Integrated community case management of childhood illness in low- and middle-income countries

Nicholas P Oliphant, Samuel Manda, Karen Daniels, Willem A Odendaal, Donela Besada, Mary Kinney, Emily White Johansson, Tanya Doherty, Nicholas P Oliphant, Samuel Manda, Karen Daniels, Willem A Odendaal, Donela Besada, Mary Kinney, Emily White Johansson, Tanya Doherty

Abstract

Background: The leading causes of mortality globally in children younger than five years of age (under-fives), and particularly in the regions of sub-Saharan Africa (SSA) and Southern Asia, in 2018 were infectious diseases, including pneumonia (15%), diarrhoea (8%), malaria (5%) and newborn sepsis (7%) (UNICEF 2019). Nutrition-related factors contributed to 45% of under-five deaths (UNICEF 2019). World Health Organization (WHO) and United Nations Children's Fund (UNICEF), in collaboration with other development partners, have developed an approach - now known as integrated community case management (iCCM) - to bring treatment services for children 'closer to home'. The iCCM approach provides integrated case management services for two or more illnesses - including diarrhoea, pneumonia, malaria, severe acute malnutrition or neonatal sepsis - among under-fives at community level (i.e. outside of healthcare facilities) by lay health workers where there is limited access to health facility-based case management services (WHO/UNICEF 2012).

Objectives: To assess the effects of the integrated community case management (iCCM) strategy on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for children younger than five years of age in low- and middle-income countries.

Search methods: We searched CENTRAL, MEDLINE, Embase and CINAHL on 7 November 2019, Virtual Health Library on 8 November 2019, and Popline on 5 December 2018, three other databases on 22 March 2019 and two trial registers on 8 November 2019. We performed reference checking, and citation searching, and contacted study authors to identify additional studies.

Selection criteria: Randomized controlled trials (RCTs), cluster-RCTs, controlled before-after studies (CBAs), interrupted time series (ITS) studies and repeated measures studies comparing generic WHO/UNICEF iCCM (or local adaptation thereof) for at least two iCCM diseases with usual facility services (facility treatment services) with or without single disease community case management (CCM). We included studies reporting on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for under-fives in low- and middle-income countries.

Data collection and analysis: At least two review authors independently screened abstracts, screened full texts and extracted data using a standardised data collection form adapted from the EPOC Good Practice Data Collection Form. We resolved any disagreements through discussion or, if required, we consulted a third review author not involved in the original screening. We contacted study authors for clarification or additional details when necessary. We reported risk ratios (RR) for dichotomous outcomes and hazard ratios (HR) for time to event outcomes, with 95% confidence intervals (CI), adjusted for clustering, where possible. We used estimates of effect from the primary analysis reported by the investigators, where possible. We analysed the effects of randomized trials and other study types separately. We used the GRADE approach to assess the certainty of evidence.

Main results: We included seven studies, of which three were cluster RCTs and four were CBAs. Six of the seven studies were in SSA and one study was in Southern Asia. The iCCM components and inputs were fairly consistent across the seven studies with notable variation for the training and deployment component (e.g. on payment of iCCM providers) and the system component (e.g. on improving information systems). When compared to usual facility services, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (RR 0.96, 95% CI 0.77 to 1.19; 2 CBA studies, 5898 children; very low-certainty evidence). iCCM may have little to no effect on neonatal mortality (HR 1.01, 95% 0.73 to 1.28; 2 trials, 65,209 children; low-certainty evidence). We are uncertain of the effect of iCCM on infant mortality (HR 1.02, 95% CI 0.83 to 1.26; 2 trials, 60,480 children; very low-certainty evidence) and under-five mortality (HR 1.18, 95% CI 1.01 to 1.37; 1 trial, 4729 children; very low-certainty evidence). iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness by 68% (RR 1.68, 95% CI 1.24 to 2.27; 2 trials, 9853 children; moderate-certainty evidence). None of the studies reported quality of care, severity of illness or adverse events for this comparison. When compared to usual facility services plus CCM for malaria, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (very low-certainty evidence) and iCCM may have little or no effect on careseeking to an appropriate provider for any iCCM illness (RR 1.06, 95% CI 0.97 to 1.17; 1 trial, 811 children; low-certainty evidence). None of the studies reported quality of care, case load or severity of illness at health facilities, mortality or adverse events for this comparison.

Authors' conclusions: iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness. However, the evidence presented here underscores the importance of moving beyond training and deployment to valuing iCCM providers, strengthening health systems and engaging community systems.

Trial registration: ClinicalTrials.gov NCT02072629 NCT02046018 NCT02694055 NCT02151578.

Conflict of interest statement

NPO has worked as a Health Specialist for UNICEF at its headquarters in New York, USA. UNICEF was involved in the development of iCCM with WHO; UNICEF has advocated for countries to adopt iCCM; and UNICEF has provided funding and technical support in numerous countries for iCCM implementation, monitoring, evaluation and research. NPO was involved in providing technical support in numerous countries for iCCM monitoring, evaluation, and implementation research. NPO works as a Health Specialist – Public Health and M&E – for the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) in Geneva, Switzerland. GFATM has funded the implementation of iCCM and CCM in numerous countries. NPO has also served as an expert advisor to the WHO on IMCI, including iCCM.

SM, KD, DB, MK and TD were members of the research team for a UNICEF commissioned evaluation of the Integrated Health Systems Strengthening (IHSS) programme, which included iCCM, in six Sub‐Saharan Africa countries.

WAO: none.

EWJ: none.

Copyright © 2021 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.

Figures

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1
Study flow diagram. See also Selection of studies and Results of the search.
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2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
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Forest plot of comparison: 1 iCCM versus usual facility services, outcome: 1.1 Comparison 1 iCCM versus usual facility services: coverage of appropriate treatment by an appropriate provider (controlled before‐after (CBA)).
5
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Forest plot of comparison: 1 iCCM versus usual care, outcome: 1.4 Comparison 1 iCCM versus usual care: coverage of appropriate treatment by an iCCM provider (controlled before‐after (CBA)).
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Forest plot of comparison: 1 iCCM versus usual care, outcome: 1.6 Comparison 1 iCCM versus usual care: coverage of careseeking to an appropriate provider of treatment services (cluster randomized controlled trial (cRCT)).
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Forest plot of comparison: 1 iCCM versus usual care, outcome: 1.7 Comparison 1 iCCM versus usual care: coverage of careseeking to an appropriate provider of treatment services (controlled before‐after (CBA)).
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Forest plot of comparison: 1 iCCM versus usual facility services, outcome: 1.6 Comparison 1 iCCM vs usual facility services: coverage of careseeking to an iCCM provider (controlled before‐after (CBA)).
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Forest plot of comparison: 2 iCCM versus usual facility services plus CCM for malaria, outcome: 2.1 Comparison 2 iCCM versus usual facility services plus CCM for malaria: coverage of appropriate treatment by an appropriate provider (controlled before‐after (CBA)).
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Forest plot of comparison: 2 iCCM versus usual facility services plus CCM for malaria, outcome: 2.2 Comparison 2 iCCM vs usual facility services + CCM for malaria: coverage of careseeking to an appropriate provider of treatment services (cRCT).
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Forest plot of comparison: 2 iCCM versus usual facility services plus CCM for malaria, outcome: 2.4 Comparison 2 iCCM vs usual facility services plus CCM for malaria: coverage of careseeking to an appropriate provider of treatment services (controlled before‐after (CBA)).
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Forest plot of comparison: 2 iCCM versus usual facility services plus CCM for malaria, outcome: 2.3 Comparison 2 iCCM vs usual facility services plus CCM for malaria: coverage of careseeking to an appropriate provider of treatment services (cluster randomized controlled trial (cRCT)).
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Forest plot of comparison: 2 iCCM versus usual facility services plus CCM for malaria, outcome: 2.6 Comparison 2 iCCM versus usual facility services plus CCM for malaria: coverage of careseeking to an iCCM provider (controlled before‐after (CBA)).
1.1. Analysis
1.1. Analysis
Comparison 1: iCCM versus usual facility services, Outcome 1: Comparison 1 iCCM vs usual facility services: coverage of appropriate treatment by an appropriate provider (CBA)
1.2. Analysis
1.2. Analysis
Comparison 1: iCCM versus usual facility services, Outcome 2: Comparison 1 iCCM vs usual facility services: coverage of appropriate treatment by an iCCM provider (CBA)
1.3. Analysis
1.3. Analysis
Comparison 1: iCCM versus usual facility services, Outcome 3: Comparison 1 iCCM vs usual facility services: mortality (cRCT)
1.4. Analysis
1.4. Analysis
Comparison 1: iCCM versus usual facility services, Outcome 4: Comparison 1 iCCM vs usual facility services: coverage of careseeking to an appropriate provider of treatment services (cRCT)
1.5. Analysis
1.5. Analysis
Comparison 1: iCCM versus usual facility services, Outcome 5: Comparison 1 iCCM vs usual facility services: coverage of careseeking to an appropriate provider of treatment services (CBA)
1.6. Analysis
1.6. Analysis
Comparison 1: iCCM versus usual facility services, Outcome 6: Comparison 1 iCCM vs usual facility services: coverage of careseeking to an iCCM provider (CBA)
2.1. Analysis
2.1. Analysis
Comparison 2: iCCM versus usual facility services plus CCM for malaria, Outcome 1: Comparison 2 iCCM vs usual facility services + CCM for malaria: coverage of appropriate treatment by an appropriate provider (CBA)
2.2. Analysis
2.2. Analysis
Comparison 2: iCCM versus usual facility services plus CCM for malaria, Outcome 2: Comparison 2 iCCM vs usual facility services + CCM for malaria: coverage of careseeking to an appropriate provider of treatment services (cRCT)
2.3. Analysis
2.3. Analysis
Comparison 2: iCCM versus usual facility services plus CCM for malaria, Outcome 3: Comparison 2 iCCM vs usual facility services + CCM for malaria: coverage of careseeking to an appropriate provider of treatment services (CBA)
2.4. Analysis
2.4. Analysis
Comparison 2: iCCM versus usual facility services plus CCM for malaria, Outcome 4: Comparison 2 iCCM vs usual facility services + CCM for malaria: coverage of careseeking to an iCCM provider (cRCT)
2.5. Analysis
2.5. Analysis
Comparison 2: iCCM versus usual facility services plus CCM for malaria, Outcome 5: Comparison 2 iCCM vs usual facility services + CCM for malaria: coverage of careseeking to an iCCM provider (CBA)

References

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Bhandari 2012d {published data only}
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Bhandari 2012f {published data only}
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Biemba 2016a {published data only}
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Biemba 2016b {published data only}
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Biemba 2016c {published data only}
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Brenner 2011 {published data only}
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Brenner 2017a {published data only}
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Brenner 2017b {published data only}
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Brenner 2017c {published data only}
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Callaghan‐Koru 2013 {published data only}
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Chinbuah 2012 {published data only}
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Dani 2017 {published data only}
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Degefie 2017a {published data only}
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Ebuehi 2010 {published data only}
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Fiedler 2008 {published data only}
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Findley 2013 {published data only}
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Ghimire 2010 {published data only}
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Gill 2011 {published data only}
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Guenther 2017 {published data only}
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Habib 2013 {published data only}
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Hamer 2012 {published data only}
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Huque 2016 {published data only}
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ICDDR 2009a {published data only}
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IPPF 1989 {published data only}
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Jarolimova 2018 {published data only}
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Johnson 2016a {published data only}
    1. NCT02694055. Proactive community case management and child survival: a cluster-randomized controlled trial. (first received 29 February 2016). [NCT02694055] []
Johnson 2016b {published data only}
    1. NCT02694055. Proactive community case management and child survival: a cluster-randomized controlled trial. (first received 29 February 2016). [NCT02694055] []
Johnson 2016c {published data only}
    1. NCT02694055. Proactive community case management and child survival: a cluster-randomized controlled trial. (first received 29 February 2016). [NCT02694055] []
Johnson 2016d {published data only}
    1. NCT02694055. Trial of proactive community case management to reduce child mortality. (first received 29 February 2016).
Kafle 2013 {published data only}
    1. Kafle KK, Karkee SB, Shrestha N, Prasad RR, Bhuju GB, Das PL, et al. Improving private drug sellers' practices for managing common health problems in Nepal. Journal of Nepal Health Research Council 2013;11(24):198-204.
Kallander 2012 {published data only}
    1. Kallander K, Tibenderana J, Kirkwood B, Hill Z, Strachan D, Soremekun S, et al. Inscale cluster randomized trial evaluating the effect of innovative motivation and supervision approaches on community health worker performance and retention in Uganda and Mozambique: intervention design. American Journal of Tropical Medicine and Hygiene 2012;87(5 Suppl 1):243.
Kalyango 2012b {published data only}
    1. Rutebemberwa E. Home and Community Management of Malaria and Pneumonia. (first received 4 March 2011. [DOI: 10.1186/ISRCTN52966230] [ISRCTN52966230]
Kanté 2019b {published data only}
    1. Phillips J. Introducing community health agents (CHA) to accelerate achievement of MDGs 4 and 5 in Tanzania: the Connect Project. (first received 21 June 2012). [ISRCTN96819844] [] []
Lal 2015 {published data only}
    1. Lal S, Ndyomugenyi R, Alexander ND, Lagarde M, Paintain L, Magnussen P, et al. Health facility utilisation changes during the introduction of community case management of malaria in South Western Uganda: an interrupted time series approach. PloS One 2015;10(9):e0137448.
Langston 2014 {published data only}
    1. Langston A, Weiss J, Landegger J, Pullum T, Morrow M, Kabadege M, et al. Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation. Global Health, Science and Practice 2014;2(3):342-54.
Littrell 2013 {published data only}
    1. Littrell M, Moukam LV, Libite R, Youmba JC, Baugh G. Narrowing the treatment gap with equitable access: mid-term outcomes of a community case management program in Cameroon. Health Policy and Planning 2013;28(7):705-16.
Ma 2017 {published data only}
    1. Ma Y, Kim H, Cho Y, Lee J, Degley JK, Adam AG, et al. Effects of community health volunteers on infectious diseases of children under five in Volta Region, Ghana: study protocol for a cluster randomized controlled trial. BMC Public Health 2017;17(1):95.
Ma 2019b {published data only}
    1. Ma Y, Sudfeld CR, Kim H, Lee J, Cho Y, Awoonor-Williams JK, et al. Evaluating the impact of community health volunteer home visits on child diarrhea and fever in the Volta Region, Ghana: a cluster-randomized controlled trial. PLoS Medicine 2019;16(6):e1002830.
Maru 2018a {published data only}
    1. Maru S, Chaudhari P. Implementing an integrated RMNCH intervention by community health workers in Achham and Dolakha: national pilot. (first received 13 December 2017). [NCT03371186] []
Maru 2018b {published data only}
    1. Maru S, Nirola I, Thapa A, Thapa P, Kunwar L, Wu WJ, et al. An integrated community health worker intervention in rural Nepal: a type 2 hybrid effectiveness-implementation study protocol. Implementation Science 2018;13:53. [DOI: 10.1186/s13012-018-0741-x] []
Matovu 2014 {published data only}
    1. Matovu F, Nanyiti A, Rutebemberwa E. Household health care-seeking costs: experiences from a randomized, controlled trial of community-based malaria and pneumonia treatment among under-fives in eastern Uganda. Malaria Journal 2014;13:222.
Mazumder 2014a {published data only}
    1. Mazumder S, Taneja S, Bahl R, Mohan P, Strand TA, Sommerfelt H, et al. Effect of implementation of Integrated Management of Neonatal and Childhood Illness programme on treatment seeking practices for morbidity in infants: cluster randomised trial. BMJ 2014;349:g4988.
Mazumder 2014b {published data only}
    1. Mazumder S, Taneja S, Bahl R, Mohan P, Strand TA, Sommerfelt H, et al. Effect of implementation of integrated management of neonatal and childhood illness programme on treatment seeking practices for morbidities in infants: cluster randomised trial. BMJ 2014;349:g4988.
Menon 1990 {published data only}
    1. Menon A, Snow RW, Byass P, Greenwood BM, Hayes RJ, N'Jie AB. Sustained protection against mortality and morbidity from malaria in rural Gambian children by chemoprophylaxis given by village health workers. Transactions of the Royal Society of Tropical Medicine and Hygiene 1990;84(6):768-72.
Mugeni 2014 {published data only}
    1. Mugeni C, Levine AC, Munyaneza RM, Mulindahabi E, Cockrell HC, Glavis-Bloom J, et al. Nationwide implementation of integrated community case management of childhood illness in Rwanda. Global Health, Science and Practice 2014;2(3):328-41.
Mukanga 2012a {published data only}
    1. Mukanga D, Tiono AB, Anyorigiya T, Kallander K, Konate AT, Oduro AR, et al. Integrated community case management of fever in children under five using rapid diagnostic tests and respiratory rate counting: a multi-country cluster randomized trial. American Journal of Tropical Medicine and Hygiene 2012;87(5 Suppl):21-9.
Mukanga 2012b {published data only}
    1. Mukanga D, Tiono AB, Anyorigiya T, Kallander K, Konate AT, Oduro AR, et al. Integrated community case management of fever in children under five using rapid diagnostic tests and respiratory rate counting: a multi-country cluster randomized trial. American Journal of Tropical Medicine and Hygiene 2012;87(5 Suppl):21-9.
Nanyonjo 2015 {published data only}
    1. Nanyonjo A, Ssekitooleko J, Counihan H, Makumbi F, Tomson G, Kallander K. Impact of an integrated community case management programme on uptake of appropriate diarrhoea and pneumonia treatments in Uganda: a propensity score matching and equity analysis study. International Journal for Equity in Health 2015;14:74.
NCT00513500 {published data only}
    1. NCT00513500. Zambia integrated management of malaria and pneumonia study. (first received 8 August 2007). []
NCT03371186 {published data only}
    1. NCT03371186. Implementing an integrated RMNCH intervention by community health workers in Achham and Dolakha: national pilot. (first received 13 December 2017).
Nzayirambaho 2013 {published data only}
    1. Nzayirambaho M, Bizimana JD, Freund RJ, Millet P, Merrien FX, Potel G, et al. Impact of home-based management of malaria combined with other community-based interventions: what do we learn from Rwanda? Pan African Medical Journal 2013;14:50.
Ogundele 2015 {published data only}
    1. Ogundele OA, Ogundele T. Effect of community level intervention on nutritional status and feeding practices of under five children in Ile Ife, Nigeria. Pan African Medical Journal 2015;22:255.
Oliphant 2014 {published data only}
    1. Oliphant NP, Muniz M, Guenther T, Diaz T, Lainez YB, Counihan H, et al. Multi-country analysis of routine data from integrated community case management (iCCM) programs in sub-Saharan Africa. Journal of Global Health 2014;4(2):020408.
Onono 2018 {published data only}
    1. Onono M, Abdi M, Mutai K, Asadhi E, Nyamai R, Okoth P, et al. Community case management of lower chest indrawing pneumonia with oral amoxicillin in children in Kenya. Acta Paediatrica 2018;107:44-52. [DOI: 10.1111/apa.14405] []
Qazi 2017 {published data only}
    1. Qazi SA. Enhanced community case management to increase access to pneumonia treatment in children under 5 years of age in sub-Saharan Africa and South Asia. (first received 9 June 2017). [CTRI/2017/02/007761] []
Rahman 2016 {published data only}
    1. Rahman M, Yunus FM, Shah R, Jhohura FT, Mistry SK, Quayyum T, et al. A controlled before-and-after perspective on the improving maternal, neonatal, and child survival program in rural Bangladesh: an impact analysis. PloS One 2016;11(9):e0161647.
Ratnayake 2017 {published data only}
    1. Ratnayake R, Ratto J, Hardy C, Blanton C, Miller L, Choi M, et al. The effects of an integrated community case management strategy on the appropriate treatment of children and child mortality in Kono district, Sierra Leone: a program evaluation. American Journal of Tropical Medicine and Hygiene 2017;97(3):964-73.
Rowe 2009 {published data only}
    1. Rowe AK, Onikpo F, Lama M, Osterholt DM, Rowe SY, Deming MS. A multifaceted intervention to improve health worker adherence to integrated management of childhood illness guidelines in Benin. American Journal of Public Health 2009;99(5):837-46.
Seidenberg 2012 {published data only}
    1. Seidenberg PD, Hamer DH, Iyer H, Pilingana P, Siazeele K, Hamainza B, et al. Impact of integrated community case management on health-seeking behavior in rural Zambia. American Journal of Tropical Medicine and Hygiene 2012;87(5 Suppl):105-10.
Siribie 2015 {published data only}
    1. Siribie M, Diarra A, Tiono AB, Soulama I, Sirima SB. Effect of a large scale community-based distribution of artemether-lumefantrine on its therapeutic efficacy among children living in a rural area of Burkina Faso. Bulletin de la Societe de Pathologie Exotique 2015;108(2):120-3. []
Sirima 2009a {published data only}
    1. Sirima SB. Home and community management of fevers/malaria and pneumonia in children under-five: a cluster randomised controlled trial of an integrated approach in a rural district of Burkina Faso. (first received 30 May 2014). []
Sirima 2009b {published data only}
    1. Sirima SB. Home management of malaria and pneumonia. (first received 30 May 2014). []
Soofi 2017a {published data only}
    1. Soofi S, Ariff S, Sadiq K, Habib A, Bhatti Z, Ahmad I, et al. Evaluation of the uptake and impact of neonatal vitamin A supplementation delivered through the Lady Health Worker programme on neonatal and infant morbidity and mortality in rural Pakistan: an effectiveness trial. Archives of Disease in Childhood 2017;102(3):216-23.
Soofi 2017b {published data only}
    1. Soofi S. Evaluation of the effectiveness and impact of community case management of severe acute malnutrition through lady health workers as compared to a facility based program: a cluster randomized controlled trial. (first received 6 February 2017). [NCT03043352] []
Tagbor 2011 {published data only}
    1. Tagbor H, Cairns M, Nakwa E, Browne E, Sarkodie B, Counihan H, et al. The clinical impact of combining intermittent preventive treatment with home management of malaria in children aged below 5 years: cluster randomised trial. Tropical Medicine & International Health 2011;16(3):280-9.
Taneja 2015 {published data only}
    1. Taneja S, Bahl S, Mazumder S, Martines J, Bhandari N, Bhan M K. Impact on inequities in health indicators: effect of implementing the integrated management of neonatal and childhood illness programme in Haryana, India. Journal of Global Health 2015;5(1):010401.
Teferi 2014a {published data only}
    1. Teferi E, Teno D, Ali I, Alemu H, Bulto T. Quality and use of IMNCI services at health center under-five clinics after introduction of integrated community-based case management (ICCM) in three regions of Ethiopia. Ethiopian Medical Journal 2014;52 Suppl 3:91-8.
Teferi 2014b {published data only}
    1. Teferi E, Alemu H, Bulto T, Ali I, Teno D. A descriptive study of the changes in coverage of preventive and promotive interventions before and after the introduction of integrated community case management (ICCM) in Ethiopia. Ethiopian Medical Journal 2014;52 Suppl 3:151-5.
Tikmani 2016 {published data only}
    1. Tikmani SS, Muhammad AA, Shafiq Y, Shah S, Kumar N, Ahmed I, et al. Ambulatory treatment of fast breathing in young infants aged <60 days: a double-blind, randomized, placebo-controlled equivalence trial in low-income settlements of Karachi. Clinical Infectious Diseases 2016;64(2):184-9. [DOI: 10.1093/cid/ciw90] []
Tine 2011 {published data only}
    1. Tine RC, Faye B, Ndour CT, Ndiaye JL, Ndiaye M, Bassene C, et al. Impact of combining intermittent preventive treatment with home management of malaria in children less than 10 years in a rural area of Senegal: a cluster randomized trial. Malaria Journal 2011;10:358.
Tiono 2008a {published data only}
    1. Tiono AB, Kabore Y, Traore A, Convelbo N, Pagnoni F, Sirima SB. Implementation of home based management of malaria in children reduces the work load for peripheral health facilities in a rural district of Burkina Faso 2788. Malaria Journal 2008;7:201.
Tiono 2008b {published data only}
    1. Tiono AB, Kabore Y, Traore A, Convelbo N, Pagnoni F, Sirima SB. Implementation of Home based management of malaria in children reduces the work load for peripheral health facilities in a rural district of Burkina Faso. Malaria Journal 2008;7:201.
Uganda 2009 {published data only}
    1. Uganda Healthy Child. Integrated community case management (ICCM) delivered by village health teams in Bushenyi district in Uganda. (first received 27 January 2014). []
Uwemedimo 2018 {published data only}
    1. Uwemedimo OT, Lewis TP, Essien EA, Chan GJ, Nsona H, Kruk ME, et al. Distribution and determinants of pneumonia diagnosis using Integrated Management of Childhood Illness guidelines: a nationally representative study in Malawi. BMJ Global Health 2018;3(2):e000506.
Yeboah‐Antwi 2010a {published data only}
    1. Yeboah-Antwi K. Zambia integrated management of malaria and pneumonia study. (first received 8 August 2007). [NCT00513500] []
Yeboah‐Antwi 2010b {published data only}
    1. Yeboah-Antwi K. Zambia Integrated Management of Malaria and Pneumonia Study. (first received 8 August 2007). [NCT00513500] []
Yeboah‐Antwi 2010c {published data only}
    1. Yeboah-Antwi K, Pilingana P, Macleod WB, Semrau K, Siazeele K, Kalesha P, et al. Community case management of fever due to malaria and pneumonia in children under five in Zambia: a cluster randomized controlled trial. PLoS Medicine 2010;7(9):e1000340. [DOI: 10.1371/journal.pmed.1000340] []
References to studies awaiting assessment Kanté 2019a {published data only}96819844
    1. Kanté AM, Exavery A, Jackson EF, Kassimu T, Baynes CD, Hingora A, et al. The impact of paid community health worker deployment on child survival: the connect randomized cluster trial in rural Tanzania. BMC Health Services Research 2019;19:492. [DOI: 10.1186/s12913-019-4203-1] [ISRCTN96819844]
Ma 2019a {published data only}49236178
    1. Ma Y, Sudfeld CR, Kim H, Lee J, Cho Y, Awoonor-Williams JK, et al. Evaluating the impact of community health volunteer home visits on child diarrhea and fever in the Volta Region, Ghana: a cluster-randomized controlled trial. PLoS Medicine 2019;16(6):e1002830. [DOI: 10.1371/journal.pmed.1002830] [ISRCTN49236178]
NCT02151578 {published data only}
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References to ongoing studies NCT00979797 {published data only}
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Rabbani 2014 {published data only}
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Taneja 2017 {published data only}http://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=17478
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Whidden 2019a {published data only}
    1. Whidden C, Treleaven E, Liu J, Padian N, Poudiougou B, Bautista-Arredondo S, et al. Proactive community case management and child survival: protocol for a cluster randomised controlled trial. BMJ Open 2019;9:e027487. [DOI: 10.1136/ bmjopen-2018-027487 ] [NCT02694055]
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Source: PubMed

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