School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
School of Public Health, Hawassa University, Hawassa, Ethiopia.
PLoS One. 2020 Nov 13;15(11):e0242451. doi: 10.1371/journal.pone.0242451. eCollection 2020.
Integrated Community Case Management (iCCM) is a strategy for promoting access of under-served populations to lifesaving treatments through extending case management of common childhood illnesses to trained frontline health workers. In Ethiopia iCCM is provided by health extension workers (HEWs) deployed at health posts. We evaluated the association between the implementation of iCCM program in Assosa Zuria zone, Benishangul Gumuz region and changes in care-seeking for common childhood illnesses.
We conducted a pre-post study without control arm to evaluate the association of interest. The iCCM program that incorporated training, mentoring and supportive supervision of HEWs with community-based demand creation activities was implemented for two years (2017-18). Baseline, midline and endline surveys were completed approximately one year apart. Across the surveys, children aged 2-59 months (n = 1,848) who recently had cough, fever or diarrhea were included. Data were analysed using mixed-effects logistic regression model.
Over the two-year period, care-seeking from any health facility and from health posts significantly increased by 10.7 and 17.4 percentage points (PP) from baseline levels of 64.5 and 34.1%, respectively (p<0.001). Care sought from health centres (p = 0.420) and public hospitals (p = 0.129) did not meaningfully change while proportion of caregivers who approached private (p = 0.003) and informal providers (p<0.001) declined. Caregivers who visited health posts for the treatment of diarrhea (19.2 PP, p<0.001), fever (15.5 PP, p<0.001), cough (17.8 PP, p<0.001) and cough with respiratory difficulty (17.3 PP, p = 0.038) significantly increased. After accounting for extraneous variables, we observed that care-seeking from iCCM providers was almost doubled (adjusted odds ratio = 2.32: 95% confidence interval; 1.88-2.86) over the period.
iCCM implementation was associated with a meaningful shift in care-seeking to health posts.
综合社区病例管理（iCCM）是通过将常见儿童疾病的病例管理扩展到经过培训的一线卫生工作者，为服务不足人群提供救生治疗的一种策略。在埃塞俄比亚，卫生推广工作者（HEWs）在卫生所提供 iCCM。我们评估了在本尚古勒-古马兹地区阿萨索齐里亚地区实施 iCCM 计划与常见儿童疾病寻求护理变化之间的关联。
我们进行了一项无对照的前后研究，以评估利益相关者的关联。该 iCCM 计划将卫生工作者的培训、指导和支持性监督与基于社区的需求创造活动相结合，实施了两年（2017-18 年）。大约相隔一年完成了基线、中程和终线调查。在整个调查中，包括了最近有咳嗽、发热或腹泻的 2-59 个月龄儿童（n=1848）。使用混合效应逻辑回归模型分析数据。
在两年期间，来自任何卫生机构和卫生所的护理寻求率分别从基线的 64.5%和 34.1%显著增加了 10.7%和 17.4%（p<0.001）。从卫生中心（p=0.420）和公立医院（p=0.129）寻求护理的比例没有明显变化，而寻求私人（p=0.003）和非正规提供者（p<0.001）的护理比例下降。前往卫生所治疗腹泻（19.2%，p<0.001）、发热（15.5%，p<0.001）、咳嗽（17.8%，p<0.001）和咳嗽伴呼吸困难（17.3%，p=0.038）的护理者显著增加。在考虑到无关变量后，我们观察到在这段时间内，从 iCCM 提供者寻求护理的比例几乎翻了一番（调整后的优势比=2.32：95%置信区间；1.88-2.86）。
iCCM 的实施与向卫生所寻求护理的显著转变有关。
