Summary of findings 1. Summary of findings: integrated community case management versus usual facility services.

iCCM compared to usual facility services
Patient or population: children U5 Settings: middle‐ and low‐income countries Intervention: iCCM Comparison: usual facility services
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	No of participants (studies)	Certainty of the evidence (GRADE)	Narrative results
	Assumed risk	Corresponding risk
	Control (baseline risk in comparison)	iCCM (endline in intervention)
1. Coverage of appropriate treatment
From an appropriate provider
Any iCCM illness	44 children U5 with any iCCM illness who received appropriate treatment from an appropriate provider, per 100 children U5 with any iCCM illness	39 children U5 with any iCCM illness who received appropriate treatment from an appropriate provider, per 100 children U5 with any iCCM illness (37 to 41 children)	RR 0.96 (0.77 to 1.19)	5898 children (2 CBAs)a,b	⊕⊝⊝⊝ Verylowc	We are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness.
2. Quality of care
No studies reported this outcome.						We do not know the effect of iCCM on quality of care.
3. Case load or severity of illness at health facilities
No studies reported this outcome.						We do not know the effect of iCCM on case load or severity of illness at health facilities.
4. Mortality
Neonatal mortality rate	43 neonatal deaths per 1000 live births	43 neonatal deaths per 1000 live births (40 to 45)	HR 1.01 (0.77 to 1.33)	65,209 children (2 cRCTs)d,e	⊕⊕⊝⊝ Lowf	iCCM may have little or no effect on neonatal mortality.
Infant mortality rate	66 infant deaths per 1000 live births	66 infant deaths per 1000 live births (64 to 69)	HR 0.98 (0.72 to 1.34)	65,209 children (2 cRCTs)d,e	⊕⊝⊝⊝ Verylowg	We are uncertain of the effect of iCCM on infant mortality.
U5 mortality rate	113 U5 deaths per 1000 live births	134 U5 deaths per 1000 live births (120 to 148)	HR1.16 (0.99 to 1.36)	4729 children (1 cRCT)e	⊕⊝⊝⊝ Verylowh	We are uncertain of the effect of iCCM on U5 mortality.
5. Adverse events
No studies reported this outcome.						We do not know the effect of iCCM on adverse events.
6. Coverage of careseeking
To an appropriate provider of treatment services
Any iCCM illness	27 children U5 with any iCCM illness for whom care was sought from an appropriate provider, per 100 children U5 with any iCCM illness	47 children U5 with any iCCM illness for whom care was sought from an appropriate provider, per 100 children U5 with any iCCM illness (45 to 48 children)	RR 1.68 (1.24 to 2.27)	9853 children (2 cRCTs)e,i	⊕⊕⊕⊝ Moderatej	iCCM probably improves coverage of careseeking to an appropriate provider of treatment services for any iCCM illness.
*The basis for the assumed risk is the control group risk across studies (number of events in control group across studies / total in control group across studies). The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CBA: controlled before‐after study; CI: confidence interval; cRCT: cluster‐randomized controlled trial; HR: hazard ratio; iCCM: integrated community case management; RR: risk ratio; U5: aged < 5 years.
GRADE Working Group grades of evidence High certainty: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different** is low. Moderate certainty: This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different** is moderate. Low certainty: This research provides some indication of the likely effect. However, the likelihood that it will be substantially different** is high. Very low certainty: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different** is very high. ** Substantially different = a large enough difference that it might affect a decision

^aYansaneh 2014.
^bMubiru 2015.
^cDowngraded three levels. We downgraded by two for serious risk of bias due to the studies being CBAs. We downgraded by one for serious inconsistency and serious imprecision. Heterogeneity was high (I² = 90%, P < 0.00001), with large effects in one CBA study (Mubiru 2015), and modest/no effects in the other CBA study (Yansaneh 2014). Confidence intervals included important effects to no effect.
^dBhandari 2012a.
^eBoone 2016.
^fDowngraded two levels. Heterogeneity was moderate (I² = 55%) but not statistically significant (P = 0.14). The effects were inconsistent across the two studies but confidence intervals overlapped and included no effect, therefore, we did not downgrade for serious inconsistency. Both trials included significant newborn components that have not been implemented widely in other contexts and Bhandari 2012a was conducted in a mixed rural/urban area of northern India, which may be contextually different than the typical rural environment where iCCM is implemented, so we downgraded one level for indirectness. We downgraded one level for serious imprecision due to large confidence intervals that included an important effect to no important effect.
^gDowngraded three levels. Heterogeneity was high (I² = 77%, P = 0.04) with inconsistent effects ( Bhandari 2012a had a benefit of 15% and Boone 2016 had no effect), so we downgraded one level for serious inconsistency. Both trials included significant newborn components that have not been implemented widely in other contexts and Bhandari 2012a was conducted in a mixed rural/urban area of northern India which may be contextually different than the typical rural environment where iCCM is implemented, so we downgraded one level for indirectness. We downgraded two levels for serious imprecision due to large confidence intervals that included an important effect to no important effect.
^hDowngraded three levels. We downgraded two levels for indirectness. Prior to January 2009, chloroquine was the treatment for malaria according to the national protocol and resistance to chloroquine may have reduced effectiveness of the intervention. Artemisinin‐based combination therapy (ACTs) were introduced in January 2009, first in health facilities and later among community health workers. The authors indicated that, due to this sequencing, people may have accessed ACTs sooner in control clusters than in intervention clusters – and this may have impacted the effect of the intervention, so we downgraded one level for indirectness. We also downgraded one level for indirectness due to the effect being based on a single cluster‐randomized controlled trial. We downgraded one level for serious imprecision due to large confidence intervals that included an important effect to no important effect.
ⁱBhandari 2012a/Mazumder 2014.
^jDowngraded one level overall. Heterogeneity was high (I² = 96%, P < 0.00001), but the effect was consistent (moderate‐to‐large effects in favour of the intervention) across studies and confidence intervals overlapped, therefore, we did not downgrade for serious inconsistency. Both trials included significant newborn components that have not been implemented widely in other contexts and Bhandari 2012a was conducted in a mixed rural/urban area of northern India which may contextually different than the typical rural environment where iCCM is implemented, so we downgraded one level for indirectness.