Evaluation of Integrated Community Case Management in Eight Districts of Central Uganda.
OBJECTIVE
Evidence is limited on whether Integrated Community Case Management (iCCM) improves treatment coverage of the top causes of childhood mortality (acute respiratory illnesses (ARI), diarrhoea and malaria). The coverage impact of iCCM in Central Uganda was evaluated.


METHODS
Between July 2010 and December 2012 a pre-post quasi-experimental study in eight districts with iCCM was conducted; 3 districts without iCCM served as controls. A two-stage household cluster survey at baseline (n = 1036 and 1042) and end line (n = 3890 and 3844) was done in the intervention and comparison groups respectively. Changes in treatment coverage and timeliness were assessed using difference in differences analysis (DID). Mortality impact was modelled using the Lives Saved Tool.


RESULTS
5,586 Village Health Team members delivered 1,907,746 treatments to children under age five. Use of oral rehydration solution (ORS) and zinc treatment of diarrhoea increased in the intervention area, while there was a decrease in the comparison area (DID = 22.9, p = 0.001). Due to national stock-outs of amoxicillin, there was a decrease in antibiotic treatment for ARI in both areas; however, the decrease was significantly greater in the comparison area (DID = 5.18; p<0.001). There was a greater increase in Artemisinin Combination Therapy treatment for fever in the intervention areas than in the comparison area but this was not significant (DID = 1.57, p = 0.105). In the intervention area, timeliness of treatments for fever and ARI increased significantly higher in the intervention area than in the comparison area (DID = 2.12, p = 0.029 and 7.95, p<0.001, respectively). An estimated 106 lives were saved in the intervention area while 611 lives were lost in the comparison area.


CONCLUSIONS
iCCM significantly increased treatment coverage for diarrhoea and fever, mitigated the effect of national stock outs of amoxicillin on ARI treatment, improved timeliness of treatments for fever and ARI and saved lives.
Malaria Consortium, Kampala, Uganda.
Denis
D
Mubiru
Keeping Children and Mothers Alive, UNICEF Uganda, Kampala, Uganda.
Robert
R
Byabasheija
Malaria Consortium, Kampala, Uganda.
John Baptist
JB
Bwanika
Malaria Consortium, Kampala, Uganda.
Joslyn Edelstein
JE
Meier
Malaria Consortium, Kampala, Uganda.
Godfrey
G
Magumba
Keeping Children and Mothers Alive, UNICEF Uganda, Kampala, Uganda.
Flavia Mpanga
FM
Kaggwa
Keeping Children and Mothers Alive, UNICEF Uganda, Kampala, Uganda.
Jackson Ojera
JO
Abusu
Keeping Children and Mothers Alive, UNICEF Uganda, Kampala, Uganda.
Alex Chono
AC
Opio
Keeping Children and Mothers Alive, UNICEF Uganda, Kampala, Uganda.
Charles Clarke
CC
Lodda
Epidemiology and Health Policy & Practice, Columbia University Mailman School of Public Health, New York, New York, United States of America.
Jaanki
J
Patel
Health Section, Programme Division, UNICEF Headquarters, New York, New York, United States of America.
Theresa
T
Diaz
D019090:Case Management / Q000706:statistics & numerical data*; D000067576:Child Health / Q000706:statistics & numerical data; D002662:Child Health Services / Q000706:statistics & numerical data; D002675:Child, Preschool; D003153:Community Health Services / Q000706:statistics & numerical data*; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care; D062486:Public Health Surveillance; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology