Integrated community case management of malaria
Community case management of malaria (CCMm) promotes the early recognition as well as prompt diagnostic testing and appropriate treatment of malaria among children under five years of age in the home or community. Through CCM, community-based service providers are given the training, supplies, and supervision necessary to manage febrile illness. Over the last several years, CCMm (previously known as Home Management of Malaria) has been evolving beyond malaria into a more comprehensive strategy that addresses, at a minimum, the three main childhood killers: malaria, pneumonia and diarrhoea.
This new approach is called integrated Community Case Management (iCCM). This is an equity-focused strategy that aims to complement and extend the reach of public health services by providing timely and effective treatment of these important diseases to populations with limited access to facility-based health care providers, and especially to children less than five years of age. 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 rapid diagnostic tests (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 and pneumonia and diarrhoea, using ACTs, oral antibiotics, oral rehydration salts and zinc. All patients are screened for the three 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.
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.
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. The main knowledge management platform for iCCM is at www.ccmcentral.com.
In 2012, the WHO Global Malaria Programme was awarded a grant by the Government of Canada to support the scale-up of iCCM using malaria as an entry point. The Rapid Access Expansion Programme – or RAcE 2015 – is now being rolled out in five malaria-endemic countries in sub-Saharan Africa: the Democratic Republic of the Congo, Malawi, Mozambique, Niger and Nigeria.
Last update: 6 March 2013