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
. 2020 Nov 13;15(11):e0242451.
doi: 10.1371/journal.pone.0242451. eCollection 2020.

Changes in care-seeking for common childhood illnesses in the context of Integrated Community Case Management (iCCM) program implementation in Benishangul Gumuz region of Ethiopia

Samson Gebremedhin  1 , Ayalew Astatkie  2 , Hajira M Amin  3 , Abebe Teshome  3 , Abebe Gebremariam  3
Affiliations

Changes in care-seeking for common childhood illnesses in the context of Integrated Community Case Management (iCCM) program implementation in Benishangul Gumuz region of Ethiopia

Samson Gebremedhin et al. PLoS One. .

Abstract

Background: Integrated Community Case Management (iCCM) is a strategy for promoting access of under-served populations to lifesaving treatments through extending case management of common childhood illnesses to trained frontline health workers. In Ethiopia iCCM is provided by health extension workers (HEWs) deployed at health posts. We evaluated the association between the implementation of iCCM program in Assosa Zuria zone, Benishangul Gumuz region and changes in care-seeking for common childhood illnesses.

Methods: We conducted a pre-post study without control arm to evaluate the association of interest. The iCCM program that incorporated training, mentoring and supportive supervision of HEWs with community-based demand creation activities was implemented for two years (2017-18). Baseline, midline and endline surveys were completed approximately one year apart. Across the surveys, children aged 2-59 months (n = 1,848) who recently had cough, fever or diarrhea were included. Data were analysed using mixed-effects logistic regression model.

Results: Over the two-year period, care-seeking from any health facility and from health posts significantly increased by 10.7 and 17.4 percentage points (PP) from baseline levels of 64.5 and 34.1%, respectively (p<0.001). Care sought from health centres (p = 0.420) and public hospitals (p = 0.129) did not meaningfully change while proportion of caregivers who approached private (p = 0.003) and informal providers (p<0.001) declined. Caregivers who visited health posts for the treatment of diarrhea (19.2 PP, p<0.001), fever (15.5 PP, p<0.001), cough (17.8 PP, p<0.001) and cough with respiratory difficulty (17.3 PP, p = 0.038) significantly increased. After accounting for extraneous variables, we observed that care-seeking from iCCM providers was almost doubled (adjusted odds ratio = 2.32: 95% confidence interval; 1.88-2.86) over the period.

Conclusion: iCCM implementation was associated with a meaningful shift in care-seeking to health posts.

PubMed Disclaimer

Conflict of interest statement

HMA, AT and AG worked at Emory University (Ethiopia) that implemented the iCCM program. SG and AY received consultancy fees for evaluating the implementation of the program. We declare that the conflict of interest declared did not alter our adherence to all PLOS one policies.

References

    1. Ruducha J, Mann C, Singh NS, Gemebo TD, Tessema NS, Baschieri A, et al. How Ethiopia achieved Millennium Development Goal 4 through multisectoral interventions: A Countdown to 2015 case study. Lancet Glob Health. 2017; 5(11): e1142–e1151. 10.1016/S2214-109X(17)30331-5 - DOI - PMC - PubMed
    1. Unicef. Under-five mortality, 2019. [Cited 2020, July 20] Available from: https://data.unicef.org/topic/child-survival/under-five-mortality/.
    1. United Nations. Sustainable Development Goals knowledge platform: Ethiopia, 2017. [Cited 2020, July 20] Available from https://sustainabledevelopment.un.org/memberstates/ethiopia.
    1. Deribew A, Tessema GA, Deribe K, Melaku YA, Lakew Y, Amare AT, et al. Trends, causes, and risk factors of mortality among children under 5 in Ethiopia, 1990–2013: findings from the Global Burden of Disease Study 2013. Population Health Metrics. 2016; 14: 42 10.1186/s12963-016-0112-2 - DOI - PMC - PubMed
    1. Girum T, Shumbej T, Shewangizaw M. Burden of malaria in Ethiopia, 2000–2016: findings from the Global Health Estimates 2016. Trop Dis Travel Med Vaccines. 2019; 5: 11 10.1186/s40794-019-0090-z - DOI - PMC - PubMed

Publication types

MeSH terms