Evaluation of integrated community case management in eight districts of Central Uganda
Malaria Consortium, Kampala, Uganda; Keeping Children and Mothers Alive, UNICEF Uganda, Kampala, Uganda; Epidemiology and Health Policy and Practice, Columbia University, Mailman School of Public Health, New York, NY, United States; Health Section, Programme Division, UNICEF Headquarters, New York, NY, United States
Objective: Evidence is limited on whether Integrated Community Case Management (iCCM) improves treatment coverage of the top causes of childhood mortality (acute respiratory illnesses (ARI), diarrhoea and malaria). The coverage impact of iCCM in Central Uganda was evaluated. Methods: Between July 2010 and December 2012 a pre-post quasi-experimental study in eight districts with iCCM was conducted; 3 districts without iCCM served as controls. A two-stage household cluster survey at baseline (n = 1036 and 1042) and end line (n = 3890 and 3844) was done in the intervention and comparison groups respectively. Changes in treatment coverage and timeliness were assessed using difference in differences analysis (DID). Mortality impact was modelled using the Lives Saved Tool. Findings: 5,586 Village Health Team members delivered 1,907,746 treatments to children under age five. Use of oral rehydration solution (ORS) and zinc treatment of diarrhoea increased in the intervention area, while there was a decrease in the comparison area (DID = 22.9, p = 0.001). Due to national stock-outs of amoxicillin, there was a decrease in antibiotic treatment for ARI in both areas; however, the decrease was significantly greater in the comparison area (DID = 5.18; p<0.001). There was a greater increase in Artemisinin Combination Therapy treatment for fever in the intervention areas than in the comparison area but this was not significant (DID = 1.57, p = 0.105). In the intervention area, timeliness of treatments for fever and ARI increased significantly higher in the intervention area than in the comparison area (DID = 2.12, p = 0.029 and 7.95, p<0.001, respectively). An estimated 106 lives were saved in the intervention area while 611 lives were lost in the comparison area. Conclusion: iCCM significantly increased treatment coverage for diarrhoea and fever, mitigated the effect of national stock outs of amoxicillin on ARI treatment, improved timeliness of treatments for fever and ARI and saved lives. Copyright: © 2015 Mubiru et al.
amoxicillin; antimalarial agent; artemisinin; cotrimoxazole; insecticide; oral rehydration solution; zinc; adolescent; adult; Article; bed net; case management; child; child health care; childhood mortality; cluster analysis; controlled study; demography; diarrhea; early intervention; female; fever; health care delivery; health survey; help seeking behavior; human; integrated health care system; major clinical study; malaria; male; middle aged; preschool child; quasi experimental study; respiratory tract disease; respiratory tract infection; social status; Uganda; urban rural difference; young adult