Effect of community based interventions on childhood diarrhea and pneumonia: uptake of treatment modalities and impact on mortality

INTRODUCTION: Diarrhea and pneumonia are the two leading causes of mortality in children under five. Improvements have occurred over the past two decades but the progress is slow to meet the MDG-4. METHODS: We conducted a systematic review of the randomized controlled trials, quasi-experimental and observational studies to estimate the effect of community based interventions including community case management on the coverage of various commodities and on mortality due to diarrhea and pneumonia. We used a standardized abstraction and grading format and performed meta-analyses for all the relevant outcomes. The estimated effect of community based interventions was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules. RESULTS: We included twenty four studies in this review. Community based interventions led to significant rise in care seeking behaviors with 13% and 9% increase in care seeking for pneumonia and diarrhea respectively. These interventions were associated with 160% increase in the use of ORS and 80% increase in the use of zinc for diarrhea. There was a 75% decline in the unnecessary use of antibiotics for diarrhea and a 40% decrease in treatment failure rates for pneumonia. Community case management for diarrhea and pneumonia is associated with a 32% reduction in pneumonia specific mortality, while the evidence on diarrhea related mortality is weak. CONCLUSION: Community based interventions have the potential to scale up care seeking and the use of essential commodities and significantly decrease morbidity and mortality burden due to diarrhea and pneumonia in children under the age of five years.