iCCM and malaria
Across Eastern and Southern Africa (ESA), pneumonia, diarrhoea and malaria are the biggest killers of children. In 2010, an estimated 205,000 children died from pneumonia, 130,000 from diarrhoea and 94,000 from malaria. Most of these deaths are preventable, and the treatments are simple and cost-effective. Yet, they remain out of reach for many children, particularly those in the most disadvantaged and marginalized communities.
Since 2005, governments in the region, with support from UNICEF and other partners, have rolled out an ambitious strategy, integrated Community Case Management, or iCCM, to save children from dying unnecessarily from these killer diseases.
The core of iCCM is the Community Health Workers (CHWs), who are trained to prevent and treat these common childhood diseases, and also provide referral services to the families they serve. They are equipped with rapid diagnostic tools, and low-cost, but life-saving medicines, such as artemisinin combination therapy (ACT) drugs for malaria; amoxicillin for pneumonia; and oral rehydration salts and zinc tablets for diarrhoea.
By reaching the most excluded and marginalized children, CHWs play a critical role in narrowing the gap of inequity in a country’s health systems. Over the past two years, some countries have also started training CHWs to provide care for babies less than 28 days of age, detecting early signs of malnutrition, and provide ready-to-use therapeutic food for severely malnourished children.
Malaria not only kills, it also leads to high levels of anaemia in children and pregnant women, increasing the number of babies born with low birth weight – one of the key underlying causes of infant mortality and developmental delays in children. It is a disease of poverty, affecting mainly the poor living in malaria-prone rural areas that offer few, if any, barriers against mosquitoes.
In addition to treatment of malaria through iCCM, malaria can be prevented through the use of Insecticide Treated Nets (ITNs), which can effectively reduce child mortality by 20 per cent, and indoor spray with insecticides.
These investments - malaria control, and treatment of malaria through iCCM - have successfully cut malaria cases by more than half in ESAR, contributing greatly towards reaching the Millennium Development Goal (MDG) 4 of reducing under-five mortality by two thirds by 2015. It is crucial to continue expanding and consolidating these successes to further reduce child mortality, especially among the most disadvantaged children.
UNICEF in action
In countries throughout ESA, UNICEF is at the forefront of expanding iCCM to halt pneumonia, diarrhoea and malaria at community level. To improve diagnosis and treatment of these diseases, UNICEF plays a vital role in the procurement, distribution and management of rapid diagnostic tools and essential medicines, as well as ITNs. Support is also provided to help countries train and manage tens of thousands of Community Health Workers, whose life-saving work enables millions of children, who are otherwise have no access to treatment, can have a chance to survive pneumonia, diarrhoea and malaria.
Despite the availability of CHWs and the life-saving treatments they provide, thousands of children in need are not benefitting from such services. Lack of demand is a major reason. To this end, UNICEF works actively in health education and social and behaviour change, to help increase the uptake to these services at community level.
As a founding member of the Roll Back Malaria (RBM) initiative, UNICEF often supports countries’ fundraising efforts to sustain and expand iCCM and malaria control. For example, UNICEF Ethiopia has just secured USD$ 100 million from the Presidential Malaria Initiative (PMI) for the next five years.
Results for children
In countries with limited access to health care facilities, iCCM has helped expand treatment for pneumonia, diarrhea and malaria to millions of children, especially in hard-to-reach areas.
Nine of ESAR’s 21 countries have reduced malaria mortality by 50 per cent since 2000. A number of malaria-prone countries have shown greatest declines in malaria cases, including Botswana, Eritrea, Ethiopia, Namibia, South Africa, and Swaziland. Rwanda and Zambia, two countries with highly endemic malaria areas have also shown declines of more than 50 per cent.
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