Bringing treatment closer to home
Despite the progress made in reducing under-ve mortality, three quarters o under-ve deathsare still due to a handul o causes – specically,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 powerulinterventions to reduce mortality.
However, inmost high-mortality countries, acility-basedservices alone do not provide adequate access totreatment,
and most importantly, not within thecrucial window o 24 hours ater 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 identiy and correctly treat most childrenwho have the conditions mentioned above.
In2004, the World Health Organization (WHO) andthe United Nations Children’s Fund (UNICEF)issued joint statements on the management opneumonia in community settings
and the clinicalmanagement o acute diarrhoea,
both o whichhighlighted the important role o community-based treatment. A recent review by the ChildHealth Epidemiology Reerence 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.
Community casemanagement (CCM) o malaria can reduce overalland malaria-specic under-ve mortality by 40and 60 per cent, respectively, and severe malariamorbidity by 53 per cent.
Oral rehydration salts(ORS) and zinc are eective against diarrhoeamortality in home and community settings, withORS estimated to prevent 70 to 90 per cent odeaths due to acute watery diarrhoea,
and zincestimated to decrease diarrhoea mortality by 11.5per cent.
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 childrenor both diarrhoea and pneumonia, as well asor malaria in malaria-aected 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 identiychildren with severe acute malnutrition throughthe assessment o mid-upper-arm circumerence(MUAC).
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-SaharanArica. While new preventive interventions –especially pneumococcal conjugate and rotavirusvaccines – will also help reduce mortality, promptand eective treatment o pneumonia, diarrhoeaand malaria remains essential.The delivery o health services is oten weakestwhere the needs are greatest, and low coverage othe most needed interventions results in a signi-cant unmet need or treatment o these majorchild killers. In developing countries, currenttreatment levels are unacceptably low:
-ment or diarrhoea.
-monia receive an antibiotic.
sub-Saharan Arica received a nger/heel stick ormalaria testing, in 11 out o 13 countries with avail-able data in the region.
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.