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首页> 外文期刊>The American Journal of Tropical Medicine and Hygiene >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
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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

机译：综合社区案例管理策略对塞拉利昂科诺区儿童儿童死亡率的适当治疗效果：方案评估

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摘要

Integrated community case management (iCCM) aims to reduce child mortality in areas with poor access to health care. iCCM was implemented in 2009 in Kono district, Sierra Leone, a postconflict area with high under-five mortality rates (U5MRs). We evaluated iCCM's impact and effects on child health using 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 community health workers (CHWs). The sample size was powered to detect a 28% decline in U5MR. Clusters were selected proportional to population size. All households were sampled to measure mortality and systematic random sampling was used to measure coverage in a subset of households. We used program data to evaluate utilization and access; 5,257 (2010) and 3,649 (2013) households were surveyed. U5MR did not change significantly (4.54 [95% confidence interval [CI]: 3.47-5.60] to 3.95 [95% CI: 3.06-4.83] deaths per 1,000 per month (P = 0.4)) though a relative change smaller than 28% could not be detected. CHWs were the first source of care for 52% (2010) and 50.9% (2013) of children. Coverage of appropriate treatment of fever by CHWs or peripheral health units increased from 45.5% [95% CI: 39.2-52.0] to 58.2% [95% CI: 50.5-65.5] (P = 0.01); changes for diarrhea and pneumonia were not significant. The continued reliance on the CHW as the first source of care and improved coverage for the appropriate treatment of fever support iCCM's role in Kono district.
机译：综合社区案例管理（ICCM）旨在减少在获得医疗保健差的地区的儿童死亡率。 ICCM于2009年在塞拉利昂市塞拉利昂塞拉利昂（Mierra Leone），该地区高出了五大死亡率（U5MR）。我们在2010年（中期）和2013年（终端）中使用集群调查（终点）评估了ICCM对儿童健康的影响，以比较儿童死亡率，覆盖适当的待遇，及时获得护理，护理质量和社区卫生工作者的认可chws）。样品大小为检测U5MR的28％下降。集群与人口大小成比例。所有家庭都被取样以衡量死亡率，并使用系统随机抽样来衡量家庭子集中的覆盖范围。我们使用程序数据来评估利用率和访问; 5,257（2010）和3,649（2013年）家庭被调查。 U5MR没有显着变化（4.54 [95％置信区间[CI]：3.47-5.60]至3.95 [95％CI：3.06-4.83]每月每月死亡（P = 0.4）），尽管相对变化小于28％无法检测到。 CHWS是52％（2010）和50.9％（2013）儿童的第一个护理来源。 CHWS或外周健康单位适当治疗发烧的适当治疗覆盖率从45.5％增加[95％CI：39.2-52.0]至58.2％[95％CI：50.5-65.5]（P = 0.01）;腹泻和肺炎的变化并不重要。继续依赖CHW作为第一个护理来源和适当治疗发烧的适当治疗的覆盖范围，支持ICCM在科诺区的作用。

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