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. 2019 Jun;9(1):010801.
doi: 10.7189/jogh.09.010801.

Evidence of Impact: iCCM as a strategy to save lives of children under five

Debra Prosnitz  1 , Samantha Herrera  1   2 , Helen Coelho  1 , Lwendo Moonzwe Davis  1 , Kirsten Zalisk  1 , Jennifer Yourkavitch  1
Affiliations

Evidence of Impact: iCCM as a strategy to save lives of children under five

Debra Prosnitz et al. J Glob Health. 2019 Jun.

Abstract

Background: In 2013, the World Health Organization (WHO) launched the Rapid Access Expansion (RAcE) programme in the Democratic Republic of Congo, Malawi, Mozambique, Niger, and Nigeria to increase coverage of diagnostic, treatment, and referral services for malaria, pneumonia, and diarrhea among children ages 2-59 months. In 2017, a final evaluation of the six RAcE sites was conducted to determine whether the programme goal was reached. A key evaluation objective was to estimate the reduction in childhood mortality and the number of under-five lives saved over the project period in the RAcE project areas.

Methods: The Lives Saved Tool (LiST) was used to estimate reductions in all-cause child mortality due to changes in coverage of treatment for the integrated community case management (iCCM) illnesses - malaria, pneumonia, and diarrhea - while accounting for other changes in maternal and child health interventions in each RAcE project area. Data from RAcE baseline and endline household surveys, Demographic and Health Surveys, and routine health service data were used in each LiST model. The models yielded estimated change in under-five mortality rates, and estimated number of lives saved per year by malaria, pneumonia and diarrhea treatment. We adjusted the results to estimate the number of lives saved by community health worker (CHW)-provided treatment.

Results: The LiST model accounts for coverage changes in iCCM intervention coverage and other health trends in each project area to estimate mortality reduction and child lives saved. Under five mortality declined in all six RAcE sites, with an average decline of 10 percent. An estimated 6200 under-five lives were saved by malaria, pneumonia, and diarrhea treatment in the DRC, Malawi, Niger, and Nigeria, of which approximately 4940 (75 percent) were saved by treatment provided by CHWs. This total excludes Mozambique, where there were no estimated under-five lives saved likely due to widespread stockouts of key medications. In all other project areas, lives saved by CHW-provided treatment contributed substantially to the estimated decline in under-five mortality.

Conclusions: Our results suggest that iCCM is a strategy that can save lives and measurably decrease child mortality in settings where access to health facility services is low and adequate resources for iCCM implementation are provided for CHW services.

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Conflict of interest statement

Competing Interests: WHO contracted ICF to estimate the impact of the RAcE interventions on all-cause mortality in children ages 2-59 months using the Lives Saved Tool (LiST) and to estimate the number of lives saved in the intervention areas based on coverage changes shown by baseline and endline household surveys in RAcE project areas. ICF developed a protocol for this evaluation. WHO provided inputs to that protocol and then approved it. ICF conducted the assessments, interpreted the results, and wrote the conclusions. WHO provided information pertaining to the accuracy of the data and supporting information used to develop this manuscript. The authors completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available upon request from the corresponding author), and declare no further conflicts of interest.

References

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