This absence of baseline data on treatment source in household surveys will limit efforts to evaluate the effects of the introduction of CCM strategies in the study countries. We recommend alternative analysis plans for assessing CCM programs using household survey data that depend on baseline data availability and on the timing of CCM policy implementation.
Highlights
Most low- and middle-income countries are making slow progress in addressing child mortality—too slow to achieve Millennium Development Goal 4 by 2015 [1]
community case management (CCM) aims to extend the treatment of childhood illnesses from health facilities into communities [5,6,7] by training and supporting existing or newly recruited community health workers to provide treatment for neonatal conditions and Citation: Hazel E, Requejo J, David J, Bryce J (2013) Measuring Coverage in MNCH: Evaluation of Community-Based Treatment of Childhood Illnesses through Household Surveys
We focused on Ethiopia, Ghana, Malawi, Mali, and Niger, five countries where the Catalytic Initiative to Save a Million Lives, a partnership of donors and United Nations agencies, is supporting CCM as a strategy to accelerate coverage for the treatment of childhood illnesses [11]
Summary
Most low- and middle-income countries are making slow progress in addressing child mortality—too slow to achieve Millennium Development Goal 4 by 2015 [1]. Doi:10.1371/journal.pmed.1001384.t002 questions on place of treatment for fever were included in the Mali (2009) and Malawi (2006) MICS surveys and in the MICS4 core questionnaire This analysis shows that, with the exception of the 2006 Ghana MICS survey, comprehensive baseline data on the place and provider of appropriate treatment of childhood pneumonia, diarrhea, and fever are not available from the major household surveys conducted in the study countries before 2010. For example, a hypothetical setting where a DHS or MICS survey collects information on both care seeking and treatment but not on place of treatment prior to implementation of a CCM program (baseline) After this survey is conducted, a CCM policy is implemented, and the government requests a time-trend analysis on the impact of the CCM program on childhood illnesses. The widespread adoption of this and any new strategy, combined with a growing recognition of the need for evidence-based evaluations of program effectiveness, underline the continuing need for modifications in household
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