title: Independent Evaluation of the integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design.
abstract: We evaluated the impact of integrated community case management of childhood illness (iCCM) on careseeking for childhood illness and child mortality in Malawi, using a National Evaluation Platform dose-response design with 27 districts as units of analysis. "Dose" variables included density of iCCM providers, drug availability, and supervision, measured through a cross-sectional cellular telephone survey of all iCCM-trained providers. "Response" variables were changes between 2010 and 2014 in careseeking and mortality in children aged 2-59 months, measured through household surveys. iCCM implementation strength was not associated with changes in careseeking or mortality. There were fewer than one iCCM-ready provider per 1,000 under-five children per district. About 70% of sick children were taken outside the home for care in both 2010 and 2014. Careseeking from iCCM providers increased over time from about 2% to 10%; careseeking from other providers fell by a similar amount. Likely contributors to the failure to find impact include low density of iCCM providers, geographic targeting of iCCM to "hard-to-reach" areas although women did not identify distance from a provider as a barrier to health care, and displacement of facility careseeking by iCCM careseeking. This suggests that targeting iCCM solely based on geographic barriers may need to be reconsidered.
authors.forename: Agbessi
authors.initials: A
authors.lastname: Amouzou
authors.forename: Mercy
authors.initials: M
authors.lastname: Kanyuka
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hazel
authors.forename: Rebecca
authors.initials: R
authors.lastname: Heidkamp
authors.forename: Andrew
authors.initials: A
authors.lastname: Marsh
authors.forename: Tiope
authors.initials: T
authors.lastname: Mleme
authors.forename: Spy
authors.initials: S
authors.lastname: Munthali
authors.forename: Lois
authors.initials: L
authors.lastname: Park
authors.forename: Benjamin
authors.initials: B
authors.lastname: Banda
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hill
authors.forename: Jamie
authors.initials: J
authors.lastname: Perin
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bryce
mesh_terms: D019090:Case Management / Q000458:organization & administration; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000458:organization & administration; D003140:Communicable Disease Control / Q000191:economics / Q000458:organization & administration*; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003906:Developing Countries; D019468:Disease Management; D005260:Female; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D015980:Public Health Practice