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