Integrated Community Case Management (ICCM) Delivered by Village Health Teams in Bushenyi District in Uganda

Healthy Child Uganda: Can Village Health Volunteers Trained in Integrated Community Case Management of Childhood Illness Improve Access to Care for Africa's Most Vulnerable Children?

In Sub-Saharan Africa (SSA), many children die from diarrhoea, acute respiratory illness (ARI) and malaria, despite well- recognized, inexpensive and highly effective treatments, since health access and human resources are limited. Healthy Child Uganda (HCU) is a Ugandan-Canadian partnership that since 2003, has developed, implemented and evaluated a Village Health Volunteer (VHV) program in 175 rural villages. Volunteers, selected by peers, provide health education and refer sick children. Volunteer retention (94%) and significant decreases in child deaths are remarkable. Now, HCU wonders whether VHV scope can extend to provide treatment for sick children using Oral Rehydration Salts (ORS)/Zinc, antibiotics, and antimalarials. Use of lay providers in this capacity, called integrated community case management (iCCM), has been proposed as a potential inexpensive solution to SSA's human health resource crisis.

PRIMARY QUESTION: In rural southwest Uganda, can iCCM provided by lay volunteers, improve the proportion of children with diarrhoea receiving ORS/Zn, ARI receiving antibiotics, and fever/malaria receiving antimalarials? Secondary study questions consider VHV capacity to prescribe appropriate drug, dose, duration; iCCM acceptance by family, and VHV; VHV retention/motivation; program cost. Selected VHV will be iCCM trained then receive treatments for distribution. Qualitative and quantitative methods including household surveys, and focus groups will consider pre/post intervention differences and differences in control and intervention populations. A research short course and micro research grants (~ $3000 to multidisciplinary groups pursuing relevant questions) will promote health system evaluation capacity. Lessons learned are critical as SSA countries move forward in planning for increased iCCM programming.

Study Overview

• Status: Completed
• Conditions: Maternal and Child Health
• Intervention / Treatment: Other: ICCM delivered by VHT; Other: ICCM delivered by VHT with Cell Phone; Other: No intervention

• Study Type: Interventional
• Enrollment (Actual): 5000
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: No older than 4 years (Child)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Children under five (< or =59 months)

Exclusion Criteria:

• Children over five years (> 59 Months)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: ICCM delivered by VHT; Health Outcomes in Communities where VHT's were trained in ICCM and given drugs.	Other: ICCM delivered by VHT; VHT's deliver ICCM to children under five in their communities
Active Comparator: ICCM delivered by VHT with cell phone; Health Outcomes in communities with VHT's who were trained in ICCM and given cell phones	Other: ICCM delivered by VHT; VHT's deliver ICCM to children under five in their communities; Other: ICCM delivered by VHT with Cell Phone; ICCM delivered to children under 5 by VHT trained in ICCM and given cell phones
Active Comparator: Health outcomes in communities with no ICCM; Health outcomes in communities with VHT's who were not trained in ICCM	Other: No intervention; VHT's selected by no ICCM training given and no drugs or cell phones.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of change in number of children under five in intervention area who receive appropriate Integrated Community Case Management Treatment from a Community Health Worker for presumed pneumonia.	Children diagnosed by a Community Health Worker with presumed pneumonia (fast breathing and cough) treated with Amoxicillin.	March 2013 - November 2014 (8 months)
Percentage of change in number of children under five in intervention area who receive appropriate Integrated Community Case Management Treatment from a Community Health Worker for diarrhea	Children diagnosed with diarrhea will be treated with ORS and zinc.	March 2013 - November 2014 (8 months)
Percentage of change in number of children under five in intervention area who receive Integrated Community Case Management Treatment from a Community Health Worker for fever.	Children diagnosed with fever are presumed to have malaria, as per government treatment guidelines, and are treated with Coartem.	March 2013 - November 2014 (8 months)

Collaborators and Investigators

• Sponsor: Healthy Child Uganda
• Investigators: Principal Investigator: Samuel Maling, MUST; Principal Investigator: Celestine Barigye, MUST; Principal Investigator: Jerome Kabakyenga, MUST

Publications and helpful links

General Publications

• Oliphant NP, Manda S, Daniels K, Odendaal WA, Besada D, Kinney M, White Johansson E, Doherty T. Integrated community case management of childhood illness in low- and middle-income countries. Cochrane Database Syst Rev. 2021 Feb 10;2(2):CD012882. doi: 10.1002/14651858.CD012882.pub2.

Study record dates

Study Major Dates

• Study Start: October 1, 2009
• Primary Completion (Actual): November 1, 2012
• Study Completion (Actual): May 1, 2013

Study Registration Dates

• First Submitted: January 21, 2014
• First Submitted That Met QC Criteria: January 23, 2014
• First Posted (Estimate): January 27, 2014

Study Record Updates

• Last Update Posted (Estimate): July 11, 2014
• Last Update Submitted That Met QC Criteria: July 9, 2014
• Last Verified: July 1, 2014

More Information

Terms related to this study

• Keywords: Maternal and Child Health; Rural Uganda
• Other Study ID Numbers: HCU_AHSI