TY - JOUR
T1 - Independent evaluation of the integrated community case management of childhood illness strategy in Malawi using a national evaluation platform design
AU - Amouzou, Agbessi
AU - Kanyuka, Mercy
AU - Hazel, Elizabeth
AU - Heidkamp, Rebecca
AU - Marsh, Andrew
AU - Mleme, Tiope
AU - Munthali, Spy
AU - Park, Lois
AU - Banda, Benjamin
AU - Moulton, Lawrence H.
AU - Black, Robert E.
AU - Hill, Kenneth
AU - Perin, Jamie
AU - Victora, Cesar G.
AU - Bryce, Jennifer
N1 - Publisher Copyright:
© 2016 by The American Society of Tropical Medicine and Hygiene.
PY - 2016/3
Y1 - 2016/3
N2 - 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.
AB - 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.
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U2 - 10.4269/ajtmh.15-0584
DO - 10.4269/ajtmh.15-0584
M3 - Article
C2 - 26787158
AN - SCOPUS:84960941216
SN - 0002-9637
VL - 94
SP - 574
EP - 583
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 3
ER -