Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Mar;94(3):574-583.
doi: 10.4269/ajtmh.15-0584. Epub 2016 Jan 19.

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

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

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

Agbessi Amouzou et al. Am J Trop Med Hyg. 2016 Mar.

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.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
District medians and spread for three component measures of iCCM implementation strength in Malawi (N = 27 districts). HSAs = health surveillance assistants; iCCM = integrated Community Case Management.
Figure 2.
Figure 2.
Correlations between the density of iCCM-ready HSAs and changes between 2010 and 2014 careseeking and mortality for children aged 2–59 months in Malawi (N = 27 districts). HSAs = health surveillance assistants; iCCM = integrated Community Case Management.
Figure 3.
Figure 3.
Careseeking for childhood illness in 2010 and 2014among children living in (A) the poorest and wealthiest quintiles of the population and (B) households in rural and urban areas, Malawi. HSAs = health surveillance assistants
See this image and copyright information in PMC

Comment in

References

    1. United Nations The Millennium Development Goals Report 2015. 2015 http://www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20rev%2... Available at. Accessed July 24, 2015.
    1. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. The Bellagio Child Survival Study Group How many child deaths can we prevent this year? Lancet. 2003;362:65–71. - PubMed
    1. Bryce J, el Arifeen S, Pariyo G, Lanata C, Gwatkin D, Habicht JP. Multi-Country Evaluation of IMCI Study Group Reducing child mortality: can public health deliver? Lancet. 2003;362:159–164. - PubMed
    1. WHO/UNICEF Joint Statement on Integrated Community Case Management of Childhood Illness: An Equity-Focused Strategy to Improve Access to Essential Treatment Services for Children. 2012. http://www.who.int/maternal_child_adolescent/documents/iccm_service_acce... Available at. Accessed November 2, 2014. - PMC - PubMed
    1. Chopra M, Sharkey A, Dalmiya N, Anthony D, Binkin N. On behalf of the UNICEF Equity in Child Survival, Health, and Nutrition Analysis Team Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition. Lancet. 2012;380:1331–1340. - PubMed

Publication types

MeSH terms

LinkOut - more resources