Evaluation of the Integrated Management of Childhood Illness Strategy in the Menoua Department - Cameroon Public

Abstract

Background: Between 1991 and 2011, the under-five mortality rate in Cameroon has made very
little progress, slightly dropping from 126 to 122 deaths per 1,000 live births. As developing
countries around the world renew their efforts to reach Millennium Development Goal 4 -
Reduce under-five mortality by two thirds from 2000 to 2015 - Cameroon recently adopted the
Integrated Management of Childhood Illness as a strategy to accelerate the reduction of under-
five mortality.
Objective: This paper examines the effect of the Integrated Management of Childhood Illness
(IMCI) program implemented by local organization Tockem, in the Menoua Department, to reduce
under-five mortality in the department and provide a model to be replicated in other provinces of
the country in an effort to achieve Millennium Development Goal 4.
Methods: Data on the knowledge and practices of mothers of children under the age of two were
gathered in three IMCI intervention groups to determine the impact of the IMCI strategy on the
health of children, and health behaviors of caretakers. A Knowledge, Practice and Coverage
survey was performed using a 30x10 complex sampling method in each IMCI group to measure
coverage of thirteen key health practices.
Results: There is no evidence that the IMCI strategy procured an advantage to the population
served compared to the population living in non IMCI areas. In fact, coverage of child illness
home-based management was found to be significantly lower in the IMCI area than in the two
other areas. Overall, coverage of births assisted by a qualified attendant and of mothers who
received at least two tetanus toxoid shots during their last pregnancy reached program goals.
Discussion: The full potential of the IMCI strategy implemented in the Menoua Department is
not being met. Areas of weakness identified as priority areas are for the most part dependent on
the work and performance of Community Health Workers acting as health messages relays for the
community. Improved health behaviors and practices will necessitate continued supervision and
evaluation of community health workers' performance by Tockem, along with supervision of
health facility personnel by local health districts through a more efficient health system.

Table of Contents

TABLE OF CONTENTS
Abstract .........................................................................................................................................................................
List of Tables ...................................................................................................................................................................
List of Figures ..................................................................................................................................................................
List of Acronyms ..............................................................................................................................................................
Acknowledgements ...........................................................................................................................................................
Introduction ................................................................................................................................................................. 1
The Integrated Development Model in the Menoua Department - Cameroon .............................................................................. 4
The Integrated Development Project ................................................................................................................................. 6
Tockem .......................................................................................................................................................................10
The Menoua Department ................................................................................................................................................ 21
Literature Review .......................................................................................................................................................... 27
Child Health in Cameroon................................................................................................................................................. 28
Health Policy ................................................................................................................................................................ 31
The Integrated Management of Childhood Illness Strategy (IMCI) ........................................................................................... 34
Introduction of Community-IMCI in the East Province of Cameroon ......................................................................................... 48
Integrated Management of Childhood Illness in the Menoua Department.................................................................................... 53
Introduction of the IMCI strategy in The Menoua Department ................................................................................................ 53
Methods ...................................................................................................................................................................... 66
Results ........................................................................................................................................................................ 77
Discussion .................................................................................................................................................................... 87
Comparison with Demographic Health Survey 2011 Preliminary Results ...................................................................................... 89
Comparison with past LQAS surveys .................................................................................................................................. 92
Limitations .................................................................................................................................................................... 96
Conclusion .................................................................................................................................................................... 99
Recommendations ......................................................................................................................................................... 100
References .................................................................................................................................................................. 103
APPENDICES ................................................................................................................................................................ 108
APPENDIX A ................................................................................................................................................................. 108
Map of Cameroon .......................................................................................................................................................... 108
Map of The Western Province of Cameroon ........................................................................................................................ 109
Map of Cameroon, the Western Province and the Menoua Department .................................................................................... 110
APPENDIX B ................................................................................................................................................................. 111
KPC Questionnaire (English and French versions) ................................................................................................................. 111

APPENDIX C ................................................................................................................................................................. 129

Distribution of participants by village visited ....................................................................................................................... 129

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	under-five mortality Infectious diseases IMCI Health behaviors community-based Health practices Tockem Menoua integrated case management Cameroon
Committee Chair / Thesis Advisor	Foster, Stanley, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Community-based non-profit organization (e.g., AID Atlanta)

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