Integrated Community Case Management of Childhood Illness in Ethiopia: Implementation Strength and Quality of Care

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Abstract

Ethiopia has scaled up integrated community case management of childhood illness (iCCM) in most regions. We assessed the strength of iCCM implementation and the quality of care provided by health extension workers (HEWs). Data collectors observed HEWs' consultations with sick children and carried out gold standard re-examinations. Nearly all HEWs received training and supervision, and essential commodities were available. HEWs provided correct case management for 64% of children. The proportions of children correctly managed for pneumonia, diarrhea, and malnutrition were 72%, 79%, and 59%, respectively. Only 34% of children with severe illness were correctly managed. Health posts saw an average of 16 sick children in the previous 1 month. These results show that iCCM can be implemented at scale and that community-based HEWs can correctly manage multiple illnesses. However, to increase the chances of impact on child mortality, management of severe illness and use of iCCM services must be improved.

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Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review

Christa L Fischer Walker, Jamie Perin, Martin Aryee … (2012)

Background Diarrhea is recognized as a leading cause of morbidity and mortality among children under 5 years of age in low- and middle-income countries yet updated estimates of diarrhea incidence by age for these countries are greatly needed. We conducted a systematic literature review to identify cohort studies that sought to quantify diarrhea incidence among any age group of children 0-59 mo of age. Methods We used the Expectation-Maximization algorithm as a part of a two-stage regression model to handle diverse age data and overall incidence rate variation by study to generate country specific incidence rates for low- and middle-income countries for 1990 and 2010. We then calculated regional incidence rates and uncertainty ranges using the bootstrap method, and estimated the total number of episodes for children 0-59 mo of age in 1990 and 2010. Results We estimate that incidence has declined from 3.4 episodes/child year in 1990 to 2.9 episodes/child year in 2010. As was the case previously, incidence rates are highest among infants 6-11 mo of age; 4.5 episodes/child year in 2010. Among these 139 countries there were nearly 1.9 billion episodes of childhood diarrhea in 1990 and nearly 1.7 billion episodes in 2010. Conclusions Although our results indicate that diarrhea incidence rates may be declining slightly, the total burden on the health of each child due to multiple episodes per year is tremendous and additional funds are needed to improve both prevention and treatment practices in low- and middle-income countries.

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Inequities among the very poor: health care for children in rural southern Tanzania.

Joanna Armstrong Schellenberg, Cesar Victora, Adiel K Mushi … (2003)

Few studies have been done to assess socioeconomic inequities in health in African countries. We sought evidence of inequities in health care by sex and socioeconomic status for young children living in a poor rural area of southern Tanzania. In a baseline household survey in Tanzania early in the implementation phase of integrated management of childhood illness (IMCI), we included cluster samples of 2006 children younger than 5 years in four rural districts. Questions focused on the extent to which carers' knowledge of illness, care-seeking outside the home, and care in health facilities were consistent with IMCI guidelines and messages. We used principal components analysis to develop a relative index of household socioeconomic status, with weighted scores of information on income sources, education of the household head, and household assets. 1026 (52%) of 1968 children reported having been ill in the 2 weeks before the survey. Carers of 415 (41%) of 1014 of these children had sought care first from an appropriate provider. 71 (26%) carers from families in the wealthiest quintile knew > or =2 danger signs compared with 48 (20%) of those from the poorest (p=0.03 for linear trend across quintiles) and wealthier families were more likely to bring their sick children to a health facility (p=0.02). Their children were more likely than poorer children to have received antimalarials, and antibiotics for pneumonia (p=0.0001 and 0.0048, respectively). Care-seeking behaviour is worse in poorer than in relatively rich families, even within a rural society that might easily be assumed to be uniformly poor.

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Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a meta-analysis of community-based trials.

Sandra Black, Sunil Sazawal (2003)

Pneumonia still causes around two million deaths among children annually (20% of all child deaths). Any intervention that would affect pneumonia mortality is of great public health importance. This meta-analysis provides estimates of mortality impact of the case-management approach proposed by WHO. We were able to get data from nine of ten eligible community-based studies that assessed the effects of pneumonia case-management intervention on mortality; seven studies had a concurrent control group. Standardised forms were completed by individual investigators to provide information on study description, quality scoring, follow-up, and outcome (mortality) data with three age groups (<1 month, <1 year, 0-4 years) and two mortality categories (total and pneumonia-specific). Meta-analysis found a reduction in total mortality of 27% (95% CI 18-35%), 20% (11-28%), and 24% (14-33%) among neonates, infants, and children 0-4 years of age, respectively. In the same three groups pneumonia mortality was reduced by 42% (22-57%), 36% (20-48%), and 36% (20-49%). There was no evidence of publication bias and results were unaltered by exclusion of any study. A limitation of the included studies is that they were not randomised and, because of the nature of the intervention, could not be blinded. Community-based interventions to identify and treat pneumonia have a substantial effect on neonatal, infant, and child mortality and should be incorporated into primary health care.

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Journal

Journal ID (nlm-ta): Am J Trop Med Hyg

Journal ID (iso-abbrev): Am. J. Trop. Med. Hyg

Journal ID (publisher-id): tpmd

Title: The American Journal of Tropical Medicine and Hygiene

Publisher: The American Society of Tropical Medicine and Hygiene

ISSN (Print): 0002-9637

ISSN (Electronic): 1476-1645

Publication date (Print): 06 August 2014

Publication date PMC-release: 06 August 2014

Volume: 91

Issue: 2

Pages: 424-434

Affiliations

Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ABH Services, PLC, Addis Ababa, Ethiopia; United Nations Children's Fund (UNICEF) Ethiopia Country Office, Addis Ababa, Ethiopia; Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil

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*Address correspondence to Nathan P. Miller, Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205. E-mail: nmiller@ 123456jhsph.edu

Article

DOI: 10.4269/ajtmh.13-0751

PMC ID: 4125273

PubMed ID: 24799369

SO-VID: 681fb89c-9e67-4074-a3d6-70fcca6fabf8

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted uSe, distribution, and reproduction in any medium, provided the original author and source are credited.

Integrated Community Case Management of Childhood Illness in Ethiopia: Implementation Strength and Quality of Care

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Most cited references 48

Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review

Inequities among the very poor: health care for children in rural southern Tanzania.

Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a meta-analysis of community-based trials.

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