title: Utilization of ICDS scheme in children one to six years of age in a rural block of central India. Increasing contraceptive use in rural Pakistan: an evaluation of the Lady Health Worker Programme. Effectiveness and cost of facility-based Integrated Management of Childhood Illness (IMCI) in Tanzania The impact of control measures on urinary schistosomiasis in primary school children in northern Cameroon: a unique opportunity for controlled observations. Improving quality and efficiency of facility-based child health care through Integrated Management of Childhood Illness in Tanzania. Integrated Management of Childhood Illness (IMCI) in Bangladesh: early findings from a cluster-randomised study
abstract: The evaluation of nutritional and immunization services  was undertaken in the rural ICDS block Sanwer ( Madhya Pradesh ) where the project is functioning from last 3 years . A door to door survey was conducted in 1993 in six Anganwadi areas in ICDS block and five r and omly selected matched non ICDS rural area served as controls . There were a total of 709 children in ICDS and 500 in non ICDS block in 1 - 6 years age group . The difference was not statistically significant for nutritional status in the two blocks , but a remarkably better immunization status ( p < 0.005 ) was observed in non ICDS block . The coverage for DPT ( 3 doses ) , and measles vaccination  in ICDS block was 79.57 % and 45.7 % , respectively , while in non ICDS block it was 94.4 % and 62.03 % , respectively . It seems the ICDS scheme is under utilized by the community and requires immediate attention by the health authorities Past efforts to promote  family planning in Pakistan have been disappointing , but between 1990 - 91 and 2000 - 01 contraceptive use has more than doubled . This rise has coincided with a concerted effort on the part of the Pakistani government to increase access to contraceptive services , particularly in rural areas . The Lady Health Worker Programme ( LHWP ) , initiated under the Ministry of Health in the early 1990s , aim ed at integrating family planning into the doorstep provision of primary health care . This paper presents findings from the first national evaluation of this Programme . Data are analyzed from a r and om sample survey of 4277 women living in households served by the LHWP and those living in control areas .  Logistic regression analysis was performed to determine the effect of the Programme on the uptake of modern reversible contraceptive methods  , controlling for other independent variables . The data provide strong evidence that the LHWP has succeeded in increasing modern contraceptive use among rural women . Women served by Lady Health Workers are significantly more likely to use a modern reversible method  than women in communities not served by the Programme ( OR=1.50 , 95 % CI=1.04 - 2.16 , p=0.031 ) , even after controlling for various household and individual characteristics . The model of providing doorstep services through community-based female workers should remain central to achieving universal access to safe family planning methods  by the end of the decade -- the long-term objective of Pakistan 's most recent population policy adopted in 2002 BACKGROUND The Integrated Management of Childhood Illness ( IMCI ) strategy is design ed to address major causes of child mortality at the levels of community , health facility , and health system . We assessed the effectiveness of facility-based IMCI in rural Tanzania . METHODS We compared two districts with facility-based IMCI and two neighbouring comparison districts without IMCI , from 1997 to 2002 , in a non-r and omised study . We assessed quality of  case-management for children 's illness , drug and vaccine availability , and supervision involving case-management , through a health-facility survey in 2000 . Household surveys were used to assess child-health indicators in 1999 and 2002 . Survival of children was tracked through demographic surveillance over a predefined 2-year period from mid 2000 . Further information on context ual factors was gathered through interviews and record review . The economic cost of health care for children in IMCI and comparison districts was estimated through interviews and record review at national , district , facility , and household levels . FINDINGS During the IMCI phase-in period , mortality rates in children under 5 years old were almost identical in IMCI and comparison districts . Over the next 2 years , the mortality rate was 13 % lower in IMCI than in comparison districts ( 95 % CI -7 to 30 or 5 to 21 , depending on how adjustment is made for district-level clustering ) , with a rate difference of 3.8 fewer deaths per 1000 child-years . Context ual factors , such as use of mosquito nets , all favoured the comparison districts . Costs of children 's health care with IMCI were similar to or lower than those for case-management without IMCI . INTERPRETATION Our findings indicate that facility-based IMCI is good value for money , and support widespread implementation in the context of health-sector reform , basket funding , good facility access , and high utilisation of health facilities As part of a program to integrate schistosomiasis control into the primary health care system in northern Cameroon , an unexpected opportunity to undertake a controlled evaluation of the impact of interventions was recognized . Inadvertently , a large part of Mindjil , one of four assessment villages , had been essentially excluded from the program , creating a unique natural control . The prevalence of infection with Schistosoma hematobium in school-aged children was 7 % in the areas where the control program was implemented , and 71 % in the excluded areas ( P < 0.0002 ) . High intensity infection was 1 % and 26 % in the two areas , respectively ( P < 0.0002 ) . Children in the school where the control interventions were implemented had a significantly lower prevalence of infection with Schistosoma hematobium ( P < 0.005 ) . Subjects in intervention areas demonstrated greater knowledge about the transmission of schistosomiasis than those in the control area . This study documented and quantified program impact in a controlled manner not usually possible in field studies and also illustrated how unrecognized intracultural diversity ( within culture differences ) in target population s may effect disease control programs in communities OBJECTIVES To assess the effect of Integrated Management of Childhood Illness ( IMCI ) relative to routine care on the quality and efficiency of providing care for sick children in first-level health facilities in Tanzania , and to disseminate the results for use in health sector decision-making . DESIGN Non-r and omized controlled trial to compare child health care quality and economic costs in two intervention ( > 90 % of health care workers trained in IMCI ) and two comparison districts in rural Tanzania . PARTICIPANTS For quality measures , all sick children presenting for care at r and om sample s of first-level health facilities ; for costs , all national , district , facility and household costs associated with child health care , taking a societal perspective . RESULTS IMCI training is associated with significantly better child health care in facilities at no additional cost to districts . The cost per child visit managed correctly was lower in IMCI than in routine care setting s : $ 4.02 versus $ 25.70 , respectively , in 1999 US dollars and after st and ardization for variations in population size . CONCLUSION IMCI improved the quality and efficiency of child health care relative to routine child health care in the study districts . Previous study results indicated that the introduction of IMCI in these Tanzanian districts was associated with mortality levels that were 13 % lower than in comparison districts . We can therefore conclude that IMCI is also more cost-effective than routine care for improving child health outcomes . The dissemination strategy for these results led to adoption of IMCI for nationwide implementation within 12 months of study completion BACKGROUND We report the preliminary findings from a continuing cluster r and omised evaluation of the Integrated Management of Childhood Illness ( IMCI ) strategy in Bangladesh . METHODS 20 first-level outpatient facilities in the Matlab sub-district and their catchment areas were r and omised to either IMCI or st and ard care . Surveys were done in households and in health facilities at baseline and were repeated about 2 years after implementation . Data on use of health facilities were recorded . IMCI implementation included health worker training , health systems support , and community level activities guided by formative research . FINDINGS 94 % of health workers in the intervention facilities were trained in IMCI . Health systems supports were generally available , but implementation of the community activities was slow . The mean index of correct treatment for sick children was 54 in IMCI facilities compared with 9 in comparison facilities ( range 0 - 100 ) . Use of the IMCI facilities increased from 0.6 visits per child per year at baseline to 1.9 visits per child per year about 21 months after IMCI introduction . 19 % of sick children in the IMCI area were taken to a health worker compared with 9 % in the non-IMCI area . INTERPRETATION 2 years into the assessment , the results show improvements in the quality of care in health facilities , increases in use of facilities , and gains in the proportion of sick children taken to an appropriate health care provider . These findings are being used to strengthen child health care nationwide . They suggest that low levels of use of health facilities could be improved by investing in quality of care and health systems support
target: Our analysis shows few instances where there is full integration of a health intervention or where an intervention is completely non-integrated .
  Instead , there exists a highly heterogeneous picture both for the nature and also for the extent of integration .
  Health systems combine both non-integrated and integrated interventions , but the balance of these interventions varies considerably
background: A longst and ing debate on health systems organization relates to benefits of integrating  health programmes that emphasize specific interventions into mainstream health systems to increase access and improve health outcomes .
  This debate has long been characterized by polarization of views and ideologies , with protagonists for and against integration arguing the relative merits of each approach .
  However , all too frequently these arguments have not been based on hard evidence .
  The presence of both integrated and non-integrated programmes in many countries suggests there may be benefits to either approach , but the relative merits of integration in various context s and for different interventions have not been systematic ally analysed and documented .
  In this paper we present findings of a systematic review that explores a broad range of evidence on : ( i ) the extent and nature of the integration of targeted health programmes that emphasize specific interventions into critical health systems functions , ( ii ) how the integration or non-integration of health programmes into critical health systems functions in different context s has influenced programme success , ( iii ) how context ual factors have affected the extent to which these programmes were integrated into critical health systems functions .