{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T06:50:19Z","timestamp":1778568619057,"version":"3.51.4"},"reference-count":37,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","license":[{"start":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T00:00:00Z","timestamp":1670976000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,14]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Ethiopia has adopted the Integrated Community Case Management of Newborn and Child Illness (iCMNCI) strategy to expand access to neonatal and child health services. This study assessed compliance with the iCMNCI case management protocol at the primary care settings. A descriptive cross-sectional assessment was conducted in eight districts of Benishangul-Gumuz Region from April to December 2019, and 1,217 sick children aged 2 to 59 months and 43 sick young infants aged 0 to 2 months who sought clinical consultation at the 236 health posts were selected purposively. Trained supervisors reviewed the medical records of two most recent cases from each illness category to quantify the extent to which health workers correctly assessed, classified, treated, and followed up cases per the iCMNCI guidelines. A total of 32,981 children sought clinical consultation of whom 31,830 (96.5%) were aged 2 to 59 months, and 1,151 (3.5%) were young infants aged 0 to 2 months. Of the 1,217 selected children, 426 (35%) had pneumonia, 287 (23.6%) malaria, 501 (41.2%) diarrhea, and 3 (0.2%) had malnutrition. Nearly two-thirds 306 (72%) of pneumonia cases were correctly classified as having had the disease and 297 (70%) were correctly treated for pneumonia; 213 (74%) were correctly classified as having had malaria and 210 (73%) were correctly treated for malaria; and 393 (78%) were correctly classified as having had diarrhea and 297 (59%) were correctly treated for diarrhea. Generally, the current practices of child illness assessment, classification, and treatment have deviated from iCMNCI guidelines. Future interventions should support frontline health workers to comply strictly with case management protocols through training, mentorship, and supervision.<\/jats:p>","DOI":"10.4269\/ajtmh.21-1018","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T16:13:53Z","timestamp":1667232833000},"page":"1337-1344","source":"Crossref","is-referenced-by-count":6,"title":["Poor Adherence to the Integrated Community Case Management of Newborn and Child Illness Protocol in Rural Ethiopia"],"prefix":"10.4269","volume":"107","author":[{"given":"Solomon","family":"Abtew","sequence":"first","affiliation":[{"name":"Project HOPE, Assosa, Ethiopia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariamawit","family":"Negatou","sequence":"additional","affiliation":[{"name":"Project HOPE, Addis Ababa, Ethiopia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamiru","family":"Wondie","sequence":"additional","affiliation":[{"name":"Project HOPE, Addis Ababa, Ethiopia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yenealem","family":"Tadesse","sequence":"additional","affiliation":[{"name":"Project HOPE, Addis Ababa, Ethiopia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wondwossen A.","family":"Alemayehu","sequence":"additional","affiliation":[{"name":"Project HOPE, Addis Ababa, Ethiopia;"},{"name":"Project HOPE, Washington, District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawit A.","family":"Tsegaye","sequence":"additional","affiliation":[{"name":"Project HOPE, Addis Ababa, Ethiopia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitswat","family":"Mulaw","sequence":"additional","affiliation":[{"name":"Project HOPE, Addis Ababa, Ethiopia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dagne","family":"Muluneh","sequence":"additional","affiliation":[{"name":"Project HOPE, Assosa, Ethiopia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Collison","sequence":"additional","affiliation":[{"name":"Project HOPE, Washington, District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eden Ahmed","family":"Mdluli","sequence":"additional","affiliation":[{"name":"Project HOPE, Washington, District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Legese A.","family":"Mekuria","sequence":"additional","affiliation":[{"name":"Project HOPE, Addis Ababa, Ethiopia;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","year":"2020"},{"key":"b2","year":"2015"},{"key":"b3","series-title":"Ethiopia Mini Demographic and Health Survey 2019: Key Indicators","year":"2019"},{"key":"b4","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"3027","DOI":"10.1016\/S0140-6736(16)31593-8","article-title":"Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the sustainable development goals","volume":"388","year":"2016"},{"key":"b5","series-title":"BMC Public Health","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/s12889-016-3979-8","article-title":"Cause of neonatal deaths in northern Ethiopia: a prospective cohort study","volume":"17","year":"2017"},{"key":"b6","series-title":"Ethiopia Demographic and Health Survey 2016","year":"2017"},{"key":"b7","year":"2015"},{"key":"b8","series-title":"UN\u2013Inter-agency Group for Child Mortality Estimation. Levels and Trends of Child Mortality. The 2012 Report","year":"2012"},{"key":"b9","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1016\/0140-6736(92)91720-S","article-title":"Meta-analysis of intervention trials on case\u2013management of pneumonia in community settings","volume":"340","author":"Sazawal","year":"1992"},{"key":"b10","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1016\/S0140-6736(13)60648-0","article-title":"Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost?","volume":"381","year":"2013"},{"key":"b11","series-title":"Int J Epidemiol","first-page":"i75","article-title":"The effect of oral rehydration solution and recommended home fluids on diarrhea mortality","volume":"39 (Suppl 1)","year":"2010"},{"key":"b12","series-title":"Int J Epidemiol","first-page":"i63","article-title":"Zinc for the treatment of diarrhoea: effect on diarrhoea morbidity, mortality and incidence of future episodes","volume":"39 (Suppl 1)","year":"2010"},{"key":"b13","series-title":"Trans R Soc Trop Med Hyg","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1016\/j.trstmh.2008.03.024","article-title":"Artemisinin-based combination therapy for uncomplicated malaria in sub-Saharan Africa: the efficacy, safety, resistance and policy implementation since Abuja 2000","volume":"102","year":"2008"},{"key":"b14","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1016\/S0140-6736(04)17145-6","article-title":"Making health systems more equitable","volume":"364","year":"2004"},{"key":"b15","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1016\/S0140-6736(03)12515-9","article-title":"Inequities among the very poor: health care for children in rural southern Tanzania","volume":"361","year":"2003"},{"key":"b16","series-title":"Bull World Health Organ","first-page":"205","article-title":"High mortality despite good care-seeking behaviour: a community study of childhood deaths in Guinea-Bissau","volume":"75","year":"1997"},{"key":"b17","year":"2020"},{"key":"b18","series-title":"J Glob Health","doi-asserted-by":"publisher","first-page":"010803","DOI":"10.7189\/jogh.09.010803","article-title":"Effect of community-based intervention on improving access to treatment for sick under-five children in hard-to-reach communities in Niger State, Nigeria","volume":"9","author":"Oresanya","year":"2019"},{"key":"b19","series-title":"Ethiop Med J","first-page":"15","article-title":"National scale\u2013up of integrated community case management in rural Ethiopia: implementation and early lessons learned","volume":"52 (Suppl 3)","year":"2014"},{"key":"b20","series-title":"National Strategy for Child Survival in Ethiopia (2015\/16\u20132019\/20)","year":"2015"},{"key":"b21","series-title":"Health Policy Plan","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1093\/heapol\/czv115","article-title":"Access to integrated community case management of childhood illnesses services in rural Ethiopia: a qualitative study of the perspectives and experiences of caregivers","volume":"31","year":"2016"},{"key":"b22","series-title":"Health Policy Plan","first-page":"i5","article-title":"Programmatic pathways to child survival: results of a multi-country evaluation of IMNCI","volume":"20 (Suppl 1)","year":"2005"},{"key":"b23","series-title":"Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals: A Systematic Review, Country Case Studies, and Recommendations for Integration into National Health Systems","year":"2010"},{"key":"b24","series-title":"Trop Doct","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1177\/004947559502500207","article-title":"Case management quality assessment in rural areas of Papua New Guinea","volume":"25","year":"1995"},{"key":"b25","series-title":"Ethiop Med J","first-page":"73","article-title":"Effect of performance review and clinical mentoring meetings (PRCMM) on recording of community case management by health extension workers in Ethiopia","volume":"52 (Suppl 3)","year":"2014"},{"key":"b26","series-title":"J Glob Health","doi-asserted-by":"publisher","first-page":"020404","DOI":"10.7189\/jogh.06.020404","article-title":"Assessment of the impact of quality improvement interventions on the quality of sick child care provided by Health Extension Workers in Ethiopia","volume":"6","year":"2016"},{"key":"b27","series-title":"Acta Paediatr","doi-asserted-by":"publisher","first-page":"2100","DOI":"10.1111\/apa.14888","article-title":"Health extension workers\u2019 diagnostic accuracy for common childhood illnesses in four regions of Ethiopia: a cross-sectional study","volume":"108","year":"2019"},{"key":"b28","series-title":"Cochrane Database Syst Rev","first-page":"CD012882","article-title":"Integrated community case management of childhood illness in low- and middle-income countries","volume":"2","year":"2021"},{"key":"b29","year":"2020"},{"key":"b30","year":"2016"},{"key":"b31","series-title":"Operationalizing Management of Sick Young Infants with Possible Serious Bacterial Infection (PSBI) When Referral Is Not Feasible in the Context of Existing Maternal, Newborn, and Child Health Programmes\n License: CC BY-NC-SA 3.0 IGO","year":"2017"},{"key":"b32","year":"2018"},{"key":"b33","series-title":"PLoS One","doi-asserted-by":"publisher","first-page":"e0225846","DOI":"10.1371\/journal.pone.0225846","article-title":"Correction: analyzing data from the digital healthcare exchange platform for surveillance of antibiotic prescriptions in primary care in urban Kenya: A mixed-methods study","volume":"14","author":"Mekuria","year":"2019"},{"key":"b34","series-title":"Ethiop Med J","first-page":"91","article-title":"Quality and use of IMNCI services at health center under-five clinics after introduction of integrated community-based case management (ICCM) in three regions of Ethiopia","volume":"52 (Suppl 3)","year":"2014"},{"key":"b35","series-title":"Ethiop Med J","first-page":"65","article-title":"Effectiveness of supportive supervision on the consistency of integrated community cases management skills of the health extension workers in 113 districts of Ethiopia","volume":"52 (Suppl 3)","year":"2014"},{"key":"b36","series-title":"Ethiop Med J","first-page":"99","article-title":"Effect of integrated community case management of common childhood illnesses on the quality of malaria case management provided by health extension workers at health posts","volume":"52 (Suppl 3)","year":"2014"},{"key":"b37","series-title":"Ethiop Med J","first-page":"83","article-title":"Integrated community case management: quality of care and adherence to medication in Beneshangul-Gumuz Region, Ethiopia","volume":"52 (Suppl 3)","year":"2014"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/107\/6\/article-p1337.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/107\/6\/article-p1337.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/107\/6\/article-p1337.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T19:06:44Z","timestamp":1675710404000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/107\/6\/article-p1337.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,14]]},"references-count":37,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.21-1018","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,14]]}}}