Tadesse Yenealem, Eniyew Andargachew, Mengistu Birkety, Eniyew Antenane, Marsh David R
Ethiop Med J. 2014 Oct;52 Suppl 3:47-55.
The integrated community case management (iCCM) strategy has brought fully integrated treatment for sick children to the community in Ethiopia since 2010.
To describe patterns of use of iCCM services in 31 woredas (districts) in three regions of Ethiopia.
We analyzed all 60,452 encounters (58,341 [98.2%] for children 2-59 months of age and 2079 [1.8%] for children < 2 months of age) recorded in iCCM registration books from December 24, 2012 to January 15, 2013 in 622 randomly sampled health posts.
Children 2-23 months constituted more than half (58.9%) of the total children treated, and about half of the registered infants < 2 months (1000/2079 [48.1%]) were not sick since some Health Extension Workers (HEWs) were recording well-infant visits. On average, sick children had 1.3 symptoms, more among children 2-59 months than among young infants (1.4 vs. 1.04, respectively). The main classifications for children 2-59 months were diarrhea with some or no dehydration (29.8%), pneumonia (20.7%), severe uncomplicated malnutrition (18.5%), malaria (11.2%), and other severe diseases (4.0%). More than half the sick children < 2 months (52.7%) had very severe disease. Treatment rates (per 1000 children per year) were low for all classifications: 11.9 for malaria (in malarious kebeles only), 20.3 for malnutrition, 21.2 for pneumonia, and 29.2 for diarrhea with wide regional variations, except for pneumonia. Nearly two-thirds of health posts (64%) treated ≤ 5 cases/month, but one treated 40. Health Extension Workers saw 60% more sick children 2-59 months in the third quarter of 2012 than in the third quarter of 2011.
The use of iCCM services is low and increasing slowly, and the few busy health posts deserve further study. Recording healthy young infants in sick registers complicates tracking this vulnerable group.
自2010年以来，综合社区病例管理（iCCM）策略已将患病儿童的全面综合治疗带到了埃塞俄比亚的社区。
描述埃塞俄比亚三个地区31个沃雷达（县）的iCCM服务使用模式。
我们分析了2012年12月24日至2013年1月15日期间在622个随机抽取的卫生站的iCCM登记册中记录的所有60452次就诊情况（2至59个月大的儿童58341次[98.2%]，2个月以下的儿童2079次[1.8%]）。
2至23个月大的儿童占接受治疗儿童总数的一半以上（58.9%），约一半登记的2个月以下婴儿（1000/2079[48.1%]）没有生病，因为一些卫生推广工作者（HEW）记录了健康婴儿的就诊情况。患病儿童平均有1.3种症状，2至59个月大的儿童比小婴儿更多（分别为1.4种和1.04种）。2至59个月大儿童的主要分类为伴有一些或无脱水的腹泻（29.8%）、肺炎（20.7%）、重度单纯性营养不良（18.5%）、疟疾（11.2%）和其他严重疾病（4.0%）。2个月以下患病儿童中超过一半（52.7%）患有非常严重的疾病。所有分类的治疗率（每年每1000名儿童）都很低：疟疾为11.9（仅在疟疾流行的凯贝勒地区），营养不良为20.3，肺炎为21.2，腹泻为29.2，除肺炎外，各地区差异很大。近三分之二的卫生站（64%）每月治疗≤5例，但有一个治疗了40例。2012年第三季度，卫生推广工作者诊治的2至59个月大的患病儿童比2011年第三季度多60%。
iCCM服务的使用率较低且增长缓慢，少数繁忙的卫生站值得进一步研究。将健康的小婴儿记录在患病登记册中使跟踪这一弱势群体变得复杂。
