Integrated community case management by drug sellers influences appropriate treatment of paediatric febrile illness in South Western Uganda: a quasi-experimental study

Abstract Background Malaria, pneumonia and diarrhoea continue to be the leading causes of death in children under the age of five years (U5) in Uganda. To combat these febrile illnesses, integrated community case management (iCCM) delivery models utilizing community health workers (CHWs) or drug sellers have been implemented. The purpose of this study is to compare the cost-effectiveness of delivering iCCM interventions via drug sellers versus CHWs in rural Uganda. Methods This study was a cost-effectiveness analysis to compare the iCCM delivery model utilizing drug sellers against the model using CHWs. The effect measure was the number of appropriately treated U5 children, and data on effectiveness came from a quasi-experimental study in Southwestern Uganda and the inSCALE cross-sectional household survey in eight districts of mid-Western Uganda. The iCCM interventions were costed using the micro-costing (ingredients) approach, with costs expressed in US dollars. Cost and effect data were linked together using a decision tree model and analysed using the Amua modelling software. Results The costs per 100 treated U5 children were US$591.20 and US$298.42 for the iCCM trained-drug seller and iCCM trained-CHW models, respectively, with 30 and 21 appropriately treated children in the iCCM trained-drug seller and iCCM trained-CHW models. When the drug seller arm (intervention) was compared to the CHW arm (control), an incremental effect of 9 per 100 appropriately treated U5 children was observed, as well as an incremental cost of US$292.78 per 100 appropriately treated children, resulting in an incremental cost-effectiveness ratio (ICER) of US$33.86 per appropriately treated U5 patient. Conclusion Since both models were cost-effective compared to the do-nothing option, the iCCM trained-drug seller model could complement the iCCM trained-CHW intervention as a strategy to increase access to quality treatment.

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The Effects of an Integrated Community Case Management Strategy on the Appropriate Treatment of Children and Child Mortality in Kono District, Sierra Leone: A Program Evaluation

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.17-0040 ◽

2017 ◽

Vol 97 (3) ◽

pp. 964-973 ◽

Cited By ~ 2

Author(s):

Ruwan Ratnayake ◽

Jeffrey Ratto ◽

Colleen Hardy ◽

Curtis Blanton ◽

Laura Miller ◽

...

Keyword(s):

Program Evaluation ◽

Case Management ◽

Sierra Leone ◽

Child Mortality ◽

Management Strategy ◽

Community Case Management ◽

Integrated Community Case Management ◽

Appropriate Treatment ◽

Kono District

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Usage of and satisfaction with Integrated Community Case Management care in western Uganda: a cross-sectional survey

Malaria Journal ◽

10.1186/s12936-021-03601-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

James S. Miller ◽

Palka Patel ◽

Sara Mian-McCarthy ◽

Andrew Christopher Wesuta ◽

Michael Matte ◽

...

Keyword(s):

Case Management ◽

Health Facility ◽

Health Workers ◽

Initial Assessment ◽

Community Case Management ◽

Cross Sectional Survey ◽

Integrated Community Case Management ◽

Cross Sectional ◽

Western Uganda ◽

Children Under 5

Abstract Background In some areas of Uganda, village health workers (VHW) deliver Integrated Community Case Management (iCCM) care, providing initial assessment of children under 5 years of age as well as protocol-based treatment of malaria, pneumonia, and diarrhoea for eligible patients. Little is known about community perspectives on or satisfaction with iCCM care. This study examines usage of and satisfaction with iCCM care as well as potential associations between these outcomes and time required to travel to the household’s preferred health facility. Methods A cross-sectional household survey was administered in a rural subcounty in western Uganda during December 2016, using a stratified random sampling approach in villages where iCCM care was available. Households were eligible if the household contained one or more children under 5 years of age. Results A total of 271 households across 8 villages were included in the final sample. Of these, 39% reported that it took over an hour to reach their preferred health facility, and 73% reported walking to the health facility; 92% stated they had seen a VHW for iCCM care in the past, and 55% had seen a VHW in the month prior to the survey. Of respondents whose households had sought iCCM care, 60% rated their overall experience as “very good” or “excellent,” 97% stated they would seek iCCM care in the future, and 92% stated they were “confident” or “very confident” in the VHW’s overall abilities. Longer travel time to the household’s preferred health facility did not appear to be associated with higher propensity to seek iCCM care or higher overall satisfaction with iCCM care. Conclusions In this setting, community usage of and satisfaction with iCCM care for malaria, pneumonia, and diarrhoea appears high overall. Ease of access to facility-based care did not appear to impact the choice to access iCCM care or satisfaction with iCCM care.

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Cost-Effectiveness Analysis of Integrated Community Case Management Delivery Models Utilizing Drug Sellers and Community Health Workers for Treatment of Under-Five Febrile Cases of Malaria, Pneumonia, Diarrhea in Rural Uganda.

10.21203/rs.3.rs-479714/v1 ◽

2021 ◽

Author(s):

Patrick Lubogo ◽

John Edward Lukyamuzi ◽

Deo Kyambadde ◽

Alex Aboda Komakech ◽

Freddy Eric Kitutu ◽

...

Keyword(s):

Cost Effectiveness ◽

Case Management ◽

Community Health ◽

Health Workers ◽

Community Case Management ◽

Integrated Community Case Management ◽

Effectiveness Analysis ◽

Delivery Models ◽

Drug Sellers ◽

Drug Seller

Abstract Background Malaria, pneumonia, and diarrhea continue to be the leading causes of death in children under the age of five in Uganda. To combat the above-mentioned febrile illnesses, integrated community case management (iCCM) delivery models utilizing CHWs or drug sellers have been implemented. The purpose of this study is to compare the cost-effectiveness of delivering iCCM interventions via drug sellers versus community health workers in rural Uganda.MethodologyThis study was a cost-effectiveness analysis to compare the iCCM delivery model utilizing drug sellers against the model using CHWs. The effect measure was the number of appropriately treated U5 children, and data on effectiveness came from a quasi-experimental study in Southwestern Uganda and the inSCALE cross-sectional household survey in eight districts of mid-Western Uganda. The iCCM interventions were costed using the micro-costing (ingredients) approach, with costs expressed in US dollars. Cost and effect data were linked together using a decision tree model and analyzed using the Amua modeling software.ResultsThe costs per 100 treated U5 were US$591.20 and US$298.42 for the iCCM trained-drug seller and iCCM trained-CHW models, respectively, with 30 and 21 appropriately treated children in the iCCM trained-drug seller and iCCM trained-CHW models. When the drug seller arm (intervention) was compared to the CHW arm (control), an incremental effect of 9 per 100 appropriately treated under-five children was observed, as well as an incremental cost of US$292.78 per 100 appropriately treated children, resulting in an ICER of US$33.86 per appropriately treated U5 patient.ConclusionSince both models were cost-effective compared to the do-nothing option, the iCCM trained-drug seller model could complement the iCCM trained-CHW intervention as a strategy to increase access to quality treatment.

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Effect of Integrated Community Case Management on Access and Utilization of Maternal, Newborn and Child Health and Immunization Services in Hard-to-Reach Communities in Migori County, Kenya: A Quasi-Experimental Study

10.21203/rs.3.rs-75610/v1 ◽

2020 ◽

Author(s):

Duncan N. Shikuku ◽

Leakey K. Masavah ◽

Maxwell Muganda ◽

Felix Otieno ◽

George Magolo ◽

...

Keyword(s):

Child Health ◽

Case Management ◽

Community Health ◽

Immunization Coverage ◽

Community Case Management ◽

Integrated Community Case Management ◽

Danger Signs ◽

Immunization Services ◽

Quasi Experimental ◽

And Child Health

Abstract Background Integrated community case management (iCCM) improves access to management of leading causes of under 5 (U5) mortality. Evidence of iCCM on maternal and newborn health and immunization services is scanty. The objective of this study was to determine the additional effect of iCCM on antenatal, skilled birth attendance (SBA) and immunization coverage in hard-to-reach communities.Methods A quasi-experimental (nonequivalent control group pretest – posttest) design for iCCM in Migori county. The intervention was iCCM training, mentorship/coaching and supportive supervision of 20 community health volunteers (CHVs). Twelve months pre-post intervention Kenya Health Information System (KHIS) data between July 2017-Sept 2019 reviewed. Differences in proportions for MNCH indicators pre – post-training were tested through test of proportions and considered statistically significant at P≤0.05 values.ResultsPost-training, average monthly community cases identification increased from 1.3-5, 0-1.5, 8.9-11.8 for suspected pneumonia, malnutrition and malaria positive cases treated in the intervention sites respectively. Intervention communities reported significant increases in proportions of malaria positive cases treated (32.0% vs 47.8%), pregnant women referred for ANC (25.4% vs 45.8%), defaulters referred for ANC (9.8% vs 14.9%), newborns with danger signs referred (1.4% vs 7.3%), U5s referred for immunization (4% vs 7.5%) and defaulters referred for immunization (2.2% vs 3%) (P≤0.05). Control communities reported significant reductions in proportion of malaria positive cases treated (57.6% vs 41.6%) and U5s referred for immunization (10% vs 5%) (P<0.0001) with no changes in MNH indicators (P≥0.05). Intervention facilities reported significant increases in 4th ANC coverage (39.4% vs 79.3%), SBA (24.5% vs 43%) and immunization coverage for U5s in all key expanded program on immunization antigens (P≤0.05) with no change in the control facilities.Conclusion iCCM improved access and utilization of ANC, SBA and immunization coverage in the hard-to-reach communities. Community level management of childhood illnesses using simple algorithms by CHVs as well as identification and referral of antenatal mothers for ANC, immunization defaulters, and newborns with danger signs for hospital management improved. Governments should strengthen community health systems so that CHVs are motivated and retained to carry out demand creation for maternal, newborn and child health and immunization services in hard-to-reach communities.

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