The effects of an integrated community case management strategy on the appropriate treatment of children and child mortality in Kono District: A program evaluation

The goal of IRC’s integrated community case management (iCCM) intervention in Sierra Leone is to increase access to prompt and effective treatment of malaria, diarrhea, and pneumonia by treating these conditions at the community level through community health workers (CHWs). In March 2009, the IRC received funding from CIDA to expand the program and conduct a mid-term mortality survey. iCCM aims to reduce child mortality in remote areas. Integrated iCCM was implemented in 2009 in Kono District, Sierra Leone, a post-conflict area with poor access to care and high under-five mortality rates.

We conducted cluster surveys in 2010 (midterm) and 2013 (endline) to compare indicators on child mortality, coverage of appropriate treatment, timely access to care, quality of care, and recognition of CHWs. The sample size was powered to detect a 28% decline in under-five mortality rate. We analyzed routine program data to assess utilization and equity of access. 5,257 (2010) and 3,649 (2013) households were surveyed. Under-five mortality rate did not change significantly, however, at midterm it lower than anticipated and the power was too low to detect a relative change smaller than 28%. The ≥5 year mortality rate increased from 0.68 to 0.93 deaths per 1,000 per month (p = 0.03). CHWs were the first source of care for 52% (2010) and 50.9% (2013) of ill children. Appropriate treatment of fever by CHWs or peripheral health units increased from 45.5% to 58.2% (p = 0.01). As beneficial effects for fever treatment and process indicators were observed, the findings support iCCM as a core strategy for Kono District.