RT Journal Article
SR Electronic
T1 Nationwide implementation of integrated community case management of childhood illness in Rwanda
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP 328
OP 341
DO 10.9745/GHSP-D-14-00080
VO 2
IS 3
A1 Mugeni, Catherine
A1 Levine, Adam C
A1 Munyaneza, Richard M
A1 Mulindahabi, Epiphanie
A1 Cockrell, Hannah C
A1 Glavis-Bloom, Justin
A1 Nutt, Cameron T
A1 Wagner, Claire M
A1 Gaju, Erick
A1 Rukundo, Alphonse
A1 Habimana, Jean Pierre
A1 Karema, Corine
A1 Ngabo, Fidele
A1 Binagwaho, Agnes
YR 2014
UL http://www.ghspjournal.org/content/2/3/328.abstract
AB 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. 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.