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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 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{at}gmail.com
Adam C Levine
bThe Warren Alpert Medical School of Brown University, Providence, RI, USA
*Co-first authors
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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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Figures & Tables

Figures

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    Figure 1.

    Date of Implementation of Integrated Community Case Management by District, Rwanda

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    Figure 2.

    Seasonal Average Schematic Applied to Community Mortality Data, Rwanda

    Abbreviation: iCCM, integrated community case management.

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    Figure 3.

    Total Under-5 Mortality by District, Rwanda

    Abbreviation: iCCM, integrated community case management.

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    Figure 4.

    Total Under-5 Health Facility Use by District, Rwanda

    Abbreviation: iCCM, integrated community case management.

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    A community health worker draws blood from a child for malaria testing.

Tables

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    Table 1. Treatment of Childhood Illnesses by Community Health Workers Before and After iCCM Implementation, Rwanda, 2010–2011, N = 21 Districts
    IllnessBaseline PeriodComparison PeriodDifference (95% CI)P Value (2-tailed)
    Pneumonia0.255.285.03 (3.06, 7.00)< .001
    Diarrhea0.833.802.97 (0.97, 4.97).01
    Malaria19.147.27−11.87 (−21.92, −1.83).03
    • Treatment data are reported as number per 1,000 child-months.

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    Table 2. Under-5 Mortality and Health Facility Use Before and After iCCM Implementation, Rwanda
    Indicator (No. of Districts)Baseline PeriodComparison PeriodDifference (95% CI)P Value (2-tailed)
    Community mortality (15)0.380.200.18 (0.11, 0.24)< .001
    Health facility mortality (28)0.090.10−0.02 (−0.05, 0.01).41
    Total mortality (15)0.480.300.19 (0.10, 0.27)<.001
    Health center use (30)2.482.000.48 (0.13, 0.82).009
    District hospital use (28)2.171.910.26 (−0.08, 0.59).10
    Total health facility use (28)4.573.880.69 (0.15, 1.23).006
    • All data are reported as number per 1,000 child-months. Because of rounding, differences may not appear exact.

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    Table 3. Comparison of Expected With Actual Declines in Child Mortality and Health Facility Use, Rwanda
    Indicator (No. of Districts)ExpectedActualDifference (95% CI)P Value (2-tailed)
    Health facility use (19)0.051.041.00 (0.16, 1.84).03
    Total mortality (15)0.050.190.13 (0.06, 0.21).003
    • All data are reported as number per 1,000 child-months. Because to rounding, differences may not appear exact.

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    Table 4. Comparison of Rwanda 2010 DHS With 2010 HMIS Data for CHW Use
    IllnessRwanda 2010 DHSRwanda 2010 HMISComparison
    Proportion With Symptoms in Past 2 WeeksProportion Seeking Care or Advice From CHWNo. Children/1,000 Child-Months Seeking Care or Advice From CHWNo. Children/1,000 Child-Months Receiving Treatment From CHWProportion of Those Seeking Care Who Received Treatment From CHW
    ARI4%13%9.625.2855%
    Diarrhea13%13%34.063.8011%
    Fever16%16%49.307.2715%
    • Abbreviations: ARI, acute respiratory infection; CHW, community health worker; DHS, Demographic and Health Survey; HMIS, health management information system.

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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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