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- Title
Integrated community case management (iCCM) of childhood infection saves lives in hard-to-reach communities in Nicaragua.
- Authors
Rivera, Dixmer; Shah, Rashed; Guenther, Tanya; Adamo, Meredith; Koepsell, Jeanne; Reyes, Carmen Maria; McInerney, Mary; Marsh, David R.
- Abstract
Objective. To describe Nicaragua's integrated community case management (iCCM) program for hard-to-reach, rural communities and to evaluate its impact using monitoring data, including annual, census-based infant mortality data. Method. This observational study measured the strength of iCCM implementation and estimated trends in infant mortality during 2007-2013 in 120 remote Nicaraguan communities where brigadistas ("health brigadiers") offered iCCM services to children 2-59 months old. The study used program monitoring data from brigadistas' registers and supervision checklists, and derived mortality data from annual censuses conducted by the Ministry of Health. The mortality ratio (infant deaths over number of children alive in the under-1-year age group) was calculated and point estimates and exact binomial confidence intervals (CIs) were reported. Results. Monitoring data revealed strong implementation of iCCM over the study period, with medicine availability, completeness of recording, and correct classification always exceeding 80%. Treatments provided by brigadistas for pneumonia and diarrhea closely tracked expected cases and caregivers consistently sought treatment more frequently from brigadistas than from health facilities. The infant mortality ratio decreased more in iCCM areas compared to the non-iCCM areas. Statistically significant reduction ranged from 52% in 2010 (mortality rate ratio 0.48; 95% CI: 0.25-0.92) to 59% in 2013 (mortality rate ratio 0.41; 95% CI: 0.21-0.81). Conclusions. The iCCM has been found to be an effective and feasible strategy to save infant lives in hard-to-reach communities in Nicaragua. The impact was likely mediated by increased use of curative interventions, made accessible and available at the community level, and delivered through high-quality services, by brigadistas.
- Subjects
NICARAGUA; BIOAVAILABILITY; CAREGIVERS; CENSUS; CONFIDENCE intervals; DIARRHEA; HEALTH facilities; HEALTH services accessibility; INFANT mortality; INFECTION; MEDICAL care; MEDICAL quality control; SCIENTIFIC observation; PNEUMONIA; RURAL conditions; COMMUNITY-based social services; SOCIAL services case management; COMMUNITY services; HUMAN services programs; CLINICAL supervision; EVALUATION of human services programs; CHILDREN; PREVENTION
- Publication
Pan American Journal of Public Health / Revista Panamericana de Salud Pública, 2017, Vol 41, p1
- ISSN
1020-4989
- Publication type
Article