ObjectiveEvidence 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.MethodsBetween 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.Findings5,586 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.ConclusioniCCM 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.

Background: Despite global and local initiatives to increase vaccine uptake, timeliness of vaccinations and vaccine uptake remain low among residents of islands and fishing communities in Uganda. Vaccine coverage (all vaccines) among island communities stands at 37.1% compared to 55%, the national level. This qualitative study was conducted to (i) understand key barriers to vaccine uptake among residents of islands and fishing communities of Lake Victoria, Buganda sub-region, Uganda and (ii) identify specific needs of the communities; ahead of implementation of a mobile health intervention to promote vaccine uptake. Methods: Explorator y qualitative. Data were collected through focus group discussions with women of reproductive age and village health teams (VHT) and key informant interviews with the health coordinators and health service providers. Data were analysed through content analysis, by coding pre-established and recurrent themes.Results: Under the barriers, seven themes were identified: Opportunity cost of seeking vaccines versus making a living, Distance/Cost to health facility, Availability of service provider, Attitudes towards vaccines, Decision making regarding the use of vaccines, Knowledge of availability of services, and Attitudes of service providers. Participants suggested strategies to improve uptake: 1) more health education and regular reminders using VHTs, public address systems and mobile technology; 2) bring services closer to people through scheduled vaccination campaigns to reduce on cost of seeking services; and 3) strengthening public-private partnerships in the health sector for delivery of vaccine services. Conclusion: In light of the current barriers to vaccine uptake, innovations to increase the utilisation of vaccination services in remote underserved settings need to be multi-pronged, responding to user, structural and supply-side factors. The use of mobile technology and public-private partnerships for health have the potential to bridge existing vaccine delivery and uptake gaps.