1921
Volume 97, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Integrated community case management (iCCM) aims to reduce child mortality in areas with poor access to health care. iCCM was implemented in 2009 in Kono district, Sierra Leone, a postconflict area with high under-five mortality rates (U5MRs). We evaluated iCCM’s impact and effects on child health using cluster surveys in 2010 (midterm) and 2013 (endline) to compare indicators on child mortality, coverage of appropriate treatment, timely access to care, quality of care, and recognition of community health workers (CHWs). The sample size was powered to detect a 28% decline in U5MR. Clusters were selected proportional to population size. All households were sampled to measure mortality and systematic random sampling was used to measure coverage in a subset of households. We used program data to evaluate utilization and access; 5,257 (2010) and 3,649 (2013) households were surveyed. U5MR did not change significantly (4.54 [95% confidence interval [CI]: 3.47–5.60] to 3.95 [95% CI: 3.06–4.83] deaths per 1,000 per month ( = 0.4)) though a relative change smaller than 28% could not be detected. CHWs were the first source of care for 52% (2010) and 50.9% (2013) of children. Coverage of appropriate treatment of fever by CHWs or peripheral health units increased from 45.5% [95% CI: 39.2–52.0] to 58.2% [95% CI: 50.5–65.5] ( = 0.01); changes for diarrhea and pneumonia were not significant. The continued reliance on the CHW as the first source of care and improved coverage for the appropriate treatment of fever support iCCM’s role in Kono district.

[open-access] 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.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.17-0040
2017-09-07
2019-01-18
Loading full text...

Full text loading...

/deliver/fulltext/14761645/97/3/tpmd170040.html?itemId=/content/journals/10.4269/ajtmh.17-0040&mimeType=html&fmt=ahah

References

  1. You D, Hug L, Ejdemyr S, Idele P, Hogan D, Mathers C, Gerland P, New JR, Alkema L, ; United Nations Inter-agency Group for Child Mortality Estimation, 2015. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet 386: 22752286. [Google Scholar]
  2. UNICEF and WHO, 2015. Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival: The 2015 Report. New York, NY: UNICEF and Geneva, Switzerland: WHO.
  3. Bertone MP, Samai M, Edem-Hotah J, Witter S, , 2014. A window of opportunity for reform in postconflict settings? The case of human resources for health policies in Sierra Leone, 2002–2012. Conflict Health 8: 11.
  4. Fornah JS, Macarthy P, Sawaneh ST, Sillah A, Nandy R, Roberts L, , 2001. Mortality In Kenema District, Sierra Leone: A Survey Covering Jan. 2000–Jan. 2001. Freetown, Sierra Leone: International Rescue Committee.
  5. Checchi F, Roberts L, , 2005. Interpreting and Using Mortality Data in Humanitarian Emergencies: A primer for Non-Epidemiologists. Network Paper Humanitarian Practice. London, UK: Overseas Development Institute.
  6. Maxmen A, , 2013. Sierra Leone’s free health-care initiative: work in progress. Lancet 381: 191192. [Google Scholar]
  7. Witter S, Wurie H, Bertone MP, , 2016. The free health care initiative: how has it affected health workers in Sierra Leone? Health Policy Plan 31: 19. [Google Scholar]
  8. Ministry of Health and Sanitation, 2009. National Health Sector Strategic Plan 2010–2015. Freetown, Sierra Leone: Government of Sierra Leone.
  9. WHO, UNICEF, 2012. WHO/UNICEF Joint Statement on Integrated Community Case Management (iCCM): An Equity-Focused Strategy to Improve Access to Essential Treatment Services for Children. Geneva, Switzerland: World Health Organization and New York, NY: UNICEF.
  10. Amouzou A, Morris S, Moulton LH, Mukanga D, , 2014. Assessing the impact of integrated community case management (iCCM) programs on child mortality: review of early results and lessons learned in sub-Saharan Africa. J Glob Health 4: 020411. [Google Scholar]
  11. Amouzou A, Hazel E, Shaw B, Miller NP, Tafesse M, Mekonnen Y, Moulton LH, Bryce J, Black RE, , 2016. Effects of the integrated community case management of childhood illness strategy on child mortality in Ethiopia: a cluster randomized Trial. Am J Trop Med Hyg 94: 596604. [Google Scholar]
  12. Amouzou A, , 2016. Independent evaluation of the integrated community case management of childhood illness strategy in Malawi using a National Evaluation Platform Design. Am J Trop Med Hyg 94: 574583. [Google Scholar]
  13. Daelmans B, Seck A, Nsona H, Wilson S, Young M, , 2016. Integrated community case management of childhood illness: what have we learned? Am J Trop Med Hyg 94: 571573. [Google Scholar]
  14. Diaz T, Aboubaker S, Young M, , 2014. Current scientific evidence for integrated community case management (iCCM) in Africa: findings from the iCCM evidence symposium. J Glob Health 4: 020101. [Google Scholar]
  15. Munos M, Guiella G, Roberton T, Maiga A, Tiendrebeogo A, Tam Y, Bryce J, Baya B, , 2016. Independent evaluation of the rapid scale-up program to reduce under-five mortality in Burkina Faso. Am J Trop Med Hyg 94: 584595. [Google Scholar]
  16. Kruk ME, Freedman LP, Anglin GA, Waldman RJ, , 2010. Rebuilding health systems to improve health and promote statebuilding in post-conflict countries: a theoretical framework and research agenda. Soc Sci Med 70: 8997. [Google Scholar]
  17. Statistics Sierra Leone (SSL) and UNICEF Sierra Leone, 2011. Sierra Leone Multiple Indicator Cluster Survey 2010, Final Report. Freetown, Sierra Leone: SSL and UNICEF.
  18. World Health Organization. WHO Global Database on Child Growth and Malnutrition. Department of Nutrition for Health and Development (NHD). Geneva, Switzerland: WHO. Available at: http://www.who.int/nutgrowthdb/about/introduction/en/index5.html. Accessed May 30, 2017.
  19. Ministry of Health and Sanitation, 2012. Policy for Community Health Workers in Sierra Leone. Freetown, Sierra Leone: Government of Sierra Leone.
  20. IRC Child Survival Program, 2007. Community Based Treatment Mortality Survey, 26 March–2 April 2007. Freetown, Sierra Leone: IRC.
  21. Chinbuah AM, Gyapong JO, Pagnoni F, Wellington EK, Gyapong M, , 2006. Feasibility and acceptability of the use of artemether-lumefantrine in the home management of uncomplicated malaria in children 6–59 months old in Ghana. Trop Med Int Health 11: 10031016. [Google Scholar]
  22. Sazawal S, Black RE, Pneumonia Case Management Trials G, , 2003. Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a meta-analysis of community-based trials. Lancet Infect Dis 3: 547556. [Google Scholar]
  23. Brown CA, Lilford RJ, , 2006. The stepped wedge trial design: a systematic review. BMC Med Res Methodol 6: 54. [Google Scholar]
  24. International ICF, U.S. Agency for International Development, 2011. Demographic and Health Surveys Methodology—Questionnaires: Household, Woman’s, and Man’s. MEASURE DHS Phase III. Calverton, MD: .
  25. Cairns KL, Woodruff BA, Myatt M, Bartlett L, Goldberg H, Roberts L, , 2009. Cross-sectional survey methods to assess retrospectively mortality in humanitarian emergencies. Disasters 33: 503521. [Google Scholar]
  26. Habicht JP, Victora CG, Vaughan JP, , 1999. Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact. Int J Epidemiol 28: 1018. [Google Scholar]
  27. Oliphant NP, Muniz M, Guenther T, Diaz T, Lainez YB, Counihan H, Pratt A, , 2014. Multi-country analysis of routine data from integrated community case management (iCCM) programs in sub-Saharan Africa. J Glob Health 4: 020408. [Google Scholar]
  28. Yansaneh AI, Moulton LH, George AS, Rao SR, Kennedy N, Bangura P, Brieger WR, Kabano A, Diaz T, , 2014. Influence of community health volunteers on care seeking and treatment coverage for common childhood illnesses in the context of free health care in rural Sierra Leone. Trop Med Int Health 19: 14661476. [Google Scholar]
  29. Lainez YB, Wittcoff A, Mohamud AI, Amendola P, Perry HB, D’Harcourt E, , 2012. Insights from community case management data in six sub-Saharan African countries. Am J Trop Med Hyg 87 (Suppl): 144150. [Google Scholar]
  30. McMahon SA, George AS, Yumkella F, Diaz T, , 2013. Spoiled breast milk and bad water; local understandings of diarrhea causes and prevention in rural Sierra Leone. BMC Public Health 13: 1172.
  31. Eisele TP, Rhoda DA, Cutts FT, Keating J, Ren R, Barros AJ, Arnold F, , 2013. Measuring coverage in MNCH: total survey error and the interpretation of intervention coverage estimates from household surveys. PLoS Med 10: e1001386. [Google Scholar]
  32. Mubiru D, , 2015. Evaluation of integrated community case management in eight districts of central Uganda. PLoS One 10: e0134767. [Google Scholar]
  33. Statistics Sierra Leone, 2014. Sierra Leone Demographic and Health Survey 2013. Rockville, MD: ICF International.
  34. GBD Mortality Causes of Death Collaborators, 2015. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England) 385: 117171. [Google Scholar]
  35. GBD 2015 Maternal Mortality Collaborators, , 2016. Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388: 17751812. [Google Scholar]
  36. The Sphere Project, 2004. Humanitarian Charter and Minimum Standards in Disaster Response. Oxford: Oxfam.
  37. World Health Organization, 2012. Outbreak news. Cholera, Sierra Leone. Wkly Epidemiol Rec 87: 337338. [Google Scholar]
  38. WHO Regional Office for Africa, 2012. Sierra Leone: Cholera (Situation as of 16 October 2012). Geneva, Switzerland: World Health Organization.
  39. Hazel E, Bryce J, , 2016. Group I-JiEW. On bathwater, babies, and designing programs for impact: evaluations of the integrated community case management strategy in Burkina Faso, Ethiopia, and Malawi. Am J Trop Med Hyg 94: 568570. [Google Scholar]
  40. Campbell H, El Arifeen S, Hazir T, O’Kelly J, Bryce J, Rudan I, Qazi SA, , 2013. Measuring coverage in MNCH: challenges in monitoring the proportion of young children with pneumonia who receive antibiotic treatment. PLoS Med 10: e1001421. [Google Scholar]
  41. Hazir T, , 2013. Measuring coverage in MNCH: a prospective validation study in Pakistan and Bangladesh on measuring correct treatment of childhood pneumonia. PLoS Med 10: e1001422. [Google Scholar]
  42. Bryce J, Arnold F, Blanc A, Hancioglu A, Newby H, Requejo J, Wardlaw T, , 2013. Measurement CWGoIC. Measuring coverage in MNCH: new findings, new strategies, and recommendations for action. PLoS Med 10: e1001423. [Google Scholar]
  43. Fischer Walker CL, Fontaine O, Black RE, , 2013. Measuring coverage in MNCH: current indicators for measuring coverage of diarrhea treatment interventions and opportunities for improvement. PLoS Med 10: e1001385. [Google Scholar]
  44. Perry HB, , 2016. Community health worker programmes after the 2013–2016 Ebola outbreak. Bull World Health Organ 94: 551553. [Google Scholar]
  45. Ratnayake R, Crowe SJ, Jasperse J, Privette G, Stone E, Miller L, Hertz D, Fu C, Maenner MJ, Jambai A, Morgan O, , 2016. Assessment of community event-based surveillance for ebola virus disease, Sierra Leone, 2015. Emerg Infect Dis 22: 14311437. [Google Scholar]
  46. Kieny MP, Dovlo D, , 2015. Beyond ebola: a new agenda for resilient health systems. Lancet 385: 9192. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.17-0040
Loading
/content/journals/10.4269/ajtmh.17-0040
Loading

Data & Media loading...

  • Received : 16 Jan 2017
  • Accepted : 19 Apr 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error