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Utilization of integrated community case management services in three regions in Ethiopia after two years of implementation.

BACKGROUND
The integrated community case management (iCCM) strategy has brought fully integrated treatment for sick children to the community in Ethiopia since 2010.


OBJECTIVES
To describe patterns of use of iCCM services in 31 woredas (districts) in three regions of Ethiopia.


METHODS
We analyzed all 60,452 encounters (58,341 [98.2%] for children 2-59 months of age and 2079 [1.8%] for children < 2 months of age) recorded in iCCM registration books from December 24, 2012 to January 15, 2013 in 622 randomly sampled health posts.


RESULTS
Children 2-23 months constituted more than half (58.9%) of the total children treated, and about half of the registered infants < 2 months (1000/2079 [48.1%]) were not sick since some Health Extension Workers (HEWs) were recording well-infant visits. On average, sick children had 1.3 symptoms, more among children 2-59 months than among young infants (1.4 vs. 1.04, respectively). The main classifications for children 2-59 months were diarrhea with some or no dehydration (29.8%), pneumonia (20.7%), severe uncomplicated malnutrition (18.5%), malaria (11.2%), and other severe diseases (4.0%). More than half the sick children < 2 months (52.7%) had very severe disease. Treatment rates (per 1000 children per year) were low for all classifications: 11.9 for malaria (in malarious kebeles only), 20.3 for malnutrition, 21.2 for pneumonia, and 29.2 for diarrhea with wide regional variations, except for pneumonia. Nearly two-thirds of health posts (64%) treated ≤ 5 cases/month, but one treated 40. Health Extension Workers saw 60% more sick children 2-59 months in the third quarter of 2012 than in the third quarter of 2011.


CONCLUSION
The use of iCCM services is low and increasing slowly, and the few busy health posts deserve further study. Recording healthy young infants in sick registers complicates tracking this vulnerable group.