iCCM/ integrated Community Case Management, and malaria

iCCM and malaria

© UNICEF/NYHQ2006-2248/Pirozzi

A five-month-old baby with malaria and a severe respiratory infection lies in a hospital in Mozambique.

Across Eastern and Southern Africa, pneumonia, diarrhoea and malaria are the biggest killers of children. In 2012, an estimated 197,000 children died from pneumonia, 115,000 from diarrhoea and 84,000 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 newborn babies and children, including detecting early signs of malnutrition, and providing ready-to-use therapeutic food for severely malnourished children. 

Malaria control

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. Since 2005, more than 80 million ITNs have been provided to rural families in across the region, and millions of houses have been sprayed with insecticides. These investments have successfully cut malaria cases by more than half in ESA, contributing greatly towards reaching the Millennium Development Goal (MDG) 4 of reducing under-five mortality by two thirds by 2015.

UNICEF in action

© UNICEF/NYHQ2007-1789/Nesbitt

A nurse distributes insecticide-treated mosquito nets to prevent malaria at a health centre in Angola.

In countries throughout ESA, UNICEF is at the forefront of expanding iCCM to halt pneumonia, diarrhoea and malaria at the 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 to ensure children - especially those who 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 increase the uptake of 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. This includes assisting countries to develop proposals for donors such as the Global Fund, the World Bank, the Presidential Malaria Initiative, and many bilateral donors.

Results for children

In countries with limited access to health care facilities, iCCM has helped expand treatment for pneumonia, diarrhoea and malaria to millions of children, especially in hard-to-reach areas.

• A number of malaria-prone countries have shown 50 per cent decline in malaria cases, including Botswana, Eritrea, Ethiopia, Madagascar, Namibia, Rwanda, South Africa, Swaziland, Tanzania and Zambia. Among them, Rwanda, Tanzania and Zambia are three countries with highly endemic malaria areas.