Utilization of Integrated Community Case Management Service and Associated Factors Among Mothers/Caregivers Who Have Sick Eligible Children in Southern Ethiopia

Utilization of integrated community-based case management of childhood illness and associated factors in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Despite significant progress being made in reducing under-five mortality, three-fourths of under-five deaths are still caused by preventable conditions such as pneumonia, diarrhea, malaria, and newborn issues. Integrated community case management of childhood illnesses (ICCM) could serve as a means to reduce preventable child mortality in Low- and Middle-Income countries. Our aim was to assess the overall level of ICCM utilization and its associated factors in Ethiopia.

METHODS

Candidate studies for inclusion in this review were identified through searches across various databases, including PubMed, EMBASE, Google Scholar, and university repositories online databases, spanning from February 1, 2024, to March 18, 2024. The quality assessment of the studies included in this systematic review and meta-analysis was conducted using the Newcastle-Ottawa Quality Assessment Scale (NOS). Data extraction and analysis were carried out using Microsoft Excel and Stata 17 software, respectively. Heterogeneity among the studies was assessed using Cochran's Q test and I2 statistics, while the presence of publication bias was evaluated through funnel plots and Egger's regression asymmetry test. Subgroup analysis was performed based on sample size and study site.

RESULTS

In this study, the pooled level of ICCM utilization was found to be 42.73 (95%, CI 27.65%, 57.80%) based on the evidence obtained from ten primary studies. In this review, parents' awareness about illness (OR = 2.77, 95%, CI 2.06, 3.74), awareness about ICCM service (OR = 3.64, 95%, CI 2.16, 6.14), perceived severity of the disease (OR = 3.14, 95%, CI 2.33, 4.23), secondary/above level of education (OR = 2.57, 95%, CI 1.39, 4.77), and live within 30 min distance to the health post (OR = 3.93, 95%, CI 2.30, 6.74) were variables significantly associated with utilization of ICCM in Ethiopia.

CONCLUSION

The utilization of ICCM was found to be low in Ethiopia. Factors such as parents' awareness about the illness, knowledge of ICCM services, perceived severity of the disease, attending a secondary or more level of education, and living within 30 min distance to the health post were significantly associated with the utilization of ICCM. Therefore, it is crucial to focus on creating awareness and improving access to high-quality ICCM services to reduce child morbidity and mortality from preventable causes.

Evaluation of integrated community case management of the common childhood illness program in Gondar city, northwest Ethiopia: a case study evaluation design

BACKGROUND

Integrated Community Case Management (ICCM) of common childhood illness is one of the global initiatives to reduce mortality among under-five children by two-thirds. It is also implemented in Ethiopia to improve community access and coverage of health services. However, as per our best knowledge the implementation status of integrated community case management in the study area is not well evaluated. Therefore, this study aimed to evaluate the implementation status of the integrated community case management program in Gondar City, Northwest Ethiopia.

METHODS

A single case study design with mixed methods was employed to evaluate the process of integrated community case management for common childhood illness in Gondar town from March 17 to April 17, 2022. The availability, compliance, and acceptability dimensions of the program implementation were evaluated using 49 indicators. In this evaluation, 484 mothers or caregivers participated in exit interviews; 230 records were reviewed, 21 key informants were interviewed; and 42 observations were included. To identify the predictor variables associated with acceptability, we used a multivariable logistic regression analysis. Statistically significant variables were identified based on the adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value. The qualitative data was recorded, transcribed, and translated into English, and thematic analysis was carried out.

RESULTS

The overall implementation of integrated community case management was 81.5%, of which availability (84.2%), compliance (83.1%), and acceptability (75.3%) contributed. Some drugs and medical equipment, like Cotrimoxazole, vitamin K, a timer, and a resuscitation bag, were stocked out. Health care providers complained that lack of refreshment training and continuous supportive supervision was the common challenges that led to a skill gap for effective program delivery. Educational status (primary AOR = 0.27, 95% CI:0.11-0.52), secondary AOR = 0.16, 95% CI:0.07-0.39), and college and above AOR = 0.08, 95% CI:0.07-0.39), prescribed drug availability (AOR = 2.17, 95% CI:1.14-4.10), travel time to the to the ICCM site (AOR = 3.8, 95% CI:1.99-7.35), and waiting time (AOR = 2.80, 95% CI:1.16-6.79) were factors associated with the acceptability of the program by caregivers.

CONCLUSION AND RECOMMENDATION

The overall implementation status of the integrated community case management program was judged as good. However, there were gaps observed in the assessment, classification, and treatment of diseases. Educational status, availability of the prescribed drugs, waiting time and travel time to integrated community case management sites were factors associated with the program acceptability. Continuous supportive supervision for health facilities, refreshment training for HEW's to maximize compliance, construction clean water sources for HPs, and conducting longitudinal studies for the future are the forwarded recommendation.

Care-seeking behaviours of mothers and associated factors for possible serious bacterial infection in young infants during COVID-19 pandemic in Ethiopia: mixed-methods formative research

OBJECTIVES

Implementation research was employed to examine rates and contextual factors associated with mothers' care-seeking for their sick neonates and identify challenges for community-based possible serious bacterial infection (PSBI) services access and implementation during the COVID-19 pandemic.

DESIGN

We conducted formative research involving household survey and programmatic qualitative study.

SETTING

This formative study was conducted in Dembecha and Lume woredas of Amhara and Oromia regions.

PARTICIPANTS

Data were captured from 4262 mothers aged 15-49 years who gave live birth 2-14 months before data collection, and interviews with 18 programme managers and 16 service providers in April to May 2021.

ANALYSIS

A multilevel regression model was employed to identify predictors of maternal care-seeking for PSBI and thematic qualitative analysis to inform strategy development to strengthen PSBI implementation.

RESULTS

Overall, 12% (95% CI 11.0% to 12.9%) and 8% (95% CI 7.9% to 9.6%) of mothers reported any newborn illness and severe neonatal infection (PSBI), respectively. More than half of mothers sought formal medical care, 56% (95% CI 50.7% to 60.8%) for PSBI. Women who received postnatal care within 6 weeks (adjusted OR (AOR) 2.08; 95% CI 1.12 to 3.87) and complete antenatal care (ie, weight measured, blood pressure taken, urine and blood tested) (AOR 2.04; 95% CI 1.12 to 3.75) had higher odds of care-seeking for PSBI. Conversely, fear of COVID-19 (AOR 0.27; 95% CI 0.15 to 0.47) and residing more than 2 hours of walking distance from the health centre (AOR 0.39; 95% CI 0.16 to 0.93) were negatively associated with care-seeking for severe newborn infection. Multiple pre-existing health system bottlenecks were identified from interviews as barriers to PSBI service delivery and exacerbated by the COVID-19 pandemic.

CONCLUSION

We found gaps in and factors associated with care-seeking behaviour of mothers for their sick young infants including fear of COVID-19 and pre-existing health system-level barriers. The findings of the study were used to design and implement strategies to mitigate COVID-19 impacts on management of PSBI.

Integrated Community Case Management Utilization Status and Associated Factors Among Caretakers of Sick Children Under the Age of 5 Years in West Shewa, Ethiopia

Objective

To assess the utilization status and associated factors of integrated community case management (ICCM) of caretakers with <5 years of sick children.

Methods

Community-based cross-sectional study was employed with caretakers whose child was sick in the last 3 months before data collection. Bivariate and multivariable logistic regression analyses were employed.

Results

About 624 respondents participated in the study; 325 (52.1%) utilized integrated community case management. Caring for children between the ages 24–36 months old, (AOR = 1.26, 95%CI: 0.23, 0.90); women health development army (WHDA) training, (AOR = 5.76, 95%CI: 3.57, 9.30); certified as model family, (AOR = 3.98, 95%CI: 2.45, 6.46); perceived severity, (AOR = 5.29, 95%CI: 2.64, 10.60); awareness of danger sign, (AOR = 2.76, 95%CI: 1.69, 4.50), and awareness of ICCM, (AOR = 5.42, 95%CI: 1.67, 17.58) were associated with ICCM utilization.

Conclusion

This study revealed that age of the child, caretakers' awareness of ICCM, awareness of danger signs, illness severity, women's health developmental army training, and graduation as a model family were associated with ICCM utilization. Therefore, it is recommended that promote health education using community-level intervention modalities focusing on common childhood illness symptoms, danger signs, severity, and care-seeking behavior.

Utilization of integrated community case management service of childhood illness (ICCM) and associated factors among under-five children in Shashogo district, Hadiya zone, south Ethiopia

Background

Integrated community case management (ICCM) service is provision of concurrent clinical and preventive care by trained community health workers for common childhood illnesses in the community. In Ethiopia, integrated community case management (ICCM) service utilization is low and its magnitude is unknown as well as no adequate evidence on its associated factors. This study aimed to investigate use of integrated community case management service of childhood illness and factors associated with it.

Methods

A community-based cross-sectional study was conducted in Shashogo district. A total of 422 mothers who have under-five children were selected using simple random sampling method. Structured interviewer administered pre-tested in 5% of the sample; questionnaire was used to collect data. Descriptive statistics, binary and multivariable logistic regression analyses were used.

Results

The proportion of integrated community case management (ICCM) service utilization among sick under-five children in past six months at Shashogo district was found was 199(47.2%, with 95%CI:(43.2, 51.2)). Receiving training on health extension packages as model family AOR = 2.07(1.05, 4.08), experiencing frequent childhood illness AOR = 1.92(1.11, 3.33), having information about ICCM service AOR = 3.73(1.42, 9.76), and having a postnatal care visit in recent child AOR = 13(7.37, 23.06) were associated with utilization of integrated community case management service.

Conclusion

ICCM service was not used as planned though there is offer of free of charge service nearby. ICCM service is affected by maternal and child health utilization. Hence, collaborative activities of information, education, and communication activities are needed.