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Open Access

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

Catherine Mugeni, Adam C Levine, Richard M Munyaneza, Epiphanie Mulindahabi, Hannah C Cockrell, Justin Glavis-Bloom, Cameron T Nutt, Claire M Wagner, Erick Gaju, Alphonse Rukundo, Jean Pierre Habimana, Corine Karema, Fidele Ngabo and Agnes Binagwaho
Global Health: Science and Practice August 2014, 2(3):328-341; https://doi.org/10.9745/GHSP-D-14-00080
Catherine Mugeni
aRwanda Ministry of Health, Kigali, Rwanda
*Co-first authors
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  • For correspondence: cmugeni@gmail.com
Adam C Levine
bThe Warren Alpert Medical School of Brown University, Providence, RI, USA
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Richard M Munyaneza
aRwanda Ministry of Health, Kigali, Rwanda
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Epiphanie Mulindahabi
aRwanda Ministry of Health, Kigali, Rwanda
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Hannah C Cockrell
cBrown University, Watson Institute for International Studies, Development Studies Program, Providence, RI, USA
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Justin Glavis-Bloom
bThe Warren Alpert Medical School of Brown University, Providence, RI, USA
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Cameron T Nutt
dDartmouth Center for Health Care Delivery Science, Hanover, NH, USA
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Claire M Wagner
eGlobal Health Delivery Partnership, Boston, MA, USA
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Erick Gaju
aRwanda Ministry of Health, Kigali, Rwanda
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Alphonse Rukundo
fMalaria and other Parasitic Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda
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Jean Pierre Habimana
fMalaria and other Parasitic Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda
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Corine Karema
fMalaria and other Parasitic Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda
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Fidele Ngabo
aRwanda Ministry of Health, Kigali, Rwanda
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Agnes Binagwaho
aRwanda Ministry of Health, Kigali, Rwanda
gHarvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA
hDartmouth College, Geisel School of Medicine, Hanover, NH, USA
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Between 2008 and 2011, Rwanda introduced iCCM of childhood illness nationwide. One year after iCCM rollout, community-based treatment for diarrhea and pneumonia had increased significantly, and under-5 mortality and overall health facility use had declined significantly.

ABSTRACT

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.

  • Received: 2014 May 12.
  • Accepted: 2014 Jul 10.
  • Published: 2014 Aug 1.
  • © Mugeni and Levine et al.

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 properly cited. To view a copy of this license, visit http://creativecommons.org/licenses/by/3.0/

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Global Health: Science and Practice: 2 (3)
Global Health: Science and Practice
Vol. 2, No. 3
August 01, 2014
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Nationwide implementation of integrated community case management of childhood illness in Rwanda
Catherine Mugeni, Adam C Levine, Richard M Munyaneza, Epiphanie Mulindahabi, Hannah C Cockrell, Justin Glavis-Bloom, Cameron T Nutt, Claire M Wagner, Erick Gaju, Alphonse Rukundo, Jean Pierre Habimana, Corine Karema, Fidele Ngabo, Agnes Binagwaho
Global Health: Science and Practice Aug 2014, 2 (3) 328-341; DOI: 10.9745/GHSP-D-14-00080

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Nationwide implementation of integrated community case management of childhood illness in Rwanda
Catherine Mugeni, Adam C Levine, Richard M Munyaneza, Epiphanie Mulindahabi, Hannah C Cockrell, Justin Glavis-Bloom, Cameron T Nutt, Claire M Wagner, Erick Gaju, Alphonse Rukundo, Jean Pierre Habimana, Corine Karema, Fidele Ngabo, Agnes Binagwaho
Global Health: Science and Practice Aug 2014, 2 (3) 328-341; DOI: 10.9745/GHSP-D-14-00080
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