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Mutale W, Ayles H, Lewis J, Bosompraph S, Chilengi R, Tembo MM, Sharp A, Chintu N, Stringer J. Protocol-driven primary care and community linkage to reduce all-cause mortality in rural Zambia: a stepped-wedge cluster randomized trial. Front Public Health 2023; 11:1214066. [PMID: 37727608 PMCID: PMC10505962 DOI: 10.3389/fpubh.2023.1214066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/03/2023] [Indexed: 09/21/2023] Open
Abstract
Introduction While tremendous progress has been made in recent years to improve the health of people living in low- and middle-income countries (LMIC), significant challenges remain. Chief among these are poor health systems, which are often ill-equipped to respond to current challenges. It remains unclear whether intensive intervention at the health system level will result in improved outcomes, as there have been few rigorously designed comparative studies. We present results of a complex health system intervention that was implemented in Zambia using a cluster randomized design. Methods BHOMA was a complex health system intervention comprising intensive clinical training and quality improvement measures, support for commodities procurement, improved community outreach, and district level management support. The intervention was introduced as a stepped wedge cluster-randomized trial in 42 predominately rural health centers and their surrounding communities in Lusaka Province, Zambia. Baseline survey was conducted between January-May 2011, mid-line survey was conducted February-November, 2013 and Endline survey, February-November 2015.The primary outcome was all-cause mortality among those between 28 days and 60 years of age and assessed through community-based mortality surveys. Secondary outcomes included post-neonatal under-five mortality and service coverage scores. Service coverage scores were calculated across five domains (child preventative services; child treatment services; family planning; maternal health services, and adult health services). We fit Cox proportional hazards model with shared frailty at the cluster level for the primary analysis. Mortality rates were age-standardized using the WHO World Standard Population. Results Mortality declined substantially from 3.9 per 1,000 person-years in the pre-intervention period, to 1.5 per 1,000 person-years in the post intervention period. When we compared intervention and control periods, there were 174 deaths in 49,230 person years (age-standardized rate = 4.4 per 1,000 person-years) in the control phase and 277 deaths in 74,519 person years (age-standardized rate = 4.6 per 1,000 person-years) in the intervention phase. Overall, there was no evidence for an effect of the intervention in minimally-adjusted [hazard ratio (HR) = 1.18; 95% confidence interval (CI): 0.88, 1.56; value of p = 0.265], or adjusted (HR = 1.12; 95% CI: 0.84, 1.49; value of p = 0.443) analyses.Coverage scores that showed some evidence of changing with time since the cluster joined the intervention were: an increasing proportion of children sleeping under insecticide treated bed-net (value of p < 0.001); an increasing proportion of febrile children who received appropriate anti-malarial drugs (value of p = 0.039); and an increasing proportion of ever hypertensive adults with currently controlled hypertension (value of p = 0.047). No adjustments were made for multiple-testing and the overall coverage score showed no statistical evidence for a change over time (value of p = 0.308). Conclusion We noted an overall reduction in post-neonatal under 60 mortality in the study communities during the period of our study, but this could not be attributed to the BHOMA intervention. Some improvements in service coverage scores were observed. Clinical Trial Registration clinicaltrials.gov, Identifier NCT01942278.
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Affiliation(s)
- Wilbroad Mutale
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Helen Ayles
- Zambia AIDS Related Tuberculosis (ZAMBART), Lusaka, Zambia
| | - James Lewis
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Samuel Bosompraph
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | | | - Ab Sharp
- Zambia AIDS Related Tuberculosis (ZAMBART), Lusaka, Zambia
| | | | - Jeffrey Stringer
- University of North Carolina, Global Women Health, Chapel Hill, NC, United States
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Allen KC, Whitfield K, Rabinovich R, Sadruddin S. The role of governance in implementing sustainable global health interventions: review of health system integration for integrated community case management (iCCM) of childhood illnesses. BMJ Glob Health 2021; 6:bmjgh-2020-003257. [PMID: 33789866 PMCID: PMC8016094 DOI: 10.1136/bmjgh-2020-003257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 01/16/2023] Open
Abstract
Improving health outcomes in countries with the greatest burden of under-5 child mortality requires implementing innovative approaches like integrated community case management (iCCM) to improve coverage and access for hard-to-reach populations. ICCM improves access for hard-to-reach populations by deploying community health workers to manage malaria, diarrhoea and pneumonia. Despite documented impact, challenges remain in programme implementation and sustainability. An analytical review was conducted using evidence from published and grey literature from 2010 to 2019. The goal was to understand the link between governance, policy development and programme sustainability for iCCM. A Governance Analytical Framework revealed thematic challenges and successes for iCCM adaptation to national health systems. Governance in iCCM included the collective problems, actors in coordination and policy-setting, contextual norms and programmatic interactions. Key challenges were country leadership, contextual evidence and information-sharing, dependence on external funding, and disease-specific stovepipes that impede funding and coordination. Countries that tailor and adapt programmes to suit their governance processes and meet their specific needs and capacities are better able to achieve sustainability and impact in iCCM.
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Affiliation(s)
- Koya C Allen
- Malaria Eradication Scientific Alliance (MESA), Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Kate Whitfield
- Malaria Eradication Scientific Alliance (MESA), Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Regina Rabinovich
- Malaria Elimination Initiative, Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalunya, Spain.,ExxonMobil Malaria Scholar in Residence, Department of Immunology and Infectious Diseases, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Salim Sadruddin
- Child Health, MOMENTUM Country and Global Leadership, Washington, DC, USA
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Tamiru D, Berhanu M, Dagne T, Kebede A, Getachew M, Tafese F, Kebede A, Etea HM, Amdissa D, Wakjira T, Tamiru A. Quality of integrated community case management services at public health posts, Southwest Ethiopia. J Pediatr Nurs 2021; 57:32-37. [PMID: 33212344 DOI: 10.1016/j.pedn.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study is to assess the quality of an integrated community case management service (ICCM) and associated factors at health posts in Ethiopia. DESIGN AND METHODS Institution-based cross-sectional study design was conducted in the health posts of Jimma zone. Data were collected using a structured questionnaire and in-depth interviews. Binary logistic regression was used to identify independent predictors of client satisfaction on services and the qualitative data were presented by triangulating with quantitative findings. RESULTS This study indicated that 80%, 65% and 55% of health extension workers (HEW) correctly assessed cases, classified cases and prescribed drugs of ICCM cases respectively. Some caregivers (40.2%) knew about danger signs which they heard from HEWs (81.9%). More than one-fourth (29.01%) of caregivers reported that their children were exposed to illness like diarrhea (39.1%) in the last two weeks. HEWs have demonstrated to a large number of caregivers (66%) how to give medications. Being a housewife [AOR = 0.17(0.05,0.56)], having a farmer husband[AOR = 3.77(1.09,12.98)] and having a government employed husband [AOR = 5.32(1.03,27.48)] were significantly associated with ICCM services. CONCLUSIONS More than half of health extension workers correctly assessed, classified and prescribed drugs for ICCM cases. Some caregivers knew about danger signs which the majority of them heard from health extension workers. Being a housewife and paternal occupation were significantly associated with clients' satisfaction in ICCM services. PRACTICE IMPLICATIONS Findings of this study can be used to guide the development of programs to improve integrated community case management service in Ethiopia by informing policymakers and other stakeholders about challenges of ICCM services.
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Affiliation(s)
- Dessalegn Tamiru
- Jimma University, Nutrition and Dietetics Department, Jimma, Ethiopia.
| | | | - Tesfaye Dagne
- Jimma University, Health Economics, Management and Policy, Jimma, Ethiopia
| | - Alemi Kebede
- Jimma University Population and Family Health Department, Jimma, Ethiopia
| | - Muluneh Getachew
- Jimma University, Health Economics, Management and Policy, Jimma, Ethiopia
| | - Fikru Tafese
- Jimma University, Health Economics, Management and Policy, Jimma, Ethiopia
| | - Ayantu Kebede
- Jimma University, Department of Epidemiology, Jimma, Ethiopia
| | | | - Demuma Amdissa
- Jimma University, Department of Behavioural Science and Society, Jimma, Ethiopia
| | - Tekle Wakjira
- Jimma University, Department of Gynaecology and obstetrics, Jimma, Ethiopia
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Berhanu A, Alemayehu M, Daka K, Binu W, Suleiman M. Utilization of Integrated Community Case Management of Childhood Illnesses at Health Posts in Southern Ethiopia. Pediatric Health Med Ther 2020; 11:459-467. [PMID: 33273879 PMCID: PMC7705263 DOI: 10.2147/phmt.s282698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/13/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Even if strategic actions were undertaken to tackle common childhood illnesses, Ethiopia still stood as one of the six countries accounting for half of the global under-five deaths. So this study aimed to assess the utilization of integrated community case management during childhood illness at health posts in the study area. METHODS A community-based cross-sectional study was conducted using a multistage sampling technique that includes 633 sick under-five children with common childhood illnesses. The data was entered into EpiData 3.1 and exported to SPSS 20 for further analysis. Descriptive statistics, bivariate and multivariate logistic regression analyses were computed and adjusted odds ratio within 95% confidence interval was used to measure the statistical association between variables. RESULTS Out of the planned 633 participant, 624 caregivers underwent all the study components making the response rate 98.6%. The study indicated that only 10.6% of the sick children sought care from health posts. Income (AOR = 2.99, 95% CI: 1.37-6.53), previous service utilization (AOR = 6.66, 95% CI: 1.81-24.04), awareness of service availability (AOR = 4.74, 95% CI: 1.39-12.10), ownership of health insurance (AOR = 2.63, 95% CI: 1.45-4.76), distance (AOR = 5.23, 95% CI: 1.69-10.19) and type of illness (AOR = 2.97, 95% CI: 1.41-6.25) were the associated factors. CONCLUSION The low utilization of integrated community case management insights to focus on availing additional well-equipped health posts, creating community awareness on services at health posts and at what time the services are given to address the problem of the majority.
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Affiliation(s)
- Asefa Berhanu
- Wolaita Zone Health Department, Wolaita Sodo, Ethiopia
| | - Mihiretu Alemayehu
- Wolaita Sodo University, College of Health Sciences and Medicine, School of Public Health, Wolaita Sodo, Ethiopia
| | - Kassa Daka
- Wolaita Sodo University, College of Health Sciences and Medicine, School of Public Health, Wolaita Sodo, Ethiopia
| | - Wakgari Binu
- Wolaita Sodo University, College of Health Sciences and Medicine, School of Public Health, Wolaita Sodo, Ethiopia
| | - Mohammed Suleiman
- Wolaita Sodo University, College of Health Sciences and Medicine, Department of Anesthesia, Wolaita Sodo, Ethiopia
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Nanyonjo A, Kertho E, Tibenderana J, Källander K. District Health Teams' Readiness to Institutionalize Integrated Community Case Management in the Uganda Local Health Systems: A Repeated Qualitative Study. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:190-204. [PMID: 32606091 PMCID: PMC7326515 DOI: 10.9745/ghsp-d-19-00318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 03/04/2020] [Indexed: 11/28/2022]
Abstract
District health teams failed to transition from partner-supported integrated community case management (iCCM) programs to locally-run and fully-institutionalized programs. Successful iCCM institutionalization requires local ownership with increased coordination among governmental and nongovernmental actors at the national and district levels. Introduction: Several countries have adopted integrated community case management (iCCM) as a strategy for improved health service delivery in areas with poor health facility coverage. Early implementation of iCCM is often run by nongovernmental organizations financed by donors through projects. Such projects risk failure to transition into programs run by the local health system upon project closure. Engagement of subnational health authorities such as district health teams (DHTs) is essential for a smooth transition. Methods: We used a repeated qualitative study design to assess the readiness of and progress made by DHTs in institutionalizing iCCM into the functions of locally decentralized health systems in 9 western Uganda districts. Readiness data were derived from structured group interviews with DHTs before iCCM policy adoption in 2010 and again in 2015. Progressive institutionalization achievements were assessed through key informant interviews with targeted DHT members and local government district planners in the same areas. Findings: In the readiness study, DHTs expressed commitment to institutionalize iCCM into the local health system through the development of district-specific iCCM activity work plans and budgets. The DHTs further suggested that they would implement district-led training, motivation, and supervision of community health workers; procurement of iCCM medicines and supplies; and advocacy activities for inclusion of iCCM indicators into the national health information systems. After iCCM policy adoption, follow-up study data findings showed that iCCM was largely not institutionalized into the local district health system functions. The poor institutionalization was attributed to lack of stewardship on how to transition from externally supported implementation to district-led programming, conflicting guidelines on community distribution of medicines, poor community-level accountability systems, and limited decision-making autonomy at the district level. Conclusion: Successful institutionalization of iCCM requires local ownership with increased coordination and cooperation among governmental and nongovernmental actors at both the national and district levels.
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Affiliation(s)
| | | | | | - Karin Källander
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Sadruddin S, Pagnoni F, Baugh G. Lessons from the integrated community case management (iCCM) Rapid Access Expansion Program. J Glob Health 2019; 9:020101. [PMID: 31360441 PMCID: PMC6657662 DOI: 10.7189/jogh.09.020101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 2012, the Government of Canada awarded a grant to the World Health Organization’s Global Malaria Programme (GMP) to support the scale-up of integrated community case management (iCCM) of pneumonia, diarrhoea and malaria among children under 5 in sub-Saharan Africa under the Rapid Access Expansion Programme (RAcE). The two main objectives of the programme were to: (1) Contribute to the reduction of child mortality due to malaria, pneumonia and diarrhoea by increasing access to diagnostics, treatment and referral services, and (1) Stimulate policy updates in participating countries and catalyze scale-up of integrated community case management (iCCM) through documentation and dissemination of best practices. Based on the results of the implementation research and programmatic lessons, this collection provides evidence on impact and improving coverage of iCCM in routine health systems, and opportunities and challenges of implementing and sustaining delivery of iCCM at scale.
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Affiliation(s)
- Salim Sadruddin
- Global Malaria Programme, World Health Organization, Geneva Switzerland
| | - Franco Pagnoni
- Director, TIPTOP Project, Barcelona Institute for Global Health, Barcelona, Spain
| | - Gunther Baugh
- Independent Consultant, Geneva, Switzerland (formerly with Global Malaria Programme, World Health Organization)
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Yourkavitch J, Davis LM, Hobson R, Arscott-Mills S, Anson D, Baugh G, Sadruddin S, Mantshumba JC, Sambou B, Bakukulu JT, Leya PN, Luhanga M, Mgalula L, Jenda G, Nsona H, Nassivila SA, de Carvalho E, Smith M, Absi M, Aboubakar F, Konate AT, Wahab M, Ufere J, Isiguzo C, Ozor L, Gimba PB, Ndaliman I. Integrated community case management: planning for sustainability in five African countries. J Glob Health 2019; 9:010802. [PMID: 31275567 PMCID: PMC6596361 DOI: 10.7189/jogh.09.010802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The World Health Organization (WHO) launched an initiative to plan for the sustainability of integrated community case management (iCCM) programmes supported by the Rapid Access Expansion (RAcE) Programme in five African countries in 2016. WHO contracted experts to facilitate sustainability planning among Ministries of Health, WHO, nongovernmental organisation grantees, and other stakeholders. Methods We designed an iterative and unique process for each RAcE project area which involved creating a sustainability framework to guide planning; convening meetings to identify and prioritise elements of the framework; forming technical working groups to build country ownership; and, ultimately, creating roadmaps to guide efforts to fully transfer ownership of the iCCM programmes to host countries. For this analysis, we compared priorities identified in roadmaps across RAcE project sites, examined progress against roadmaps via transition plans, and produced recommendations for short-term actions based on roadmap priorities that were unaddressed or needed further attention. Results This article describes the sustainability planning process, roadmap priorities, progress against roadmaps, and recommendations made for each project area. We found a few patterns among the prioritised roadmap elements. Overall, every project area identified priorities related to policy and coordination of external stakeholders including funders; supply chain management; service delivery and referral system; and communication and social mobilisation, indicating that these factors have persisted despite iCCM programme maturity, and are also of concern to new programmes. We also found that a facilitated process to identify and document programme priorities in roadmaps, along with deliberately planning for transition from an external implementer to a national system could support the sustainability of iCCM programmes by facilitating teams of stakeholders to accomplish explicit tasks related to transitioning the programme. Conclusions Certain common elements are of concern for sustaining iCCM programmes across countries, among them political leadership, supply chain management, data processes, human resources, and community engagement. Adapting and using a sustainability planning approach created an inclusive and comprehensive dialogue about systemic factors that influence the sustainability of iCCM services and facilitated changes to health systems in each country.
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Affiliation(s)
| | | | | | | | - Daniel Anson
- Independent Consultant, Silver Spring, Maryland, USA; formerly ICF, Rockville, Maryland, USA
| | | | | | | | - Bacary Sambou
- World Health Organization, Kinshasa, Democratic Republic of Congo
| | | | - Pascal Ngoy Leya
- Abt Associates; formerly International Rescue Committee, Kinshasa, Democratic Republic of Congo
| | | | | | | | | | | | | | | | | | | | | | | | - Joy Ufere
- World Health Organization, Abuja, Nigeria
| | | | - Lynda Ozor
- World Health Organization, Abuja, Nigeria
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Dalglish SL, Vogel JJ, Begkoyian G, Huicho L, Mason E, Root ED, Schellenberg J, Estifanos AS, Ved R, Wehrmeister FC, Labadie G, Victora CG. Future directions for reducing inequity and maximising impact of child health strategies. BMJ 2018; 362:k2684. [PMID: 30061111 PMCID: PMC6283368 DOI: 10.1136/bmj.k2684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sarah L Dalglish
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Joanna J Vogel
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organization, Geneva, Switzerland
| | | | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible and School of Medicine, Universidad Peruana Cayetano Heredia Lima, Peru
| | | | - Elisabeth Dowling Root
- Department of Geography and Division of Epidemiology, Ohio State University, Columbus, Ohio, USA
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Abiy Seifu Estifanos
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rajani Ved
- National Health Systems Resource Center, New Delhi, India
| | - Fernando C Wehrmeister
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Guilhem Labadie
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Cesar G Victora
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
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Ratnayake R, Ratto J, Hardy C, Blanton C, Miller L, Choi M, Kpaleyea J, Momoh P, Barbera Y. The Effects of an Integrated Community Case Management Strategy on the Appropriate Treatment of Children and Child Mortality in Kono District, Sierra Leone: A Program Evaluation. Am J Trop Med Hyg 2017; 97:964-973. [PMID: 28722630 PMCID: PMC5590598 DOI: 10.4269/ajtmh.17-0040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/19/2017] [Indexed: 11/07/2022] Open
Abstract
Integrated community case management (iCCM) aims to reduce child mortality in areas with poor access to health care. iCCM was implemented in 2009 in Kono district, Sierra Leone, a postconflict area with high under-five mortality rates (U5MRs). We evaluated iCCM's impact and effects on child health using cluster surveys in 2010 (midterm) and 2013 (endline) to compare indicators on child mortality, coverage of appropriate treatment, timely access to care, quality of care, and recognition of community health workers (CHWs). The sample size was powered to detect a 28% decline in U5MR. Clusters were selected proportional to population size. All households were sampled to measure mortality and systematic random sampling was used to measure coverage in a subset of households. We used program data to evaluate utilization and access; 5,257 (2010) and 3,649 (2013) households were surveyed. U5MR did not change significantly (4.54 [95% confidence interval [CI]: 3.47-5.60] to 3.95 [95% CI: 3.06-4.83] deaths per 1,000 per month (P = 0.4)) though a relative change smaller than 28% could not be detected. CHWs were the first source of care for 52% (2010) and 50.9% (2013) of children. Coverage of appropriate treatment of fever by CHWs or peripheral health units increased from 45.5% [95% CI: 39.2-52.0] to 58.2% [95% CI: 50.5-65.5] (P = 0.01); changes for diarrhea and pneumonia were not significant. The continued reliance on the CHW as the first source of care and improved coverage for the appropriate treatment of fever support iCCM's role in Kono district.
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Affiliation(s)
- Ruwan Ratnayake
- Health Unit, International Rescue Committee, New York, New York
| | - Jeffrey Ratto
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Colleen Hardy
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Curtis Blanton
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura Miller
- International Rescue Committee, Freetown, Sierra Leone
| | - Mary Choi
- Health Unit, International Rescue Committee, New York, New York
| | - John Kpaleyea
- International Rescue Committee, Freetown, Sierra Leone
| | | | - Yolanda Barbera
- Health Unit, International Rescue Committee, New York, New York
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Buregyeya E, Rutebemberwa E, LaRussa P, Lal S, Clarke SE, Hansen KS, Magnussen P, Mbonye AK. Comparison of the capacity between public and private health facilities to manage under-five children with febrile illnesses in Uganda. Malar J 2017; 16:183. [PMID: 28464890 PMCID: PMC5414200 DOI: 10.1186/s12936-017-1842-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/26/2017] [Indexed: 12/08/2023] Open
Abstract
Background Public health facilities are usually the first to receive interventions compared to private facilities, yet majority of health seeking care is first done with the latter. This study compared the capacity to manage acute febrile illnesses in children below 5 years in private vs public health facilities in order to design interventions to improve quality of care. Methods A survey was conducted within 57 geographical areas (parishes), from August to October 2014 in Mukono district, central Uganda. The survey comprised both facility and health worker assessment. Data were collected on drug stocks, availability of treatment guidelines, diagnostic equipment, and knowledge in management of malaria, pneumonia and diarrhoea, using a structured questionnaire. Results A total of 53 public and 241 private health facilities participated in the study. While similar proportions of private and public health facilities stocked Coartem, the first-line anti-malarial drug, (98 vs 95%, p = 0.22), significantly more private than public health facilities stocked quinine (85 vs 53%, p < 0.01). Stocks of obsolete anti-malarial drugs, such as chloroquine, were reported in few public and private facilities (3.7 vs 12.5%, p = 0.06). Stocks of antibiotics-amoxycillin and gentamycin were similar in both sectors (≥90% for amoxicillin; ≥50 for gentamycin). Training in malaria was reported by 65% of public health facilities vs 56% in the private sector, p = 0.25), while, only 21% in the public facility and 12% in the private facilities, p = 0.11, reported receiving training in pneumonia. Only 55% of public facilities had microscopes. Malaria treatment guidelines were significantly lacking in the private sector, p = 0.01. Knowledge about first-line management of uncomplicated malaria, pneumonia and diarrhoea was significantly better in the public facilities compared to the private ones, though still sub-optimal. Conclusion Deficiencies of equipment, supplies and training exist even in public health facilities. In order to significantly improve the capacity to handle acute febrile illness among children under five, training in proper case management, availability of supplies and diagnostics need to be addressed in both sectors.
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Affiliation(s)
- Esther Buregyeya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
| | - Elizeus Rutebemberwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Phillip LaRussa
- Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, USA
| | - Sham Lal
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Sîan E Clarke
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Kristian S Hansen
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Pascal Magnussen
- Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Anthony K Mbonye
- Ministry of Health, Box 7272, Kampala & School of Public Health-Makerere University, Kampala, Uganda
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