Ensuring access for the most remote communities: An evaluation of an integrated community case management program in Kono District, Sierra Leone
Integrated community case management (iCCM) through community health workers (CHWs) aims to reduce under five child mortality rates (U5MR) in remote communities. Kono District had a high malaria burden and U5MR. In 2009, iCCM for children aged 2-59 months expanded district-wide. We evaluated the effect of iCCM on mortality, care-seeking, and appropriate treatment by CHWs or government clinic.
We conducted cluster surveys in 2010 and 2013, powered to detect a 28% decline in U5MR. The 2010 survey used a stepped wedge design consistent with the phased expansion. Clusters were selected by proportional to population size (2010) and using simple random sampling with weighting (2013). Households were selected exhaustively or using systematic random sampling. Caregivers reported on mortality over a one-year period and child morbidity and care-seeking over a two-week period.
In 2010 and 2013, 5,257 and 3,649 households were surveyed, respectively. Between the years, U5MR remained unchanged although the ≥5 mortality rate increased from 0.68 to 0.93 deaths/1,000/month (p=0.03). iCCM remained the first source of care for >50% of children aged under five years. Government clinics declined as the first source of care from 30.0% to 21.7% (p=0.02). Appropriate treatment for fever by CHWs or government clinics increased from 45.5% to 58.2% (p=0.01).
As iCCM is the main source of care and contributes to increased appropriate treatment, it is a key strategy for remote communities. A decrease in U5MR was not detected though the study was not powered to detect a relative change smaller than 28%.
Learning Areas:Conduct evaluation related to programs, research, and other areas of practice
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related research
Describe and analyze the rationale, study design and outcomes of an evaluation of a child health program that addresses remote communities in pre-Ebola Sierra Leone.
Keyword(s): Child Health, Evaluation
Qualified on the content I am responsible for because: I am an epidemiologist who works on the evaluation of health programs and control of infectious diseases for the International Rescue Committee. I contributed to the design, training and supervision of enumerators, data collection, field work and reporting for this study.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.