Community case management improves use of treatment for childhood diarrhea, malaria and pneumonia in a remote district of Ethiopia

Background: Ethiopia’s Health Extension Workers (HEW) deliver preventive interventions and treat childhood diarrhea and malaria, but not pneumonia. Most of Ethiopia’s annual estimated 4 million childhood pneumonia cases go untreated. Objective: Evaluate the performance of volunteers in providing Community Case Management (CCM) for diarrhea,fever and pneumonia – in a pre-HEW setting in Liben Woreda, Oromiya Regional State. Methods: Save the Children supported Ministry of Health and communities to deliver child survival interventions from 1997-2006. We obtained permission in 2005 to train 45 volunteers from remote kebeles in CCM. We evaluated the strategy through reviewing registers and supervision records; examining CCM workers; focus group discussions;and three household surveys. Results: The CCM workers treated 4787 cases, mainly: malaria (36%), pneumonia (26%), conjunctivitis (14%), and watery diarrhea with some dehydration (12%). They saw 2.5 times more cases of childhood fever, pneumonia, and diarrhea than all the woreda’s health facility staff combined. Quality of care was good. Conclusion: The availability, quality, demand, and use of CCM were high. These CCM workers were less educated and less trained than HEWs who perform complicated tasks (Rapid Diagnostic Tests) and dispense expensive antimalarial drugs like Coartem®. They should also treat pneumonia with inexpensive drugs like cotrimoxazole to help achieve Millennium Development Goal 4.

A cluster randomised controlled trial of the community effectiveness of two interventions in rural Malawi to improve health care and to reduce maternal, newborn and infant mortality

<p>Abstract</p> <p>Background</p> <p>The UN Millennium Development Goals call for substantial reductions in maternal and child mortality, to be achieved through reductions in morbidity and mortality during pregnancy, delivery, postpartum and early childhood. The MaiMwana Project aims to test community-based interventions that tackle maternal and child health problems through increasing awareness and local action.</p> <p>Methods/Design</p> <p>This study uses a two-by-two factorial cluster-randomised controlled trial design to test the impact of two interventions. The impact of a community mobilisation intervention run through women's groups, on home care, health care-seeking behaviours and maternal and infant mortality, will be tested. The impact of a volunteer-led infant feeding and care support intervention, on rates of exclusive breastfeeding, uptake of HIV-prevention services and infant mortality, will also be tested. The women's group intervention will employ local female facilitators to guide women's groups through a four-phase cycle of problem identification and prioritisation, strategy identification, implementation and evaluation. Meetings will be held monthly at village level. The infant feeding intervention will select local volunteers to provide advice and support for breastfeeding, birth preparedness, newborn care and immunisation. They will visit pregnant and new mothers in their homes five times during and after pregnancy.</p> <p>The unit of intervention allocation will be clusters of rural villages of 2500-4000 population. 48 clusters have been defined and randomly allocated to either women's groups only, infant feeding support only, both interventions, or no intervention. Study villages are surrounded by 'buffer areas' of non-study villages to reduce contamination between intervention and control areas. Outcome indicators will be measured through a demographic surveillance system. Primary outcomes will be maternal, infant, neonatal and perinatal mortality for the women's group intervention, and exclusive breastfeeding rates and infant mortality for the infant feeding intervention.</p> <p>Structured interviews will be conducted with mothers one-month and six-months after birth to collect detailed quantitative data on care practices and health-care-seeking. Further qualitative, quantitative and economic data will be collected for process and economic evaluations.</p> <p>Trial registration</p> <p>ISRCTN06477126</p