Skip to main content
. 2021 Feb 10;2021(2):CD012882. doi: 10.1002/14651858.CD012882.pub2

Summary of findings 2. Summary of findings: integrated community case management versus usual facility services plus CCM for malaria.

iCCM compared to usual facility services + CCM for malaria
Patient or population: children U5
Settings: middle‐ and low‐income countries
Intervention: iCCM
Comparison: usual facility services + CCM for malaria
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 18 children U5 with any iCCM illness who received appropriate treatment from an appropriate provider, per 100 children U5 with any iCCM illness 24 children U5 with any iCCM illness who received appropriate treatment from an appropriate provider, per 100 children U5 with any iCCM illness (22 to 25 children) RR 1.59 (0.66 to 3.87) 7876 children (1 CBA)a ⊕⊝⊝⊝ Verylowb 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
No studies reported this outcome. We do not know the effect of iCCM on 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 66 children U5 with any iCCM illness for whom care was sought from an appropriate provider, per 100 children U5 with any iCCM illness 70 children U5 with any iCCM illness for whom care was sought from an appropriate provider, per 100 children U5 with any iCCM illness (65 to 74 children) RR 1.21 (0.90 to 1.62) 811 children (1 cRCT)c ⊕⊕⊝⊝ Lowd iCCM may have little or no effect on 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; CCM: community case management; CI: confidence interval; cRCT: cluster‐randomized controlled trial; iCCM: integrated community case management; RR: risk ratio; U5: aged under‐five 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

aMunos 2016.
bDowngraded three levels (two levels for serious risk of bias due to the study being a CBA, one level for serious imprecision).
cKalyango 2012a.
dDowngraded two levels. We downgraded one level for risk of bias because the primary outcome measure for Kalyango 2012a, U5 mortality, has never been published – indicating risk of reporting bias for this study. We downgraded one level for indirectness due to the effect being based on a single cluster‐randomized controlled trial.