Oliphant Nicholas P, Muñiz Maria, Guenther Tanya, Diaz Theresa, Laínez Yolanda Barberá, Counihan Helen, Pratt Abigail
UNICEF, Programme Division, Health, New York, USA.
Save the Children, Washington, DC, USA.
J Glob Health. 2014 Dec;4(2):020408. doi: 10.7189/jogh.04.020408.
To identify better performing iCCM programs in sub-Saharan Africa (SSA) and identify factors associated with better performance using routine data.
We examined 15 evaluations or studies of integrated community case management (iCCM) programs in SSA conducted between 2008 and 2013 and with information about the program; routine data on treatments, supervision, and stockouts; and, where available, data from community health worker (CHW) surveys on supervision and stockouts. Analyses included descriptive statistics, Fisher exact test for differences in median treatment rates, the Kruskal-Wallis test for differences in the distribution of treatment rates, and Spearman's correlation by program factors.
The median percent of annual expected cases treated was 27% (1-74%) for total iCCM, 37% (1-80%) for malaria, 155% (7-552%) for pneumonia, and 27% (1-74%) for diarrhoea. Seven programs had above median total iCCM treatments rates. Four programs had above median treatment rates, above median treatments per active CHW per month, and above median percent of expected cases treated. Larger populations under-five targeted were negatively associated with treatment rates for fever, malaria, diarrhea, and total iCCM. The ratio of CHWs per population was positively associated with diarrhoea treatment rates. Use of rapid diagnostic tests (RDTs) was negatively associated with treatment rates for pneumonia. Treatment rates and percent of annual expected cases treated were equivalent between programs with volunteer CHWs and programs with salaried CHWs.
There is large variation in iCCM program performance in SSA. Four programs appear to be higher performing in terms of treatment rates, treatments per CHW per month, and percent of expected cases treated. Treatment rates for diarrhoea are lower than expected across most programmes. CHWs in many programmes are overtreating pneumonia. Programs targeting larger populations under-five tend to have lower treatment rates. The reasons for lower pneumonia treatment rates where CHWs use RDTs need to be explored. Programs with volunteer CHWs and those with salaried CHWs can achieve similar treatment rates and percent of annual expected cases treated but to do so volunteer programs must manage more CHWs per population and salaried CHWs must provide more treatments per CHW per month.
识别撒哈拉以南非洲地区（SSA）表现更佳的综合社区病例管理（iCCM）项目，并利用常规数据确定与更佳表现相关的因素。
我们研究了2008年至2013年期间在SSA开展的15项关于iCCM项目的评估或研究，这些研究包含项目信息、治疗、监督和药品短缺的常规数据，以及（如有）社区卫生工作者（CHW）关于监督和药品短缺的调查数据。分析包括描述性统计、用于中位数治疗率差异的Fisher精确检验、用于治疗率分布差异的Kruskal-Wallis检验，以及按项目因素进行的Spearman相关性分析。
iCCM总体年度预期病例治疗的中位数百分比为27%（1%-74%），疟疾为37%（1%-80%），肺炎为155%（7%-552%），腹泻为27%（1%-74%）。七个项目的iCCM总体治疗率高于中位数。四个项目的治疗率高于中位数，每月每位活跃CHW的治疗量高于中位数，且预期病例治疗的百分比高于中位数。目标五岁以下人口较多与发热、疟疾、腹泻和iCCM总体的治疗率呈负相关。每人口CHW的比例与腹泻治疗率呈正相关。快速诊断检测（RDT）的使用与肺炎治疗率呈负相关。有志愿CHW的项目和有受薪CHW的项目在治疗率和年度预期病例治疗百分比方面相当。
SSA的iCCM项目表现差异很大。四个项目在治疗率、每位CHW每月的治疗量以及预期病例治疗百分比方面似乎表现更佳。大多数项目中腹泻的治疗率低于预期。许多项目中的CHW对肺炎治疗过度。针对较大五岁以下人口的项目往往治疗率较低。需要探究CHW使用RDT时肺炎治疗率较低的原因。有志愿CHW的项目和有受薪CHW的项目可以实现相似的治疗率和年度预期病例治疗百分比，但要做到这一点，志愿项目必须每人口管理更多CHW，而受薪CHW项目必须每位CHW每月提供更多治疗。
