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Pediatrics & Child Health

Integrated Community Case Management (iCCM) Overview

Strategy enabling trained Community Health Workers (CHWs/VHTs) to assess, classify, and treat uncomplicated cases of malaria, pneumonia, and diarrhoea in children under 5 at community level, plus recognize and refer severe cases.

Also known as: iCCM, VHT Child Treatment

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Referral and warning signs

When to refer

VHTs refer children with: Any General Danger Sign, Chest indrawing (pneumonia), Signs of dehydration, Blood in stool (dysentery), Negative RDT but fever persists, Severe malnutrition, Any condition beyond their scope.

Red flags

  • All General Danger Signs.
  • Chest indrawing.
  • Signs of dehydration.
  • Blood in stool.

Signs and symptoms

  • Focus on recognizing key symptoms for classification:
  • - Pneumonia: Cough/Difficult breathing + Fast breathing (age-specific) +/- Chest indrawing (referral).
  • - Diarrhoea: Loose stools +/- Dehydration signs +/- Blood (referral).
  • - Malaria: Fever +/- Danger signs.
  • - General Danger Signs (prompting referral): Convulsions, Lethargy/Unconscious, Unable to drink/feed, Vomits everything.

Risk factors

  • Limited access to facility-based care.
  • High burden of malaria, pneumonia, diarrhoea.

Diagnosis

Clinical assessment

Assessment using simplified algorithms based on IMCI principles, focusing on key signs and symptoms.

Investigations

  • Respiratory Rate counting (using timer).
  • Malaria RDT.
  • Temperature check (or tactile assessment).
  • Assessment for danger signs.

Diagnostic criteria

Classification based on simplified algorithms leading to treatment or referral decision.

Management

Non-pharmacological management

  • Counseling on home care (fluids, feeding, danger signs).
  • Referral coordination.
  • Community health promotion (hygiene, nets, immunization).

Pharmacological treatment

  • Treatments Provided by VHTs:
  • - Pneumonia (Fast breathing only): Amoxicillin Dispersible Tablets (DT) 250mg (Dose packs: RED 2-11m = 1 tab BID; GREEN 1-5y = 2 tabs BID) for 5 days.
  • - Diarrhoea (No dehydration/blood): ORS + Zinc (10mg <6m, 20mg >6m) for 10 days.
  • - Malaria (Fever + Positive RDT, no danger signs): Artemether-Lumefantrine (AL) ACT (Dose packs: YELLOW 4m-2y = 1 tab BID; BLUE 2-5y = 2 tabs BID) for 3 days.
  • - Pre-referral for Severe Malaria/Fever with Danger Signs: Rectal Artesunate (Dose by age band: 4-11m=1; 1-3y=2; 3-5y=3 capsules).
  • (Note: VHTs may manage other conditions based on specific program training e.g., deworming, Vitamin A).

Monitoring

Follow-up mechanisms vary by program (e.g., home visits, linkage to facility). Track referrals.

Complications

  • Delayed referral of severe cases.
  • Incorrect classification or treatment.
  • Stock-outs of essential medicines.

Prevention

  • Strengthening health system linkage (supervision, supply chain).
  • Continuous VHT training and support.
  • Community engagement.

Patient education

  • (VHT counseling to caregiver):
  • Diagnosis and treatment given.
  • How to administer medicines correctly.
  • Importance of completing treatment.
  • Need for fluids and continued feeding.
  • Danger signs requiring immediate referral to health facility.
  • Prevention messages.

Uganda-specific notes

iCCM implemented nationally through Village Health Teams (VHTs). Aims to improve access to care for the 3 main childhood killers. Relies heavily on VHT training, supervision, commodity supply, and linkage with health facilities.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 17, Section 17.4

  • National iCCM Guidelines and Job Aids, MOH Uganda

    (Specific VHT protocols)

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