The impact of integrated community case management on malaria related morbidity in children under 5 years in West Nile, Uganda

Abstract

Introduction: Integrated Community case management (iCCM) provides timely and effective treatment of malaria, pneumonia, and diarrhea to children under the age of five with limited access to healthcare facilities. iCCM has been implemented in Koboko, Maracha, and Nebbi districts in the West Nile region since 2015. Timely treatment of malaria cases under iCCM was anticipated to reduce malaria morbidity. However, there’s limited information on the impact of iCCM on malaria morbidity in the region. This study assessed the impact of iCCM on malaria-related morbidity in children under 5 years in the West Nile region, Uganda. Methods: This was a cross-sectional study with mixed methods of data collection. Malaria case management data from 2014 to 2019 was reviewed from DHIS2. Malaria morbidity trends were analyzed by interrupted time series models to determine the effectiveness of iCCM adjusting for temporal correlation and seasonality. A total of 15 KIIs were conducted with DHOs, iCCM focal persons, and 6 VHTs to further explore the impact of iCCM. 10 IDIs were conducted with iCCM beneficiaries. Qualitative data was analyzed manually using thematic analysis. Results: Following the introduction of iCCM, there was a 38% reduction in confirmed malaria cases from 11,747 to 7,256 (p-value<0.001) and 42% reduction in monthly malaria incidence from 122 to 70 (p-value<0.001). There was an associated 53.9% decline in malaria incidence (95%CI: 52%-54%) from IRR of 1.007 to 0.468 (P –value<0.005). In the KIIs and IDs, the consensus was that iCCM increased access to treatment services, and is strengthened by the availability of commodities, training and capacity building of the VHTs, community involvement, and support. Conclusion: Implementation of iCCM was associated with a reduction in malaria incidence in children under five years. iCCM should be scaled up to achieve the global targets (GTS 2016-2030) and country goals (MSP 2020-2025) of malaria reduction and elimination. Community involvement, motivation of the VHTs, and the availability of commodities are crucial in ensuring the success of the program.