Outcomes of the Integrated Community Malaria Case Management (iCCM) Programme by Community Health Workers in Ibenga Catchment Area, Mpongwe District, Zambia: A Cross-Sectional Study

Abstract

Malaria remains a major cause of morbidity and mortality among children under five years in Zambia, particularly in rural and hard-to-reach communities where access to health facilities is limited. Integrated Community Case Management (iCCM), delivered by trained Community Health Workers (CHWs), and brings malaria diagnosis and treatment closer to communities. This study assessed the coverage, reported adherence to malaria treatment guidelines, and factors influencing utilization of iCCM services in Ibenga Catchment Area, Mpongwe District, Zambia. A quantitative cross-sectional study was conducted among 403 participants comprising 384 caregivers of children under five years and 19 CHWs. Data were collected using structured questionnaires and CHW assessment tools and analysed using IBM SPSS Statistics version 27. Descriptive statistics, chi-square tests and binary logistic regression were performed. Associations were reported using adjusted odds ratios (aORs) with 95% confidence intervals (CIs), with statistical significance set at p < 0.05. iCCM coverage was high, with 88.0% of households reporting previous use of CHW malaria services. Among caregivers reporting a child with recent fever, 75.9% first sought care from a CHW. Self-reported adherence to key malaria treatment practices was high, although only 15.8% of CHWs had received refresher training within the previous year. Overall, 88.6% of children recovered. Distance to the nearest CHW was strongly associated with utilization (aOR = 0.13, 95% CI: 0.07–0.25; p < 0.001), while caregiver education was also independently associated with utilization (aOR = 0.56, 95% CI: 0.32–0.98; p = 0.043). The iCCM programme in Ibenga achieved high coverage and community uptake, with good reported treatment practices and clinical outcomes. However, geographic distance remains an important barrier to equitable utilization, while limited refresher training may affect programme sustainability. Improving the geographic distribution of CHWs and outreach services, strengthening routine refresher training and CHW incentives, and independently verifying CHW adherence are recommended to improve equitable access and sustain the quality of iCCM services.