Despite the progress made in reducing under-five mortality, three quarters of under-five deaths are still due to a handful of causes – specifically, pneumonia, diarrhea, malaria and newborn conditions. Malnutrition is associated with about one third of the deaths. The correct treatment of childhood pneumonia, diarrhea and malaria is one of the most powerful interventions to reduce mortality. However, in most high-mortality countries, facility-based services alone do not provide adequate access to treatment, and most importantly, not within the crucial window of 24 hours after onset of symptoms. If child mortality is to be adequately addressed, the challenge of access must be taken on.
Community health workers (CHWs) – appropriately trained, supervised and supported with an uninterrupted supply of medicines and equipment – can identify and correctly treat most children who have the conditions mentioned above. A recent review by the Child Health Epidemiology Reference Group (CHERG) estimated that community management of all cases of childhood pneumonia could result in a 70 per cent reduction in mortality from pneumonia in children less than 5 years old. Community case management (CCM) of malaria can reduce overall and malaria-specific under-five mortality by 40 and 60 per cent, respectively, and severe malaria morbidity by 53 per cent. Oral rehydration salts (ORS) and zinc are effective against diarrhea mortality in home and community settings, with ORS estimated to prevent 70 to 90 per cent of deaths due to acute watery diarrhea, and zinc estimated to decrease diarrhea mortality by 11.5 per cent.
For these reasons, the United Nation’s Children’s Fund (UNICEF), the World Health Organization (WHO) and partners working in an increasing number of countries are supporting the iCCM strategy to train, supply and supervise front-line workers to treat children for both diarrhea and pneumonia, as well as for malaria in malaria-affected countries, using ORS and zinc, oral antibiotics, and artemisinin-based combination therapy (ACT). In addition, the availability of high-quality rapid diagnostic tests for malaria (RDTs) has made it possible to test for malaria at the community level. RDT use will make the need for high-quality integrated treatment, including iCCM, even more pressing, to ensure adequate health worker response to febrile children with or without malaria. Finally, iCCM also enables community health workers to identify children with severe acute malnutrition through the assessment of mid-upper-arm circumference (MUAC).