Changes in care-seeking for common childhood illnesses in the context of Integrated Community Case Management (iCCM) program implementation in Benishangul Gumuz region of Ethiopia

• Type of Material: Article
• Authors: Samson Gebremedhin, Addis Ababa University; Ayalew Astatkie, Hawassa University; Hajira M. Amin, Emory University; Abebe Teshome, Emory University; Abebe Gebremariam, Emory University
• Language: English
• Date: 2020-11-13
• Publisher: Public Library of Science (PLoS)
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Gebremedhin et al
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0242451
• Title of Journal or Parent Work: PLoS One
• Volume: 15
• Issue: 11
• Grant/Funding Information: The study was funded by UNICEF Ethiopia. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
• Keywords: under-served population; health posts; childhood illness; health extension workers (HEWs); lifesaving treatment; Integrated Community Case Management (iCCM); Assosa Zuria zone; Benishangul Gumuz region; Ethiopia
• Research Categories: Health Sciences, Health Care Management

Abstract

Background 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. Methods 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. Results 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. Conclusion iCCM implementation was associated with a meaningful shift in care-seeking to health posts.