Nationwide implementation of integrated community case management of childhood illness in Rwanda.

Authors:
Claire M Wagner
Claire M Wagner
Harvard Medical School
Corine Karema, MD, MSc
Corine Karema, MD, MSc
Quality and Equity Health care
Independent Malaria, Infectious diseases, HSS and Global Health consultant and Senior technical advisor
Malaria & infectious diseases- Neglected Tropical Diseases, Malaria control and Elimination, Global Health
Kigali, Kigali City | Rwanda

Glob Health Sci Pract 2014 Aug 5;2(3):328-41. Epub 2014 Aug 5.

Rwanda Ministry of Health , Kigali , Rwanda ; Harvard Medical School, Department of Global Health and Social Medicine , Boston, MA , USA ; Dartmouth College, Geisel School of Medicine , Hanover, NH , USA.

Background: Between 2008 and 2011, Rwanda introduced integrated community case management (iCCM) of childhood illness nationwide. Community health workers in each of Rwanda's nearly 15,000 villages were trained in iCCM and equipped for empirical diagnosis and treatment of pneumonia, diarrhea, and malaria; for malnutrition surveillance; and for comprehensive reporting and referral services.

Methods: We used data from the Rwanda health management information system (HMIS) to calculate monthly all-cause under-5 mortality rates, health facility use rates, and community-based treatment rates for childhood illness in each district. We then compared a 3-month baseline period prior to iCCM implementation with a seasonally matched comparison period 1 year after iCCM implementation. Finally, we compared the actual changes in all-cause child mortality and health facility use over this time period with the changes that would have been expected based on baseline trends in Rwanda.

Results: The number of children receiving community-based treatment for diarrhea and pneumonia increased significantly in the 1-year period after iCCM implementation, from 0.83 cases/1,000 child-months to 3.80 cases/1,000 child-months (P = .01) and 0.25 cases/1,000 child-months to 5.28 cases/1,000 child-months (P<.001), respectively. On average, total under-5 mortality rates declined significantly by 38% (P<.001), and health facility use declined significantly by 15% (P = .006). These decreases were significantly greater than would have been expected based on baseline trends.

Conclusions: This is the first study to demonstrate decreases in both child mortality and health facility use after implementing iCCM of childhood illness at a national level. While our study design does not allow for direct attribution of these changes to implementation of iCCM, these results are in line with those of prior studies conducted at the sub-national level in other low-income countries.

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Source
http://dx.doi.org/10.9745/GHSP-D-14-00080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168626PMC
August 2014
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