Measuring coverage in MNCH: evaluation of community-based treatment of childhood illnesses through household surveys

PLoS Med. 2013;10(5):e1001384. doi: 10.1371/journal.pmed.1001384. Epub 2013 May 7.


Community case management (CCM) is a strategy for training and supporting workers at the community level to provide treatment for the three major childhood diseases--diarrhea, fever (indicative of malaria), and pneumonia--as a complement to facility-based care. Many low- and middle-income countries are now implementing CCM and need to evaluate whether adoption of the strategy is associated with increases in treatment coverage. In this review, we assess the extent to which large-scale, national household surveys can serve as sources of baseline data for evaluating trends in community-based treatment coverage for childhood illnesses. Our examination of the questionnaires used in Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2005 and 2010 in five sub-Saharan African countries shows that questions on care seeking that included a locally adapted option for a community-based provider were present in all the DHS surveys and in some MICS surveys. Most of the surveys also assessed whether appropriate treatments were available, but only one survey collected information on the place of treatment for all three illnesses. This absence of baseline data on treatment source in household surveys will limit efforts to evaluate the effects of the introduction of CCM strategies in the study countries. We recommend alternative analysis plans for assessing CCM programs using household survey data that depend on baseline data availability and on the timing of CCM policy implementation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Africa South of the Sahara / epidemiology
  • Case Management* / trends
  • Child
  • Child Health Services* / trends
  • Child, Preschool
  • Developing Countries*
  • Diarrhea / diagnosis
  • Diarrhea / epidemiology
  • Diarrhea / therapy*
  • Family Characteristics
  • Fever / diagnosis
  • Fever / epidemiology
  • Fever / therapy*
  • Global Health
  • Guideline Adherence
  • Health Care Surveys* / trends
  • Health Services Accessibility
  • Health Services Needs and Demand
  • Health Services Research / methods*
  • Health Services Research / trends
  • Humans
  • Infant
  • Infant, Newborn
  • Patient Acceptance of Health Care
  • Pneumonia / diagnosis
  • Pneumonia / epidemiology
  • Pneumonia / therapy*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Program Evaluation
  • Quality Indicators, Health Care
  • Research Design
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome

Grant support

This work was conducted under the auspices of the Child Health Epidemiology Reference Group (CHERG) for WHO and UNICEF, with financial support from The Bill & Melinda Gates Foundation through their grant to the US Fund for UNICEF. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.