Yansaneh 2014.

Study characteristics
Methods	Design: controlled before‐after study Unit of randomization: none
Participants	Inclusion criteria: consenting children aged 0–59 months and caregivers of children aged 0–59 months residing in selected households with ≥ 1 child aged 0–59 months. Consenting caregivers provided information on disease prevalence, care seeking and treatment for children under‐5 in the 2 weeks prior to the surveys Exclusion criteria: none reported
Interventions	Intervention Recruiting and training lay health workers – CHV – to provide iCCM for diarrhoea, malaria and pneumonia among children aged < 5 and referral of children aged < 5 years with severe illness to health facilities Implementing simplified IMCI‐adapted clinical guidelines for iCCM providers Providing iCCM providers with non‐monetary incentives such as community recognition, community help with household tasks of CHVs such as farming and exemption from community labour such as building or repairing roads and bridges Providing iCCM providers with iCCM drugs and equipment Providing iCCM providers and their supervisors with paper and mobile health tools to assist in workflow, help guide clinical decision‐making, and collect programmatic data. Providing iCCM providers with visual job aids to enable data collection and reporting Providing iCCM providers with supervision; frequency monthly with direct observation of case management Comparison Usual facility services
Outcomes	Mortality 2‐week period prevalence (proportion of children with ICCM symptoms (diarrhoea, presumed malaria, presumed pneumonia, or a combination) 2 weeks prior to the survey Coverage of appropriate treatment Appropriate treatment by symptom (proportion of ill children who received appropriate treatment for their symptom (antimalarials including ACT for malaria, antibiotics including cotrimoxazole for pneumonia, and ORS and zinc for diarrhoea) per Ministry of Health and Sanitation of Sierra Leone, UNICEF and WHO guidelines) Careseeking Careseeking (proportion of children ill for whom care was sought) Careseeking from an appropriate provider (proportion of children ill in the previous 2 weeks for whom care was sought from healthcare professional such as a nurse, doctor or a trained CHV) Use of traditional treatment by symptom (having treatment besides syrups and tablets provided by allopathic healthcare workers) in the previous 2 weeks
Notes	Objective: to examine whether CHVs induced significant changes in careseeking and treatment of ill children aged < 5 years 2 years after their deployment in 2 underserved districts of Sierra Leone Implementation date: August 2010 to August 2012 Location: rural, poorest quintile districts of Sierra Leone. Kambia and Pujehun districts (intervention); Kailahun and Tonkolili districts (control) Funding sources: Department of Foreign Affairs Trade and Development Canada through a grant administered by UNICEF. Other: results for Yansaneh for outcomes in this review were based on unpublished results, recalculated using data provided by Yansaneh. Results had to be recalculated to align with standard definitions for out outcomes. The recalculated results used in this review were reviewed and confirmed by Yansaneh.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Controlled before‐after study, with no random sequence generation. Districts were purposefully selected.
Allocation concealment (selection bias)	High risk	Controlled before‐after study, with no allocation concealment.
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding of participants and personnel. Lay health workers would have known if they received additional training and this may have biased their performance. Allocation was by village and parents may have known that the health workers at their primary health centre had received additional training and this may have biased their care seeking behaviour or responses to questionnaires, or both.
Blinding of outcome assessment (detection bias) All outcomes	High risk	Blinding of outcome assessors not described in the paper.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Response rates were high (94% at baseline and 96% at endline) and there no indication of systematic differences between arms.
Selective reporting (reporting bias)	Low risk	Outcomes were reported for all stated study outcomes.
Baseline outcomes similar	High risk	There were important differences in baseline outcomes, including: higher % careseeking to an appropriate provider for diarrhoea in control areas; higher % careseeking to an appropriate provider for suspected pneumonia in control areas.
Baseline characteristics similar	Unclear risk	Baseline characteristics were similar, with the exception of: lower % of households with > 6 people in control areas; lower % of households reporting being polygamous in control areas; lower % of households reporting Islam as the household religion in control areas; lower % of households reporting Mende as the household ethnicity in control areas.
Contamination	Low risk	Intervention areas (districts) and control areas (districts) were geographically separated, minimizing the risk of contamination.
Other bias	Low risk	3/9 authors have UNICEF affiliations and UNICEF advocates iCCM. Ebola may have affected implementation of iCCM, particularly for fever, e.g. causing a shift away from using RDTs to implementing WHO's "no touch" policy, in the intervention areas.

ACT: artemisinin‐based combination therapy; ARI: acute respiratory infection; ASBC: Agents de Santé à Base Communautaire; ASHA: Accredited Social Health Activists; CCM: community case management; gCHV: general community health volunteer; CHV: community health volunteer; CHW: community health worker; iCCM: integrated community case management; IMCI: integrated management of childhood illness; IMNCI: Integrated Management of Neonatal and Childhood Illness; ORS: oral rehydration salts; RDT: rapid diagnostic test; SIDA: Swedish Institute for Development Agency; UNDP: United Nations Development Programme; UNICEF: United Nations Children's Fund; USAID: United States Agency for International Development; VHT: village health team; WHO: World Health Organization.