title: Effects of the integrated Community Case Management of Childhood Illness Strategy on Child Mortality in Ethiopia: A Cluster Randomized Trial.
abstract: We conducted a cluster randomized trial of the effects of the integrated community case management of childhood illness (iCCM) strategy on careseeking for and coverage of correct treatment of suspected pneumonia, diarrhea, and malaria, and mortality among children aged 2-59 months in 31 districts of the Oromia region of Ethiopia. We conducted baseline and endline coverage and mortality surveys approximately 2 years apart, and assessed program strength after about 1 year of implementation. Results showed strong iCCM implementation, with iCCM-trained workers providing generally good quality of care. However, few sick children were taken to iCCM providers (average 16 per month). Difference in differences analyses revealed that careseeking for childhood illness was low and similar in both study arms at baseline and endline, and increased only marginally in intervention (22.9-25.7%) and comparison (23.3-29.3%) areas over the study period (P = 0.77). Mortality declined at similar rates in both study arms. Ethiopia's iCCM program did not generate levels of demand and utilization sufficient to achieve significant increases in intervention coverage and a resulting acceleration in reductions in child mortality. This evaluation has allowed Ethiopia to strengthen its strategic approaches to increasing population demand and use of iCCM services.
authors.forename: Agbessi
authors.initials: A
authors.lastname: Amouzou
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hazel
authors.forename: Bryan
authors.initials: B
authors.lastname: Shaw
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Miller
authors.forename: Mengistu
authors.initials: M
authors.lastname: Tafesse
authors.forename: Yared
authors.initials: Y
authors.lastname: Mekonnen
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bryce
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
mesh_terms: D000328:Adult; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000458:organization & administration* / Q000592:standards*; D003153:Community Health Services / Q000592:standards*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003967:Diarrhea / Q000517:prevention & control; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000517:prevention & control; D011014:Pneumonia / Q000517:prevention & control