Association between introduction of Integrated Community Case Management and utilisation of selected facility-based health services among children one year of age in Amolataar district, Uganda
Abstract
BACKGROUND: Scale-up of Integrated Community Case Management of common
childhood illnesses (ICCM) is a growing focus to address health care access barriers.
Assessment of ICCM programming has paid little attention to its effects on the utilisation of
services that are restricted to health facilities. The objective of this study was to determine the
association between introduction of ICCM and utilisation of selected facility-based services
among children one year of age in Amolataar district to inform improvements in delivery of
facility-based services in the era of ICCM.
METHODS: This was a cross-sectional study design that utilised both quantitative and
qualitative methods. Data was entered and cleaned using Excel version 2101 and analysed with
SPSS 16.0. A two-year census of under-1s treated for complicated malaria at Amolataar Health
Centre IV was performed pre and during ICCM implementation, followed by a paired samples
t-test. A binomial logistic regression was leveraged from a random sample of 426 Under-1s to
ascertain a correlation between treatment location and timeliness of Under-1 vaccination.
Lastly, inductive content analysis was utilised to analyse data from 4 FGDs and 10 KIIs.
RESULTS:163 Under-1s were recruited in the year before and 91 in the year during ICCM
implementation. The introduction of ICCM was associated with a significant 50% decline in
the monthly attendance of Under-1s treated for complicated malaria at Amolataar Health
Centre IV in the preintervention year (x̄ =13.52, SD =1.83) and the intervention year (x̄ =7.54,
SD =2.02); (t (11) =10.39, p <.001). The median age of Under-1s recruited was 5.3 months
(IQR 4.1-7.6), 57% were female, 55% had received timely vaccinations and 47% had been
treated by a CHW within the last 3 months. Not being treated in the community within the last
3 months was associated with increased odds of getting vaccinated on time by 12% (OR = 1.12,
95% CI = 1.03, 1.18). Feasible options to improve and/ maintain the utilisation of facility-based
services during ICCM implementation include; use of outreaches to provide facility-based
services to Under-1s 5km away from the nearest health facility, introducing a reminder system,
providing follow up and performing sensitisation campaigns.
CONCLUSION AND RECOMMENDATIONS: These findings demonstrate that, on one
hand, ICCM effectively decongests health facilities, while on the other, affects negatively the
utilisation of facility-based services that rely on regular facility visits. Programmatic
adjustments are called for, to allow for optimum utilisation of both community and facility based child health services