Integrated community case management of malaria
Integrated Community Case Management (iCCM) is an equity-focused strategy that complements and extends the reach of public health services by providing timely and effective treatment of malaria, pneumonia and diarrhoea to populations with limited access to facility-based health care providers, and especially to children under 5. In June 2012, WHO and UNICEF issued a joint statement to support iCCM to improve access to essential treatment services for children.
The availability of high-quality rapid diagnostic tests (RDTs) for malaria has made testing for malaria at the community level possible. The iCCM approach incorporates WHO’s recommendation that all suspected malaria cases undergo diagnostic testing prior to treatment.
The use of RDTs requires high-quality integrated treatment to ensure adequate disease management when febrile children are found not to have malaria. The significant overlap in the clinical manifestations of pneumonia and malaria further justifies an integrated diagnostic and therapeutic approach.
As part of iCCM, front-line workers at the community level are trained, supplied and supervised to diagnose and treat children for malaria, pneumonia and diarrhoea, using artemisinin-based combination therapies, oral antibiotics, oral rehydration salts and zinc. All patients are screened for the 3 diseases and treatment is administered based on the results of the examination and diagnostic testing that includes malaria RDTs, disease history and respiratory rate. The inclusion of pre-referral treatment with rectal artesunate and RDTs is recommended, where feasible.
An effective strategy
The first experiences with iCCM are encouraging. In Ghana, 92% of carers of sick children sought treatment from community-based agents trained to manage pneumonia and malaria; 77% sought care within 24 hours of onset. In Zambia, a study of iCCM for pneumonia and malaria found that 68% of children with pneumonia received early and appropriate treatment from community health workers, and overtreatment of malaria significantly declined.
Programmatic experience suggests that the iCCM strategy can be effective in achieving high treatment coverage and delivering high-quality care for sick children in the community.
Inter-agency iCCM taskforce
In 2009, an inter-agency iCCM taskforce was formed to develop and promote this approach. The iCCM taskforce is an association of multilateral and bilateral agencies and NGOs, with a steering committee of representatives from USAID, MCHIP, UNICEF, WHO and Save the Children.
Rapid Access Expansion Programme (RAcE)
In 2012, the Government of Canada awarded a grant to the WHO Global Malaria Programme to support the scale-up of integrated community case management of pneumonia, diarrhoea and malaria among children under 5 in sub-Saharan Africa. The programme is in place in 5 malaria-endemic countries with the support of selected partners: the Democratic Republic of the Congo, Malawi, Mozambique, Niger and Nigeria.