Integrated community case management of childhood illness in low‐ and middle‐income countries

3 March, 2021

Below are the citation and plain language summary of a new Cochrane systematic review.

CITATION: Integrated community case management of childhood illness in low‐ and middle‐income countries

Nicholas P Oliphant, Samuel Manda, Karen Daniels, Willem A Odendaal, Donela Besada, Mary Kinney, Emily White Johansson, Tanya Doherty.

Version published: 10 February 2021

https://doi.org/10.1002/14651858.CD012882.pub2

PLAIN LANGUAGE SUMMARY

1. What was the aim of this review?

This Cochrane Review aimed to assess the effects of integrated community case management (iCCM) for children under five in low and middle-income countries. The review authors collected and analysed all relevant studies to answer this question and found seven studies.

2. Key messages

When iCCM is compared to usual facility services, it probably increases the number of parents who seek care from a healthcare worker. But we do not know if more children get the correct treatment, and it may have no effect on the number of children who die.

3. What was studied in the review?

Each year, more than five million children die before the age of five. Most of these children live in sub-Saharan Africa or Central and Southern Asia. Many of these children suffer from infectious diseases including pneumonia and diarrhoea; and from malaria and malnutrition. And many children have more than one of these illnesses at the same time. These children do not always have easy access to healthcare services.

To address these problems, the World Health Organization, United Nations Children's Fund (UNICEF) and others have developed an approach known as iCCM. iCCM focuses on children under five years of age living in rural and hard-to-reach areas. They receive services from lay health workers who are based in the community, outside of healthcare facilities.

There are three main components of iCCM:

– Lay health workers are trained to assess children's health, provide services for common childhood illnesses and refer children to healthcare facilities where necessary. (A lay health worker is a lay person who has received some training to deliver healthcare services but is not a health professional.)

– Systems are put in place to make sure that the lay health workers have good access to supplies, get regular supervision and can easily refer children on to healthcare facilities.

– Families and communities receive communication and information about good practices for health and nutrition.

4. What were the main results of the review?

The review authors found seven relevant studies. Six were from sub-Saharan Africa and one was from Southern Asia. Some of the studies compared settings that had iCCM with settings that only had usual healthcare facilities. Some of the other studies compared settings that had iCCM with settings that had usual healthcare facilities as well as community‐based management of malaria.

When iCCM is compared to usual facility services:

– It probably increases the number of parents who seek care from a healthcare worker when their children have common childhood illnesses.

– We do not know if more children get the correct treatment for childhood illnesses because the certainty of the evidence was very low.

– There may be no effect on the number of newborn children who die.

– We do not know what the effect is on the number of infants and children under-five years who die.

– We do not know what the effect is on quality of care, side effects or the number of children who attend healthcare facilities because the studies did not measure this.

When iCCM is compared to usual facility services plus community‐based management of malaria:

– It may have no effect on the number of parents who seek care from a healthcare worker when their children have common childhood illnesses.

– We do not know if more children get the correct treatment for childhood illnesses because the certainty of the evidence was very low.

– We do not know what the effect is on the number of children who die.

– We do not know what the effect is on quality of care, side effects or the number of children who attend healthcare facilities because the studies did not measure this.

5. Authors' conclusions

iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness. However, the evidence presented here underscores the importance of moving beyond training and deployment to valuing iCCM providers, strengthening health systems and engaging community systems...

The evidence presented here underscores the importance of moving beyond training and deployment to valuing iCCM providers, strengthening health systems and engaging community systems. Depending on the context, this could mean adding remuneration of iCCM providers with a financial package commensurate with their work; a greater focus on training and support to facility‐based providers to ensure children with severe illness who are referred from iCCM providers receive quality care; expanding the iCCM package to include newborn care; a greater focus on the systems component of iCCM, including referral systems, supply chain, supervision systems, information systems, and monitoring and evaluation; and a greater focus on the social mobilization and community engagement component of iCCM (e.g. engaging women's groups as in the systematic review

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Best wishes, Neil

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CHIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All) and assistant moderator of the CHIFA forum. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org