Utilization of Integrated Community Case Management Services in Three Regions in Ethiopia after Two Years of Implementation

ABSTRACT

Background: The integrated community case management (iCCM) strategy has brought fully integrated treatment for sick children to the community in Ethiopia since 2010. Objectives: To describe patterns of use of iCCM services in 31 woredas (districts) in three regions of Ethiopia. Methods: We analyzed all 60;452 encounters (58;341 [98.2] for children 2-59 months of age and 2079 [1.8] for children2 months of age) recorded in iCCM registration books from December 24; 2012 to January 15; 2013 in 622 randomly sampled health posts. Results: Children 2-23 months constituted more than half (58.9) of the total children treated; and about half of the registered infants 2 months (1000/2079 [48.1]) were not sick since some Health Extension Workers (HEWs) were recording well-infant visits. On average; sick children had 1.3 symptoms; more among children 2-59 months than among young infants (1.4 vs. 1.04; respectively). The main classifications for children 2-59 months were diarrhea with some or no dehydration (29.8); pneumonia (20.7); severe uncomplicated malnutrition (18.5); malaria (11.2); and other severe diseases (4.0). More than half the sick children 2 months (52.7) had very severe disease. Treatment rates (per 1000 children per year) were low for all classifications 11.9 for malaria (in malarious kebeles only); 20.3 for malnutrition; 21.2 for pneumonia; and 29.2 for diarrhea with wide regional variations; except for pneumonia. Nearly two-thirds of health posts (64) treated 5 cases/month; but one treated 40. Health Extension Workers saw 60 more sick children 2-59 months in the third quarter of 2012 than in the third quarter of 2011. Conclusion: The use of iCCM services is low and increasing slowly; and the few busy health posts deserve further study. Recording healthy young infants in sick registers complicates tracking this vulnerable group