Poor Adherence to the Integrated Community Case Management of Newborn and Child Illness Protocol in Rural Ethiopia.

Ethiopia has adopted the Integrated Community Case Management of Newborn and Child Illness (iCMNCI) strategy to expand access to neonatal and child health services. This study assessed compliance with the iCMNCI case management protocol at the primary care settings. A descriptive cross-sectional assessment was conducted in eight districts of Benishangul-Gumuz Region from April to December 2019, and 1,217 sick children aged 2 to 59 months and 43 sick young infants aged 0 to 2 months who sought clinical consultation at the 236 health posts were selected purposively. Trained supervisors reviewed the medical records of two most recent cases from each illness category to quantify the extent to which health workers correctly assessed, classified, treated, and followed up cases per the iCMNCI guidelines. A total of 32,981 children sought clinical consultation of whom 31,830 (96.5%) were aged 2 to 59 months, and 1,151 (3.5%) were young infants aged 0 to 2 months. Of the 1,217 selected children, 426 (35%) had pneumonia, 287 (23.6%) malaria, 501 (41.2%) diarrhea, and 3 (0.2%) had malnutrition. Nearly two-thirds 306 (72%) of pneumonia cases were correctly classified as having had the disease and 297 (70%) were correctly treated for pneumonia; 213 (74%) were correctly classified as having had malaria and 210 (73%) were correctly treated for malaria; and 393 (78%) were correctly classified as having had diarrhea and 297 (59%) were correctly treated for diarrhea. Generally, the current practices of child illness assessment, classification, and treatment have deviated from iCMNCI guidelines. Future interventions should support frontline health workers to comply strictly with case management protocols through training, mentorship, and supervision.

Utilization of integrated community case management services in three regions in Ethiopia after two years of implementation.

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 children < 2 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.

Illness recognition, home care, and care-seeking for sick infants less than two months of age in Shebedino District, Sidama Zone, Ethiopia.

BACKGROUND: The incidence of newborn and young infant health danger signs is unknown in Ethiopia. Neverthe- less, experience shows that care-seeking is far lower than conservative morbidity estimates would project. OBJECTIVES: To examine illness recognition, home care, decision-making, and care-seeking for sick infants less than two months of age in Shebedino District, Southern Nations, Nationalities and Peoples Region in 2011. METHODS: Focus group interviews of mothers (n = 60) of recently ill children. RESULTS: Mothers reported recognizing many, but not all, evidence-based newborn danger signs. Home care ranged from probably harmless to harmful and delayed definitive care-seeking. Decision-making was widespread, but patterns of care-seeking rarely led to prompt, evidence-based care. Mothers reported 10 barriers to care- seeking at health posts: lack of knowledge about availability of curative services, fear of evil eye, social stigma, perceived financial barrier, perceived young infant fragility, an elder's contrary advice, distance, husband's re- fusal, fear of injection, and belief in recovery without medicine. CONCLUSION: Young infants are more vulnerable to illness than their older counterparts, yet they are less likely to receive the care they need without a targeted, contextualized communication strategy to generate demand for case management services that are accessible, available, and of good quality.