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

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

doi:10.4269/ajtmh.16-0110b

Cited by 4 publications

(6 citation statements)

References 4 publications

(3 reference statements)

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“…We found that having more HSA relative to the population of children under five was associated with higher average careseeking only from HSA, however, we did not observe an association between careseeking from all sources and the population-adjusted number of district HSA. This finding is in agreement with Amouzou et al that the evidence was not consistent with a large impact of the iCCM program for careseeking in children aged 2 to 59 months [10]. …”

Section: Discussionsupporting

confidence: 91%

“…In addition, we examined the correlation between program and careseeking from all sources, including HSA and health facilities, as in the primary evaluation of iCCM in Malawi [10]. For both these, we conducted sensitivity analysis for the relationship between careseeking and district population of children under five years of age.…”

Section: Methodsmentioning

confidence: 99%

“…We asked whether there was improved access to care for these illnesses only from HSAs, and then separately, whether there was improved access to care from any source. The primary evaluation of iCCM in Malawi has recently been conducted [10]. We revisited this evaluation to further investigate the evidence for iCCM in Malawi, and to make recommendations for future evaluations of iCCM and other similar programs.…”

Section: Introductionmentioning

confidence: 99%

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Hierarchical Statistical Models to Represent and Visualize Survey Evidence for Program Evaluation: iCCM in Malawi

et al. 2016

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Policy and Program evaluation for maternal, newborn and child health is becoming increasingly complex due to changing contexts. Monitoring and evaluation efforts in this area can take advantage of large nationally representative household surveys such as DHS or MICS that are increasing in size and frequency, however, this analysis presents challenges on several fronts. We propose an approach with hierarchical models for cross-sectional survey data to describe evidence relating to program evaluation, and apply this approach to the recent scale up of iCCM in Malawi. We describe careseeking for children sick with diarrhea, pneumonia, or malaria with empirical Bayes estimates for each district of Malawi at two time points, both for careseeking from any source, and for careseeking only from health surveillance assistants (HSA). We do not find evidence that children in areas with more HSA trained in iCCM are more likely to seek care for pneumonia, diarrhea, or malaria, despite evidence that many indeed are seeking care from HSA. Children in areas with more HSA trained in iCCM are more likely to seek care from a HSA, with 100 additional trained health workers in a district corresponding to a 2% average increase in careseeking from HSA. The hierarchical models presented here provide a flexible set of methods that describe the primary evidence for evaluating iCCM in Malawi and which could be extended to formal causal analyses, and to analysis for other similar evaluations with national survey data.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hierarchical Statistical Models to Represent and Visualize Survey Evidence for Program Evaluation: iCCM in Malawi

et al. 2016

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“…In these cases, the number of children is small, which leads to wide confidence intervals for these indicators, and may fail to detect differences between boys and girls as statistically significant due to low power [9]. …”

mentioning

confidence: 99%

“…Careseeking indicators are based on children who presented symptoms for each illness, usually in the two weeks before a survey. In these cases, the number of children is small, which leads to wide confidence intervals for these indicators, and may fail to detect differences between boys and girls as statistically significant due to low power [ 9 ].…”

mentioning

confidence: 99%

Gender bias in careseeking practices in 57 low– and middle–income countries

Costa¹,

Wehrmeister²,

Barros³

et al. 2017

Journal of Global Health

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BackgroundPreventive and curative medical interventions can reduce child mortality. It is important to assess whether there is gender bias in access to these interventions, which can lead to preferential treatment of children of a given sex.MethodsData from Demographic and Health Surveys carried out in 57 low– and middle–income countries were used. The outcome variable was a composite careseeking indicator, which represents the proportion of children with common childhood symptoms or illnesses (diarrhea, fever, or suspected pneumonia) who were taken to an appropriate provider. Results were stratified by sex at the national level and within each wealth quintile. Ecological analyses were carried out to assess if sex ratios varied by world region, religion, national income and its distribution, and gender inequality indices. Linear multilevel regression models were used to estimate time trends in careseeking by sex between 1994 and 2014.FindingsEight out of 57 countries showed significant differences in careseeking; in six countries, girls were less likely to receive care (Colombia, Egypt, India, Liberia, Senegal and Yemen). Seven countries had significant interactions between sex and wealth quintile, but the patterns varied from country to country. In the ecological analyses, lower careseeking for girls tended to be more common in countries with higher income concentration (P = 0.039) and higher Muslim population (P = 0.006). Coverage increased for both sexes; 0.95 percent points (pp) a year among girls (32.9% to 51.9%), and 0.91 pp (34.8% to 52.9%) among boys.ConclusionThe overall frequency of careseeking is similar for girls and boys, but not in all countries, where there is evidence of gender bias. A gender perspective should be an integral part of monitoring, accountability and programming. Countries where bias is present need renewed attention by national and international initiatives, in order to ensure that girls receive adequate care and protection.

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Proactive community case management and child survival in periurban Mali

et al. 2018

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The majority of the world’s population lives in urban areas, and regions with the highest under-five mortality rates are urbanising rapidly. This 7-year interrupted time series study measured early access to care and under-five mortality over the course of a proactive community case management (ProCCM) intervention in periurban Mali. Using a cluster-based, population-weighted sampling methodology, we conducted independent cross-sectional household surveys at baseline and at 12, 24, 36, 48, 60, 72 and 84 months later in the intervention area. The ProCCM intervention had five key components: (1) active case detection by community health workers (CHWs), (2) CHW doorstep care, (3) monthly dedicated supervision for CHWs, (4) removal of user fees and (5) primary care infrastructure improvements and staff capacity building. Under-five mortality rate was calculated using a Cox proportional hazard survival regression. We measured the percentage of children initiating effective antimalarial treatment within 24 hours of symptom onset and the percentage of children reported to be febrile within the previous 2 weeks. During the intervention, the rate of early effective antimalarial treatment of children 0–59 months more than doubled, from 14.7% in 2008 to 35.3% in 2015 (OR 3.198, P<0.0001). The prevalence of febrile illness among children under 5 years declined after 7 years of the intervention from 39.7% at baseline to 22.6% in 2015 (OR 0.448, P<0.0001). Communities where ProCCM was implemented have achieved an under-five mortality rate at or below 28/1000 for the past 6 years. In 2015, under-five mortality was 7/1000 (HR 0.039, P<0.0001). Further research is needed to elucidate the mechanisms of action and generalizability of ProCCM.

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

Cited by 4 publications

References 4 publications

Hierarchical Statistical Models to Represent and Visualize Survey Evidence for Program Evaluation: iCCM in Malawi

Hierarchical Statistical Models to Represent and Visualize Survey Evidence for Program Evaluation: iCCM in Malawi

Gender bias in careseeking practices in 57 low– and middle–income countries

Proactive community case management and child survival in periurban Mali

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