Integrated community case management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms in children under five years in Eastern Uganda

Abstract

BackgroundEfforts to improve access to treatment for common illnesses in children less than five years initially targeted malaria alone under the home management of malaria strategy. However under this strategy, children with other illnesses were often wrongly treated with anti-malarials. Integrated community case management of common childhood illnesses is now recommended but its effect on promptness of appropriate pneumonia treatment is unclear.ObjectivesTo determine the effect of integrated malaria and pneumonia management on receiving prompt and appropriate antibiotics for pneumonia symptoms and treatment outcomes as well as determine associated factors.MethodsA follow-up study was nested within a cluster-randomized trial that compared under-five mortality in areas where community health workers (CHWs) treated children with malaria and pneumonia (intervention areas) and where they treated children with malaria only (control areas). Children treated by CHWs were enrolled on the day of seeking treatment from CHWs (609 intervention, 667 control) and demographic, illness, and treatment seeking information was collected. Further information on illness and treatment outcomes was collected on day four. The primary outcome was prompt and appropriate antibiotics for pneumonia symptoms and the secondary outcome was treatment outcomes on day four.ResultsChildren in the intervention areas were more likely to receive prompt and appropriate antibiotics for pneumonia symptoms compared to children in the control areas (RR = 3.51, 95%CI = 1.75-7.03). Children in the intervention areas were also less likely to have temperature ≥37.5°C on day four (RR = 0.29, 95%CI = 0.11-0.78). The decrease in fast breathing between day one and four was greater in the intervention (9.2%) compared to the control areas (4.2%, p-value = 0.01).ConclusionsIntegrated community management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms and improves treatment outcomes.Trial registrationISRCTN: ISRCTN52966230

Where there is no doctor: can volunteer community health workers in rural Uganda provide integrated community case management?

“…20 In a multi-methods Ethiopian study, volunteer CHWs treating diarrhoea, pneumonia, and fever and were highly accessed by community members 22 . Our study is complimentary suggesting multi-illness iCCM using CHWs with variable formal education is feasible, which is supportive of work in Eastern Uganda 23,[27][28][29][30] ; however, caution is needed to further understand quality of work, an issue highlighted by a recent study from Central Uganda. 38 A strength of this implementation study was existing government health structure integration, which demonstrated real-life iCCM-programming feasibility and outcomes.…”

“…Although several iCCM study projects are underway, only one group from Eastern Uganda has published intervention outcomes and operational data thus far, specifically demonstrating feasible CHW management using a dual illness algorithm, 27 an increase in care-seeking by rural families with access to iCCM, 28 a sustained quality of care by CHWs using iCCM compared to single-illness management, 29 a sustained adherence to dual illness medicines by families under iCCM compared to single illness treatments, 30 and an increase in prompt and appropriate treatment of pneumonia under iCCM. 23 Healthy Child Uganda (HCU) is a Ugandan-Canadian university partnership that has developed, implemented, and evaluated community-based maternal and child health initiatives involving volunteer CHWs for over a decade. We describe an implementation study using a quasi-experimental design (pre/post intervention with comparison group) to understand the potential of Uganda's newly proposed national iCCM program in rural SouthWestern communities.…”

“…16,17 African iCCM studies are few, 14,18 and less still have assessed health outputs and outcomes. 5,14,[19][20][21][22][23] National programs in sub-Saharan Africa are new and while early studies are demonstrating implementation feasibility and early positive outcomes 7,8 , more studies are needed to understand implementation in a variety of contexts including use of volunteer CHWs with limited formal education and short iCCM training.…”

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

“…Early reports of the efficacy of community management of pneumonia in resource-limited settings were promising with a meta-analysis from 1992 (and subsequent reanalysis using primary data in 2003) showing a statistically significant 30% decrease in total under-five mortality in studies mostly from Asia. 5,6 Later studies have validated that many iCCM programs incorporating pneumonia care performed well on process measures [7][8][9][10][11] and outcomes 12 in the sub-Saharan African context. However, other research has shown that many iCCM programs have not achieved decreases in mortality and fail to perform on intermediate outcomes.…”

Recent Advances in Understanding the Long-Term Sequelae of Childhood Infectious Diarrhea

“…51,52 In April of 2013, the New York Academy of Sciences hosted a conference entitled “Every Child’s Potential: Integrating Nutrition, Health, and Psychosocial Interventions to Promote Early Childhood Development.” According to the World Health Organization, 24% of children under 5 years do not meet their developmental potential due to undernutrition, lack of educational and developmental opportunities for learning and social and environmental instability. To address malnutrition, enteric disease, and lack of childhood stimulation, which can all lead to loss of academic achievement, economic productivity and well-being, integrated interventions will continue to be important.…”