Introduction of Newborn Care within Integrated Community Case Management in Uganda

Abstract

Uganda's Ministry of Health, together with partners, has introduced integrated community case management (iCCM) for children under 5 years. We assessed how the iCCM program addresses newborn care in three midwestern districts through document reviews, structured interviews, and focus group discussions with village health team (VHT) members trained in iCCM, caregivers, and other stakeholders. Almost all VHT members reported that they refer sick newborns to facilities and could identify at least three newborn danger signs. However, they did not identify the most important clinical indicators of severe illness. The extent of compliance with newborn referral and quality of care for newborns at facilities is not clear. Overall iCCM is perceived as beneficial, but caregivers, VHTs, and health workers want to do more for sick babies at facilities and in communities. Additional research is needed to assess the ability of VHTs to identify newborn danger signs, referral compliance, and quality of newborn treatment at facilities.

Health systems supports for community case management of childhood illness: lessons from an assessment of early implementation in Malawi

“…Sustaining supervision is a common challenge for both facility and community-based programs in weak health systems [41,45]. The initial supervision strategy in the Malawi CCM program of adding CCM supervision to the workload of busy facility-based clinicians, which is common in other programs [43,46,47], may be an unrealistic approach for regular and sustained supervision in many settings. Although CCM programs are often implemented in environments with constrained resources, planning for resources to implement effective supervision strategies is essential for scale-up [24].…”

Integrated review of healthcare provider postnatal newborn care recommendations in Sub‐Saharan Africa

“…All four quantitative studies were rated good (Dynes et al 2013;Gobezayehu et al 2014;Reeve et al 2016;Warren et al 2010). One mixed-methods study was rated good (Kayemba et al 2012); however, it did not address reflexivity. The other mixed-methods study (Sibanda et al 2001) rated poorly because of minimal HCP findings and no reflexivity.…”

“…Eight studies included findings on HCP knowledge, beliefs or counselling on breastfeeding or feeding practices (Dhingra et al 2014;Dynes et al 2013;Gobezayehu et al 2014;Kayemba et al 2012;Mrisho et al 2008;Peltzer et al 2009;Reeve et al 2016;Warren et al 2010). HCPs recommended exclusive breastfeeding in four studies (Dhingra et al 2014;Dynes et al 2013;Gobezayehu et al 2014;Warren et al 2010); however, the recommendations were inconsistent.…”

“…South African informal HCPs gave advice on breastfeeding; however, the content and duration were not documented (Peltzer et al 2009). The recommendation to initiate immediate and exclusive breastfeeding was included in the training curriculum for Ugandan VHTs but the length of time recommended for exclusive breastfeeding was not reported (Kayemba et al 2012).…”

Introduction to a Special Supplement: Evidence for the Implementation, Effects, and Impact of the Integrated Community Case Management Strategy to Treat Childhood Infection

“…Regarding use of CCM in eastern Uganda, Rutebemberwa and others17 measured care-seeking from community medicine distributors in urban and rural settings, and Kalyango and others18 compared the effect of iCCM and home-based management of fever strategies on care-seeking from community medicine distributors and on community drug use. Kayemba and others 19. reported health system implications for adding newborn care to iCCM in Uganda.…”