Integrated community case management of childhood illness in low- and middle-income countries

Oliphant, Nicholas P.; Manda, Samuel; Daniels, Karen; Odendaal, Willem; Besada, Donela; Kinney, Mary; Johansson, Emily White; Doherty, Tanya

doi:10.1002/14651858.cd012882.pub2

Cited by 22 publications

(24 citation statements)

References 117 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Quarterly supportive supervision and mentorship conducted on regular basis ensured that knowledge and skills are maintained to promote quality community health care service utilization (32). These ndings support evidence from other studies that when well trained and mentored, CHVs can correctly manage multiple childhood illnesses (8,9,15,19,32,41,46,48,49).…”

Section: Discussionsupporting

confidence: 68%

“…In the hands of well trained, supplied and supervised CHVs, iCCM can increase access to healthcare in the underserved communities -due to geographical terrain, social, economic or natural barriers -receiving relatively inequitable public health services and contribute to prevention of U5 mortality and morbidity from easily preventable causes (6)(7)(8)(9)(10)(11)(12). In 2010, a total of 28 countries in sub-Saharan Africa through a national policy, memo or written guidelines for CCM implementation adopted and scaled-up implementation of iCCM for pneumonia, diarrhoea and malaria by deploying CHVs to areas where facility-based case management services are limited to improve the availability and geographic accessibility of integrated case management services closer to caregivers -parents/guardians (13)(14)(15)(16). Community health volunteers are often relied upon by health facilities for creating demand for reproductive, maternal, newborn and child health and immunization services.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Integrated Community Case Management on Access and Utilization of Maternal, Newborn and Child Health and Immunization Services in Hard-to-Reach Communities in Migori County, Kenya: A Quasi-Experimental Study

Shikuku¹,

Masavah²,

Muganda³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Integrated community case management (iCCM) improves access to management of leading causes of under 5 (U5) mortality. Evidence of iCCM on maternal and newborn health and immunization services is scanty. The objective of this study was to determine the additional effect of iCCM on antenatal, skilled birth attendance (SBA) and immunization coverage in hard-to-reach communities.Methods A quasi-experimental (nonequivalent control group pretest – posttest) design for iCCM in Migori county. The intervention was iCCM training, mentorship/coaching and supportive supervision of 20 community health volunteers (CHVs). Twelve months pre-post intervention Kenya Health Information System (KHIS) data between July 2017-Sept 2019 reviewed. Differences in proportions for MNCH indicators pre – post-training were tested through test of proportions and considered statistically significant at P≤0.05 values.ResultsPost-training, average monthly community cases identification increased from 1.3-5, 0-1.5, 8.9-11.8 for suspected pneumonia, malnutrition and malaria positive cases treated in the intervention sites respectively. Intervention communities reported significant increases in proportions of malaria positive cases treated (32.0% vs 47.8%), pregnant women referred for ANC (25.4% vs 45.8%), defaulters referred for ANC (9.8% vs 14.9%), newborns with danger signs referred (1.4% vs 7.3%), U5s referred for immunization (4% vs 7.5%) and defaulters referred for immunization (2.2% vs 3%) (P≤0.05). Control communities reported significant reductions in proportion of malaria positive cases treated (57.6% vs 41.6%) and U5s referred for immunization (10% vs 5%) (P<0.0001) with no changes in MNH indicators (P≥0.05). Intervention facilities reported significant increases in 4th ANC coverage (39.4% vs 79.3%), SBA (24.5% vs 43%) and immunization coverage for U5s in all key expanded program on immunization antigens (P≤0.05) with no change in the control facilities.Conclusion iCCM improved access and utilization of ANC, SBA and immunization coverage in the hard-to-reach communities. Community level management of childhood illnesses using simple algorithms by CHVs as well as identification and referral of antenatal mothers for ANC, immunization defaulters, and newborns with danger signs for hospital management improved. Governments should strengthen community health systems so that CHVs are motivated and retained to carry out demand creation for maternal, newborn and child health and immunization services in hard-to-reach communities.

show abstract

Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Effect of Integrated Community Case Management on Access and Utilization of Maternal, Newborn and Child Health and Immunization Services in Hard-to-Reach Communities in Migori County, Kenya: A Quasi-Experimental Study

Shikuku¹,

Masavah²,

Muganda³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Given that HBYC has already been scaled nationally, it will be important to identify ways to build functional systems and appropriately support ASHAs in attaining high coverage and quality and having maximum impact. Similar conclusions have been made in the face of the frequently disappointing results from community case management approaches to treating diarrhoea, pneumonia and malaria [ 31 , 32 ]. For HBYC, aside from system level strengthening, interventions will also need to target the demand side and socio-cultural barriers in adopting key health behaviours.…”

Section: Discussionsupporting

confidence: 67%

Evaluating the effectiveness of Community Health Worker home visits on infant health: A quasi-experimental evaluation of Home Based Newborn Care Plus in India

Newton-Lewis¹,

Bahety

2021

J Glob Health

View full text Add to dashboard Cite

Background Home visits by community health workers are promoted to improve the coverage and uptake of evidence-based newborn services and behaviours. However, evidence on the effectiveness of these home visits delivered through government systems at scale is limited, as is evidence from the post-neonatal period. From 2013 to 2017, the Government of India piloted an intervention called Home Based Newborn Care Plus with the goal of reducing pneumonia- and diarrhoea-related morbidity and malnutrition. Village-based Accredited Social Health Activists were incentivised to make quarterly home visits to infants between three and 12 months of age. After the pilot, the intervention was adapted and scaled up nationally (with an additional visit at 15 months of age) as a new programme called Home Based Care for Young Child. Methods The study used a quasi-experimental, difference-in-differences method to assess the quantitative impact on key outcome indicators by comparing changes over time in treatment districts with matched control districts. This was supplemented by a quantitative health worker survey and qualitative data collected at worker and community level. Results The intervention led to a significant increase in the number of home visits, and their content became more aligned with Home Based Newborn Care Plus protocols. However, absolute levels of coverage remained low. The intervention had no detectable effect on the key outcomes of feeding practices, handwashing, iron and folic acid and oral rehydration solution supplementation, growth monitoring, and immunisation. Conclusions Given the scale up of Home-Based Care for Young Child, there is a need to identify appropriate and comprehensive support for Accredited Social Health Activists to attain high coverage and quality and deliver impact. This will require reconsidering current design elements (such as incentives) and solving the underlying demand side and system level challenges (such as workload and supply chains) constraining Accredited Social Health Activists.

show abstract

“…Methods to correct this perception could include communication strategies so that CRs are aware of CHV capabilities and that RDTs and ACT are elements of proper malaria care. Improving the actual and perceived quality of care offered by CHVs, in addition to improving commodity availability, may also contribute to an increase in timely care-seeking behaviour for fever, as has been documented in past studies across LMICs [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…These services are packaged as integrated community case management (iCCM), a strategy has been shown to improve care-seeking behavior by community residents for iCCM illnesses, including malaria. [ 7 ] An estimated 36,000 CHVs cover the country of Madagascar, with two CHVs designated per fokontany (village), the smallest administrative unit. They are supported by one of the country’s 2200 HFs in 1549 communes within the 114 health districts across the country [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Experiences and perceptions of care-seeking for febrile illness among caregivers, pregnant women, and health providers in eight districts of Madagascar

Favero

Dentinger

Rakotovao

et al. 2022

Malar J

View full text Add to dashboard Cite

Background Prompt diagnosis and treatment of malaria contributes to reduced morbidity, particularly among children and pregnant women; however, in Madagascar, care-seeking for febrile illness is often delayed. To describe factors influencing decisions for prompt care-seeking among caregivers of children aged < 15 years and pregnant women, a mixed-methods assessment was conducted with providers (HP), community health volunteers (CHV) and community members. Methods One health district from each of eight malaria-endemic zones of Madagascar were purposefully selected based on reported higher malaria transmission. Within districts, one urban and one rural community were randomly selected for participation. In-depth interviews (IDI) and focus group discussions (FGD) were conducted with caregivers, pregnant women, CHVs and HPs in these 16 communities to describe practices and, for HPs, system characteristics that support or inhibit care-seeking. Knowledge tests on malaria case management guidelines were administered to HPs, and logistics management systems were reviewed. Results Participants from eight rural and eight urban communities included 31 HPs from 10 public and 8 private Health Facilities (HF), five CHVs, 102 caregivers and 90 pregnant women. All participants in FGDs and IDIs reported that care-seeking for fever is frequently delayed until the ill person does not respond to home treatment or symptoms become more severe. Key care-seeking determinants for caregivers and pregnant women included cost, travel time and distance, and perception that the quality of care in HFs was poor. HPs felt that lack of commodities and heavy workloads hindered their ability to provide quality malaria care services. Malaria commodities were generally more available in public versus private HFs. CHVs were generally not consulted for malaria care and had limited commodities. Conclusions Reducing cost and travel time to care and improving the quality of care may increase prompt care-seeking among vulnerable populations experiencing febrile illness. For patients, perceptions and quality of care could be improved with more reliable supplies, extended HF operating hours and staffing, supportive demeanors of HPs and seeking care with CHVs. For providers, malaria services could be improved by increasing the reliability of supply chains and providing additional staffing. CHVs may be an under-utilized resource for sick children.

show abstract

Integrated community case management of childhood illness in low- and middle-income countries

Abstract: Integrated community case management of childhood illness in low-and middle-income countries.

Cited by 22 publications

References 117 publications

Effect of Integrated Community Case Management on Access and Utilization of Maternal, Newborn and Child Health and Immunization Services in Hard-to-Reach Communities in Migori County, Kenya: A Quasi-Experimental Study

Effect of Integrated Community Case Management on Access and Utilization of Maternal, Newborn and Child Health and Immunization Services in Hard-to-Reach Communities in Migori County, Kenya: A Quasi-Experimental Study

Evaluating the effectiveness of Community Health Worker home visits on infant health: A quasi-experimental evaluation of Home Based Newborn Care Plus in India

Experiences and perceptions of care-seeking for febrile illness among caregivers, pregnant women, and health providers in eight districts of Madagascar

Contact Info

Product

Resources

About