. 2021 Feb 10;2021(2):CD012882. doi: 10.1002/14651858.CD012882.pub2

6. Additional summary of findings: iCCM 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 care + 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)
Coverage of appropriate treatment
From an appropriate provider
ORS and zinc for diarrhoea	10 children U5 with diarrhoea who received appropriate treatment from an appropriate provider per 100 children U5 with diarrhoea	25 children U5 with diarrhoea who received appropriate treatment from an appropriate provider per 100children U5 with diarrhoea (23 to 27)	RR 2.51 (2.05 to 3.07)	2641 children (1 CBA)^a	⊕⊝⊝⊝ Very low^b	We are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for diarrhoea (ORS and zinc).
ACT for malaria	22 children U5 with malaria who received appropriate treatment from an appropriate provider per 100 children U5 with malaria	23 children U5 with malaria who received appropriate treatment from an appropriate provider per 100children U5 with malaria (21 to 24)	RR 1.02 (0.92 to 1.13)	5235 children (1 CBA)^a	⊕⊝⊝⊝ Very low^b	We are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for malaria (ACTs).
RUTF for severe acute malnutrition	No studies reported this outcome.					We do not know the effect of iCCM on coverage of appropriate treatment from an appropriate provider for severe acute malnutrition (RUTF).
Antibiotics for newborn sepsis	No studies reported this outcome.					We do not know the effect of iCCM on coverage of appropriate treatment from an appropriate provider for newborn sepsis (antibiotics).
Antibiotics for newborn local infection	No studies reported this outcome.					We do not know the effect of iCCM on coverage of appropriate treatment from an appropriate provider for newborn local infection (antibiotics).
From an iCCM provider
Any iCCM illness	No studies reported this outcome.					We do not know the effect of iCCM on coverage of appropriate treatment from an iCCM provider for any iCCM illness.
ORS and zinc for diarrhoea	No studies reported this outcome.					We do not know the effect of iCCM on coverage of appropriate treatment from an iCCM provider for diarrhoea (ORS and zinc).
ACT for malaria	No studies reported this outcome.					We do not know the effect of coverage of iCCM on appropriate treatment from an iCCM provider for malaria (ACTs).
RUTF for severe acute malnutrition	No studies reported this outcome.					We do not know the effect of iCCM on coverage of appropriate treatment from an iCCM provider for severe acute malnutrition (RUTF).
Antibiotics for newborn sepsis	No studies reported this outcome.					We do not know the effect of iCCM on coverage of appropriate treatment from an iCCM provider for newborn sepsis (antibiotics).
Antibiotics for newborn local infection	No studies reported this outcome.					We do not know the effect of iCCM on coverage of appropriate treatment from an iCCM provider for newborn local infection (antibiotics).
Coverage of careseeking
To an appropriate provider of treatment services
Diarrhoea	31 children U5 with diarrhoea for whom care was sought from an appropriate provider per 100 children U5 with diarrhoea	49 children U5 with diarrhoea for whom care was sought from an appropriate provider per 100children U5 with diarrhoea (46 to 51)	RR 1.56 (1.40 to 1.73)	2641 children (1 CBA)^a	⊕⊝⊝⊝ Very low^b	We are uncertain of the effect of iCCM on coverage of careseeking to an appropriate provider of treatment services for diarrhoea.
Fever	48 children U5 with fever for whom care was sought from an appropriate provider per 100 children U5 with fever	56 children U5 with fever for whom care was sought from an appropriate provider per 100children U5 with fever (54 to 58)	RR 1.15 (1.09 to 1.22)	5235 children (1 CBA^a	⊕⊝⊝⊝ Very low^b	We are uncertain of the effect of iCCM on coverage of careseeking to an appropriate provider of treatment services for fever.
Suspected pneumonia	56 children U5 with suspected pneumonia for whom care was sought from an appropriate provider per 100 children U5 with suspected pneumonia	59 children U5 with suspected pneumonia for whom care was sought from an appropriate provider per 100children U5 with suspected pneumonia (55 to 64)	RR 1.06 (0.93 to 1.22)	750 children (1 CBA)^a	⊕⊝⊝⊝ Very low^b	We are uncertain of the effect of iCCM on coverage of careseeking to an appropriate provider of treatment services for suspected pneumonia.
Severe acute malnutrition	No studies reported this outcome.					We do not know the effect of iCCM on coverage of careseeking to an appropriate provider of treatment services for severe acute malnutrition.
Newborn sepsis	No studies reported this outcome.					We do not know the effect of iCCM on coverage of careseeking to an appropriate provider of treatment services for newborn sepsis.
Newborn local infection	No studies reported this outcome.					We do not know the effect of iCCM on coverage of careseeking to an appropriate provider of treatment services for newborn local infection.
Newborn danger signs	No studies reported this outcome.					We do not know the effect of iCCM on coverage of careseeking to an appropriate provider for newborn danger signs.
To an iCCM provider
Any iCCM illness	22 children U5 with any iCCM illness for whom care was sought from an iCCM provider per 100 children U5 with any iCCM illness	31 children U5 with any iCCM illness for whom care was sought from an iCCM provider per children U5 with any iCCM illness 100 (26 to 35)	RR 1.40 (1.09 to 1.80)	811 children (1 cRCT)^c	⊕⊕⊝⊝ Low^d	iCCM may improve coverage of careseeking to an iCCM provider for any iCCM illness
Diarrhoea	1 child U5 with diarrhoea for whom care was sought from an iCCM provider per 100 children U5 with diarrhoea	4 children U5 with diarrhoea for whom care was sought from an iCCM provider per 100children U5 with diarrhoea (3 to 5)	RR 8.48 (3.43 to 20.95)	2641 children (1 CBA)^a	⊕⊝⊝⊝ Very low^b	We are uncertain of the effect of iCCM on coverage of careseeking to an iCCM provider for diarrhoea.
Fever	19 children U5 with fever for whom care was sought from an iCCM provider per 100 children U5 with fever	27 children U5 with fever for whom care was sought from an iCCM provider per 100 children U5 with fever (23 to 32)	RR 1.40 (1.07 to 1.83)	754 children (1 cRCT)^c	⊕⊕⊝⊝ Low^d	iCCM may improve coverage of careseeking to an iCCM provider for fever.
Suspected pneumonia	18 children U5 with suspected pneumonia for whom care was sought from an iCCM provider per 100 children U5 with suspected pneumonia	32 children U5 with suspected pneumonia for whom care was sought from an iCCM provider per 100 children U5 with suspected pneumonia (24 to 41)	RR 1.82 (1.12 to 2.96)	236 children (1 cRCT)^b	⊕⊕⊝⊝ Low^d	iCCM may improve coverage of careseeking to an iCCM provider for suspected pneumonia.
Severe acute malnutrition	No studies reported this outcome.					We do not know the effect of iCCM on coverage of careseeking to an iCCM provider for severe acute malnutrition.
Newborn sepsis	No studies reported this outcome.					We do not know the effect of iCCM on coverage of careseeking to an iCCM provider for newborn sepsis.
Newborn local infection	No studies reported this outcome.					We do not know the effect of iCCM on coverage of careseeking to an iCCM provider for newborn local infection.
Newborn danger signs	No studies reported this outcome.					We do not know the effect of iCCM on coverage of careseeking to an iCCM provider for newborn danger signs.
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). ACT: artemisinin‐based combination therapy;CBA: controlled before‐after study; CCM: community case management; CI: confidence interval; cRCT: cluster‐randomized trial; iCCM: integrated community case management; ORS: oral rehydration salts; RR: risk ratio; RUTF: ready‐to‐use therapeutic food; U5: aged under‐five years.
GRADE Working Group grades of evidence High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: we are very uncertain about the estimate.

^aMunos 2016. ^bDowngraded three levels (two for serious risk of bias due to the study being a CBA, one for indirectness because the estimate of effect was based on one CBA). ^cKalyango 2012a. ^dDowngraded two levels. We downgraded one level for risk of bias because the primary outcome measure for Kalyango 2012a, under‐five 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 cRCT.