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Independent Evaluation of the Integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design

Wednesday, 2nd of March 2016

 

Independent Evaluation of the Integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design

1. 1.       Agbessi Amouzou, 
2. 2.       Mercy Kanyuka, 
3. 3.       Elizabeth Hazel, 
4. 4.       Rebecca Heidkamp,
5. 5.       Andrew Marsh, 
6. 6.       Tiope Mleme, 
7. 7.       Spy Munthali, 
8. 8.       Lois Park, 
9. 9.       Benjamin Banda,
10. 10.    Lawrence H. Moulton, 
11. 11.    Robert E. Black, 
12. 12.    Kenneth Hill, 
13. 13.    Jamie Perin,
14. 14.    Cesar G. Victora and 
15. 15.    Jennifer Bryce*

+Author Affiliations

1. Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; National Statistical Office, Zomba, Malawi; Chancellor College, University of Malawi, Zomba, Malawi; University of Pelotas, Pelotas, Brazil

+Author Notes

• Authors´ addresses: Agbessi Amouzou, UNICEF, New York, NY, E-mail: aamouzo1@jhmi.edu. Elizabeth Hazel, Rebecca Heidkamp, Andrew Marsh, Lois Park, Lawrence H. Moulton, Robert E. Black, Kenneth Hill, Jamie Perin, and Jennifer Bryce, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: ehazel1@jhu.edu, rheidka1@jhu.edu, amarsh6@jhmi.edu, lpark9@jhu.edu, lmoulto1@jhu.edu, rblack1@jhu.edu, kenneth_hill_1@yahoo.com, and jbryce1@jhu.edu. Mercy Kanyuka, Tiope Mleme, and Benjamin Banda, National Statistical Office, Zomba, Malawi, E-mails: mkanyuka@gmail.com, tmleme@yahoo.co.uk, and bisa1banda@yahoo.com. Spy Munthali, Chancellor College, University of Malawi, Zomba, Malawi, E-mail: spymunthali@gmail.com. Cesar G. Victora, University of Pelotas, Pelotas, Brazil, E-mail: cvictora@gmail.com.

1. ↵* Address correspondence to Jennifer Bryce, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205. E-mail: jbryce1@jhu.edu

We evaluated the impact of integrated community case management of childhood illness (iCCM) on careseeking for childhood illness and child mortality in Malawi, using a National Evaluation Platform dose-response design with 27 districts as units of analysis. “Dose” variables included density of iCCM providers, drug availability, and supervision, measured through a cross-sectional cellular telephone survey of all iCCM-trained providers. “Response” variables were changes between 2010 and 2014 in careseeking and mortality in children aged 2–59 months, measured through household surveys. iCCM implementation strength was not associated with changes in careseeking or mortality. There were fewer than one iCCM-ready provider per 1,000 under-five children per district. About 70% of sick children were taken outside the home for care in both 2010 and 2014. Careseeking from iCCM providers increased over time from about 2% to 10%; careseeking from other providers fell by a similar amount. Likely contributors to the failure to find impact include low density of iCCM providers, geographic targeting of iCCM to “hard-to-reach” areas although women did not identify distance from a provider as a barrier to health care, and displacement of facility careseeking by iCCM careseeking. This suggests that targeting iCCM solely based on geographic barriers may need to be reconsidered.

• Financial support: This evaluation was funded by the Bill & Melinda Gates Foundation through a grant to the World Health Organization. Foreign Affairs, Trade and Development Canada contributed to the costs of documenting program implementation and supported open access publication and printing charges through the Real-Time Results Tracking grant to Johns Hopkins University.
• Received August 11, 2015.
• Accepted November 3, 2015.
• © The American Society of Tropical Medicine and Hygiene

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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