Independent evaluation of the integrated community case management of childhood illness strategy in Malawi using a national evaluation platform design

Agbessi Amouzou, Mercy Kanyuka, Elizabeth Hazel, Rebecca Heidkamp, Andrew Marsh, Tiope Mleme, Spy Munthali, Lois Park, Benjamin Banda, Lawrence H. Moulton, Robert E. Black, Kenneth Hill, Jamie Perin, Cesar G. Victora, Jennifer Bryce

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)574-583
Number of pages10
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume94
Issue number3
DOIs
StatePublished - Mar 2016

ASJC Scopus subject areas

  • Parasitology
  • Virology
  • Infectious Diseases

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