Nationwide implementation of integrated community case management of childhood illness in Rwanda
Nationwide implementation of integrated community case management of childhood illness in Rwanda
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DOI：
10.9745/ghsp-d-14-00080
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发表时间：
2014-08-01
影响因子：
4
通讯作者：
Binagwaho, Agnes
中科院分区：
文献类型：
--
作者：
Mugeni, Catherine;Levine, Adam C.;Binagwaho, Agnes
背景：2008至2011年间，卢旺达在全国范围内推行儿童疾病综合社区病例管理。卢旺达近15,000个村庄中的每个村庄的社区卫生工作者都接受了ICCM培训，并配备了肺炎、腹泻和疟疾的经验性诊断和治疗；营养不良监测；以及全面的报告和转诊服务。方法：我们使用卢旺达卫生管理信息系统(HMI)的数据来计算每个地区每月的全原因5岁以下儿童死亡率、卫生设施使用率和儿童疾病的社区治疗率。然后，我们比较了ICCM实施前3个月的基准期和ICCM实施一年后的季节性匹配的对比时期。结果：在ICCM实施后的一年内，接受以社区为基础的腹泻和肺炎治疗的儿童数量显著增加，分别从0.83例/1,000儿童月增加到3.80例/1,000儿童月(P=.01)和0.25例/1,000儿童月到5.28例/1,000儿童月(P=.001)。平均而言，5岁以下儿童的总死亡率显著下降了38%(P=.001)，卫生设施使用率显著下降了15%(P=.006)。这些下降明显大于基于基线趋势的预期。结论：这是第一项研究表明，在国家一级实施儿童疾病ICCM后，儿童死亡率和卫生设施使用率都有所下降。虽然我们的研究设计不允许将这些变化直接归因于国际协调机制的实施，但这些结果与其他低收入国家以前在国家以下一级进行的研究的结果是一致的。
Background: Between 2008 and 2011, Rwanda introduced integrated community case management (iCCM) of childhood illness nationwide. Community health workers in each of Rwanda's nearly 15,000 villages were trained in iCCM and equipped for empirical diagnosis and treatment of pneumonia, diarrhea, and malaria; for malnutrition surveillance; and for comprehensive reporting and referral services.Methods: We used data from the Rwanda health management information system (HMIS) to calculate monthly all-cause under-5 mortality rates, health facility use rates, and community-based treatment rates for childhood illness in each district. We then compared a 3-month baseline period prior to iCCM implementation with a seasonally matched comparison period 1 year after iCCM implementation. Finally, we compared the actual changes in all-cause child mortality and health facility use over this time period with the changes that would have been expected based on baseline trends in Rwanda.Results: The number of children receiving community-based treatment for diarrhea and pneumonia increased significantly in the 1-year period after iCCM implementation, from 0.83 cases/1,000 child-months to 3.80 cases/1,000 child-months (P=.01) and 0.25 cases/1,000 child-months to 5.28 cases/1,000 child-months (P=.001), respectively. On average, total under-5 mortality rates declined significantly by 38% (P=.001), and health facility use declined significantly by 15% (P=.006). These decreases were significantly greater than would have been expected based on baseline trends.Conclusions: This is the first study to demonstrate decreases in both child mortality and health facility use after implementing iCCM of childhood illness at a national level. While our study design does not allow for direct attribution of these changes to implementation of iCCM, these results are in line with those of prior studies conducted at the subnational level in other low-income countries.