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WHO/UNICEF JOINT STATEMENT - Integrated Community Case Management

WHO/UNICEF JOINT STATEMENT - Integrated Community Case Management

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An equity-focused strategy to improve access to essential treatment services for children

This statement presents the latest evidence for integrated community case management (iCCM) of childhood illness, describes the necessary programme elements and support tools for effective implementation, and lays out actions that countries and partners can take to support the implementation of iCCM at scale.
An equity-focused strategy to improve access to essential treatment services for children

This statement presents the latest evidence for integrated community case management (iCCM) of childhood illness, describes the necessary programme elements and support tools for effective implementation, and lays out actions that countries and partners can take to support the implementation of iCCM at scale.

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Published by: The United Nations Children's Fund on Jun 14, 2012
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01/31/2013

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WHO/UNICEF JOINT STATEMENT
Integrated Community Case Management(iCCM)
An equity-focused strategy to improve accessto essential treatment services for children
 
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Bringing treatment closer to home
Despite the progress made in reducing under-ve mortality, three quarters o under-ve deathsare still due to a handul o causes – specically,pneumonia, diarrhoea, malaria and newbornconditions. Malnutrition is associated with aboutone third o the deaths.The correct treatment o childhood pneumonia,diarrhoea and malaria is one o the most powerulinterventions to reduce mortality.
1
However, inmost high-mortality countries, acility-basedservices alone do not provide adequate access totreatment,
2,3
and most importantly, not within thecrucial window o 24 hours ater onset o symp-toms. I child mortality is to be adequately add-ressed, the challenge o access must be taken on.Community health workers – appropriatelytrained, supervised and supported with anuninterrupted supply o medicines and equipment– can identiy and correctly treat most childrenwho have the conditions mentioned above.
4,5
In2004, the World Health Organization (WHO) andthe United Nations Children’s Fund (UNICEF)issued joint statements on the management opneumonia in community settings
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and the clinicalmanagement o acute diarrhoea,
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both o whichhighlighted the important role o community-based treatment. A recent review by the ChildHealth Epidemiology Reerence Group (CHERG)estimated that community management o allcases o childhood pneumonia could result in a 70per cent reduction in mortality rom pneumonia inchildren less than 5 years old.
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Community casemanagement (CCM) o malaria can reduce overalland malaria-specic under-ve mortality by 40and 60 per cent, respectively, and severe malariamorbidity by 53 per cent.
9,10
Oral rehydration salts(ORS) and zinc are eective against diarrhoeamortality in home and community settings, withORS estimated to prevent 70 to 90 per cent odeaths due to acute watery diarrhoea,
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and zincestimated to decrease diarrhoea mortality by 11.5per cent.
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For these reasons, UNICEF, WHO and partnersworking in an increasing number o countriesare supporting the iCCM strategy to train, supplyand supervise ront-line workers to treat childrenor both diarrhoea and pneumonia, as well asor malaria in malaria-aected countries, usingORS and zinc, oral antibiotics, and artemisinin-based combination therapy (ACT). In addition,the availability o high-quality rapid diagnostictests or malaria (RDTs) has made it possible totest or malaria at the community level. RDT usewill make the need or high-quality integratedtreatment, including iCCM, even more pressing, toensure adequate health worker response to ebrilechildren with or without malaria. Finally, iCCMalso enables community health workers to identiychildren with severe acute malnutrition throughthe assessment o mid-upper-arm circumerence(MUAC).
Current context
The number o children dying worldwide contin-ues to decrease, and while this is encouraging, thedecline has been slow, stagnating or even revers-ing in many countries, particularly in sub-SaharanArica. While new preventive interventions –especially pneumococcal conjugate and rotavirusvaccines – will also help reduce mortality, promptand eective treatment o pneumonia, diarrhoeaand malaria remains essential.The delivery o health services is oten weakestwhere the needs are greatest, and low coverage othe most needed interventions results in a signi-cant unmet need or treatment o these majorchild killers. In developing countries, currenttreatment levels are unacceptably low:
 •Only39percentofchildrenreceivecorrecttreat
-ment or diarrhoea.
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 •Only30percentofchildrenwithsuspectedpneu
-monia receive an antibiotic.
14
 
 •Lessthan20percentofchildrenwithfeverin
sub-Saharan Arica received a nger/heel stick ormalaria testing, in 11 out o 13 countries with avail-able data in the region.
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Poor and disadvantaged children without accessto acility-based case management are at evengreater risk, as shown in the ollowing gure.
This statement presents the latest evidence for integrated community casemanagement (iCCM) of childhood illness, describes the necessary programmeelements and support tools for effective implementation, and lays out actions thatcountries and partners can take to support the implementation of iCCM at scale.
 
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Justifcation or iCCM
Programmatic experience shows that an integrat-ed strategy can be eective in achieving hightreatment coverage and delivering high-qualitycare to sick children in the community. In Nepal,which has more than 20 years o experience incommunity-based management o child illness,69 per cent o the under-ve population has accessto treatment,
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and both the case atality rate oracute diarrhoea and the proportion o severepneumonia among acute respiratory inectioncases across the country have decreased signi-cantly.
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In Ghana, 92 per cent o caregivers o sickchildren sought treatment rom community-basedagents trained to manage pneumonia and malaria.Indeed, most sought care or their children within24 hours o onset o ever.
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In Zambia, a CCMstudy on pneumonia and malaria ound that 68per cent o children with pneumonia received
3
Notes:
Estimates are based on a subset o 59 countries or ORT+CF and 34 countries or the anti-biotics indicator, with wealth data or the period 2006–2011 covering 65 per cent and 50 per cent,respectively, o the total under-ve population in developing countries (excluding China, or whichcomparable data are not available).* Reers to ORS packets, recommended home-made fuids or increased fuids.** Excludes China.
Source:
UNICEF global databases, 2012.
Proportion o children aged 0–59 months withdiarrhoea receiving oral rehydration therapy*with continued eeding, 2006–2011Proportion o children aged 0–59 months withsuspected pneumonia receiving antibiotics,2006–2011
0%20%40%60%80%100%414648303634 Africa Asia** Developingcountries**
0%20%40%60%80%100%453325281119 Africa Asia** Developingcountries**
Poorest 20%Richest 20%
early and appropriate treatment rom communityhealth workers, and that overtreatment o malariasignicantly declined.
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In Ethiopia, workersdeployed in remote communities delivered twoand a hal times as many treatments or the threediseases than all the acility-based providers in thesame district.
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The proportion o children receiv-ing ACTs globally is also increasing, althoughsignicant gaps remain.
21
With adequate training and supervision,community health workers can retain the skillsand knowledge necessary to provide appropri-ate care. In Malawi, 68 per cent o classicationso common illnesses by Health SurveillanceAssistants were in agreement with assessmentsdone by physicians, and 63 per cent o childrenwere prescribed appropriate medication.
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