Diaz Theresa, Guenther Tanya, Oliphant Nicholas P, Muñiz Maria
UNICEF, Programme Division, Health, New York, NY, USA.
Save the Children, Washington DC, USA.
J Glob Health. 2014 Dec;4(2):020409. doi: 10.7189/jogh.04.020409.
To use a newly devised set of criteria to review the study design and scope of collection of process, outcomes and contextual data for evaluations and implementation research of integrated community case management (iCCM) in Sub-Saharan African.
We examined 24 program evaluations and implementation research studies of iCCM in sub-Saharan Africa conducted in the last 5 years (2008-2013), assessed the design used and categorized them according to whether or not they collected sufficient information to conduct process and outcome evaluations.
Five of the 24 studies used a stepped wedge design and two were randomized control trials. The remaining 17 were quasi-experimental of which 10 had comparison areas; however, not all comparison areas had a pre and post household survey. With regard to process data, 22 of the studies collected sufficient information to report on implementation strength, and all, except one, could report on program implementation. Most common missing data elements were health facility treatments, service costs, and qualitative data to assess demand. For the measurement of program outcomes, 7 of the 24 studies had a year or less of implementation at scale before the endline survey, 6 of the household surveys did not collect point of service, 10 did not collect timeliness (care seeking within 24 hours of symptoms) and 12 did not have socioeconomic (SES) information. Among the 16 studies with comparison areas, only 5 randomly selected comparison areas, while 10 had appropriate comparison areas.
Several evaluations were done too soon after implementation, lacked information on health facility treatments, costs, demand, timeliness or SES and/or did not have a counterfactual. We propose several study designs and minimal data elements to be collected to provide sufficient information to assess whether iCCM increased timely coverage of treatment for the neediest children in a cost-efficient manner.
运用一套新制定的标准，对撒哈拉以南非洲地区综合社区病例管理（iCCM）评估及实施研究中的过程、结果和背景数据的研究设计与收集范围进行审查。
我们审视了过去5年（2008 - 2013年）在撒哈拉以南非洲地区开展的24项iCCM项目评估及实施研究，评估所采用的设计，并根据其是否收集了足够信息以进行过程和结果评估进行分类。
24项研究中有5项采用了阶梯楔形设计，2项为随机对照试验。其余17项为准实验性研究，其中10项有对照地区；然而，并非所有对照地区都进行了前后住户调查。关于过程数据，22项研究收集了足够信息以报告实施力度，除1项外，所有研究都能报告项目实施情况。最常见的缺失数据元素是卫生设施治疗、服务成本以及用于评估需求的定性数据。对于项目结果的测量，24项研究中有7项在终线调查前规模实施不足一年，6项住户调查未收集服务点信息，10项未收集及时性（症状出现后24小时内就医）信息，12项没有社会经济（SES）信息。在有对照地区的16项研究中，只有5项随机选择了对照地区，而10项有合适的对照地区。
一些评估在实施后不久就进行，缺乏关于卫生设施治疗、成本、需求、及时性或SES的信息，和/或没有反事实对照。我们提出了几种研究设计以及需要收集的最少数据元素，以提供足够信息来评估iCCM是否以具有成本效益的方式增加了对最贫困儿童治疗的及时覆盖率。
