| Popis: |
Background Integrated community case management (iCCM) improves access to management of leading causes of under 5 (U5) mortality. Evidence of iCCM on maternal and newborn health and immunization services is scanty. The objective of this study was to determine the additional effect of iCCM on antenatal, skilled birth attendance (SBA) and immunization coverage in hard-to-reach communities.Methods A quasi-experimental (nonequivalent control group pretest – posttest) design for iCCM in Migori county. The intervention was iCCM training, mentorship/coaching and supportive supervision of 20 community health volunteers (CHVs). Twelve months pre-post intervention Kenya Health Information System (KHIS) data between July 2017-Sept 2019 reviewed. Differences in proportions for MNCH indicators pre – post-training were tested through test of proportions and considered statistically significant at P≤0.05 values.ResultsPost-training, average monthly community cases identification increased from 1.3-5, 0-1.5, 8.9-11.8 for suspected pneumonia, malnutrition and malaria positive cases treated in the intervention sites respectively. Intervention communities reported significant increases in proportions of malaria positive cases treated (32.0% vs 47.8%), pregnant women referred for ANC (25.4% vs 45.8%), defaulters referred for ANC (9.8% vs 14.9%), newborns with danger signs referred (1.4% vs 7.3%), U5s referred for immunization (4% vs 7.5%) and defaulters referred for immunization (2.2% vs 3%) (P≤0.05). Control communities reported significant reductions in proportion of malaria positive cases treated (57.6% vs 41.6%) and U5s referred for immunization (10% vs 5%) (Pth ANC coverage (39.4% vs 79.3%), SBA (24.5% vs 43%) and immunization coverage for U5s in all key expanded program on immunization antigens (P≤0.05) with no change in the control facilities.Conclusion iCCM improved access and utilization of ANC, SBA and immunization coverage in the hard-to-reach communities. Community level management of childhood illnesses using simple algorithms by CHVs as well as identification and referral of antenatal mothers for ANC, immunization defaulters, and newborns with danger signs for hospital management improved. Governments should strengthen community health systems so that CHVs are motivated and retained to carry out demand creation for maternal, newborn and child health and immunization services in hard-to-reach communities. |
