***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: The contribution of acute respiratory infection control project within the framework of micro-credit-based development intervention in promoting maternal knowledge of ARIs in children was assessed . Data came from a cross-sectional survey of 2814 mothers of under 5-y-old children residing in 200 r and omly selected villages in five districts in Bangladesh . Findings revealed that the ARI control project had significant positive effects in raising knowledge of clinical signs and preventive measures . When ARI control project activities were integrated with the credit-based development initiative , maternal knowledge improved even further . The study concludes that the micro-credit programme can be a catalytic agent in raising health knowledge among poor women in developing countries BACKGROUND The Integrated Management of Childhood Illness ( IMCI ) strategy is design ed to address major causes of child mortality at the levels of community , health facility , and health system . We assessed the effectiveness of facility-based IMCI in rural Tanzania . METHODS We compared two districts with facility-based IMCI and two neighbouring comparison districts without IMCI , from 1997 to 2002 , in a non-r and omised study . We assessed quality of  case-management for children 's illness , drug and vaccine availability , and supervision involving case-management , through a health-facility survey in 2000 . Household surveys were used to assess child-health indicators in 1999 and 2002 . Survival of children was tracked through demographic surveillance over a predefined 2-year period from mid 2000 . Further information on context ual factors was gathered through interviews and record review . The economic cost of health care for children in IMCI and comparison districts was estimated through interviews and record review at national , district , facility , and household levels . FINDINGS During the IMCI phase-in period , mortality rates in children under 5 years old were almost identical in IMCI and comparison districts . Over the next 2 years , the mortality rate was 13 % lower in IMCI than in comparison districts ( 95 % CI -7 to 30 or 5 to 21 , depending on how adjustment is made for district-level clustering ) , with a rate difference of 3.8 fewer deaths per 1000 child-years . Context ual factors , such as use of mosquito nets , all favoured the comparison districts . Costs of children 's health care with IMCI were similar to or lower than those for case-management without IMCI . INTERPRETATION Our findings indicate that facility-based IMCI is good value for money , and support widespread implementation in the context of health-sector reform , basket funding , good facility access , and high utilisation of health facilities OBJECTIVES To characterize community health worker ( CHW ) performance using an algorithm for managing common childhood illnesses in Siaya District , Kenya , we conducted CHW evaluations in 1998 , 1999 , and 2001 . METHODS R and omly selected CHWs were observed managing sick outpatient and inpatient children at a hospital , and their management was compared with that of an expert clinician who used the algorithm . RESULTS One hundred , 108 , and 114 CHWs participated in the evaluations in 1998 , 1999 , and 2001 , respectively . The proportions of children treated " adequately " ( with an antibiotic , antimalarial , oral rehydration solution , or referral , depending on the child 's disease classifications ) were 57.8 % , 35.5 % , and 38.9 % , respectively , for children with a severe classification and 27.7 % , 77.3 % , and 74.3 % , respectively , for children with a moderate ( but not severe ) classification . CHWs adequately treated 90.5 % of malaria cases ( the most commonly encountered classification ) . CHWs often made mistakes assessing symptoms , classifying illnesses , and prescribing correct doses of medications . CONCLUSIONS Deficiencies were found in the management of  sick children by CHWs , although care was not consistently poor . Key reasons for the deficiencies appear to be guideline complexity and inadequate clinical supervision ; other possible causes are discussed OBJECTIVE The objective of this study was to assess the effect of Integrated Management of Childhood Illness ( IMCI ) case management training on the use of antimicrobial drugs among health-care workers treating young children at first-level facilities . Antimicrobial drugs are an essential child-survival intervention . Ensuring that children younger than five who need these drugs receive them promptly and correctly can save their lives . Prescribing these drugs only when necessary and ensuring that those who receive them complete the full course can slow the development of antimicrobial resistance . METHODS Data collected through observation-based surveys in r and omly selected first-level health facilities in Brazil , Ug and a and the United Republic of Tanzania were statistically analysed . The surveys were carried out as part of the multi-country evaluation of IMCI effectiveness , cost and impact ( MCE ) . FINDINGS Results from three MCE sites show that children receiving care from health workers trained in IMCI are significantly more likely to receive correct prescriptions for antimicrobial drugs than those receiving care from workers not trained in IMCI . They are also more likely to receive the first dose of the drug before leaving the health facility , to have their caregiver advised how to administer the drug , and to have caregivers who are able to describe correctly how to give the drug at home as they leave the health facility . CONCLUSIONS IMCI case management training is an effective intervention to improve the rational use of antimicrobial drugs for sick children visiting first-level health facilities in low-income and middle-income countries BACKGROUND No satisfactory strategy for reducing  high child mortality  from malaria has yet been established in tropical Africa . We compared the effect on under-5 mortality of  teaching mothers  to promptly provide antimalarials to their sick children at home , with the present community health worker approach . METHODS Of 37 tabias ( cluster of villages ) in two districts with hyperendemic to holoendemic malaria , tabias reported to have the highest malaria morbidity were selected . A census was done which included a maternity history to determine under-5 mortality .  Tabias ( population 70,506 ) were paired according to under-5 mortality rates . One tabia from each pair was allocated by r and om number to an intervention group and the other was allocated to the control group . In the intervention tabias , mother coordinators were trained to teach other local mothers to recognise symptoms of malaria in their children and to promptly give chloroquine . In both intervention and control tabias , all births and deaths of under-5s were recorded monthly . FINDINGS From January to December 1997 , 190 of 6383 ( 29.8 per 1000 ) children under-5 died in the intervention tabias compared with 366 of 7294 ( 50.2 per 1000 ) in the control tabias . Under-5 mortality was reduced by 40 % in the intervention localities ( 95 % CI from 29.2 - 50.6 ; paired t test , p<0.003 ) . For every third child who died , a structured verbal autopsy was undertaken to ascribe cause of mortality as consistent with malaria or possible malaria , or not consistent with malaria . Of the 190 verbal autopsies , 13 ( 19 % ) of 70 in the intervention tabias were consistent with possible malaria compared with 68 ( 57 % ) of 120 in the control tabias . INTERPRETATION A major reduction in under-5 mortality can be achieved in holoendemic malaria areas through training local mother coordinators to teach mothers to give under-5 children antimalarial drugs A survey was done in June 1983 in Saradidi , Kenya , one year after the inception of a  community-based malaria control programme  to determine if people were obtaining malaria treatment from volunteer village health helpers ( VHH 's ) chosen by the community . Ten of 36 villages were r and omly chosen . From these ten villages , 100 households were r and omly selected and 222 people ten years of age or more were interviewed ; 113 ( 50.9 % ) had a history of malaria in the previous two weeks and 82 ( 72.6 % of 113 ) had taken medicine for malaria in that period . Of these 82 , 51.2 % obtained drug from the VHH , 28 % purchased it from a shop , 12.2 % from a health facility , 4.9 % from family members and 3.7 % from a private practitioner or a shop outside Saradidi . Reasons given for not obtaining treatment from the VHH 's among the 40 people who went elsewhere for treatment included : the VHH was not at home when needed ( 35 % ) ; the VHH had no drugs ( 22.5 % ) ; the patient was too sick for the VHH to treat ( 10 % ) ; had drugs already in the home ( 10 % ) ; ' not registered ' with VHH ( 10 % ) ; VHH ' no good ' ( 7.5 % ) ; and more ' convenient ' to go elsewhere ( 5 % ) . Similar results found on question ing the mother were obtained for 103 children under nine years old in these households ; 67 ( 65.0 % ) children had a history of malaria in the previous two weeks and 59 ( 88.1 % ) of these 67 children had received antimalarial treatment . The VHH was the principal source of treatment ( 50.8 % of 59 ) , followed by health facilities ( 20.3 % ) and shops ( 18.6 % ) . ( ABSTRACT TRUNCATED AT 250 WORDS Save the Children/USA in collaboration with the Ministry of Health of Mali has established over 300 village drug kits in southern Mali since 1996 . A cluster-r and omized trial was conducted between November 2001 and February 2002 in 10 health zones of Bougouni District to evaluate an intervention to ( i ) improve the skills of the village drug kit managers to counsel parents on correct home administration of chloroquine ( CQ ) , and ( ii ) increase the referral of sick children to community health centres ( CHC ) . Children 's carers were interviewed 5 d after the sale of CQ about knowledge of danger signs requiring referral , quality of counselling , administration of CQ , and referral . The intervention was associated with significant increases in knowledge of danger signs requiring referral , reported quality of counselling by the manger of the drug kit , and correct administration of CQ in the home .  Parents reported that 42.1 % of children in the intervention group were referred to the CHC by the drug kit manager compared with 11.2 % in the comparison group ( odds ratio = 7.12 , 95 % CI 2.62 - 19.38 ) . CHC registers indicated that 87.0 % of referrals recorded in drug kit referral notebooks arrived at the health centre . Further research is needed to increase the effectiveness of the counselling and the community referral mechanism tested in this study In rural , malaria-endemic Burkina Faso , we evaluated the impact of the use of pre-packaged antimalarial drugs ( PPAM ) , by mothers in the home , on the progression of disease in children from uncomplicated fever to severe malaria . In each village of one province , a core group of opinion leaders ( mainly older mothers ) was trained in the management of uncomplicated malaria , including the administration of PPAM . Full courses of antimalarial ( chloroquine ) and antipyretic ( aspirin ) drugs were packaged in age-specific bags and made widely available through community health workers who were supplied through the existing drug distribution system . Drugs were sold under a cost-recovery scheme . Local schoolteachers conducted surveys in a r and om sample of 32 villages at the end of the high transmission seasons in 1998 and 1999 . Disease history and the treatment received were investigated for all children under the age of 6 years having suffered from a fever episode in the previous 4 weeks . ' Uncomplicated malaria ' was defined as every episode of fever and ' severe malaria ' as every episode of fever followed by convulsions or loss of consciousness . During the study period , 56%[95 % confidence interval ( CI ) 50 - 62 % ] of 3202 fever episodes in children under 6 years of age were treated promptly by mothers with the pre-packaged drugs made available by the study . A total of 59 % of children receiving PPAM were reported to have received the drugs over the prescribed 3-day period , while 52 % received the correct age-specific dose .  PPAM  use was similar among literate ( 61 % ) and non-literate mothers ( 55 % ) ( P = 0.08 ) . The overall reported risk of developing severe malaria was 8 % . This risk was lower in children treated with PPAM ( 5 % ) than in children not treated with PPAM ( 11 % ) ( risk ratio = 0.47 ; 95 % CI 0.37 , 0.60 ; P < 0.0001 ) . This estimate of the impact of  PPAM  was largely unchanged when account was taken of potential confounding by age , sex , maternal literacy status , year or village . Our findings support the view that , after appropriate training and with adequately packaged drugs made available , mothers can recognize and treat promptly and correctly malarial episodes in their children and , by doing so , reduce the incidence of severe disease BACKGROUND We report the preliminary findings from a continuing cluster r and omised evaluation of the Integrated Management of Childhood Illness ( IMCI ) strategy in Bangladesh . METHODS 20 first-level outpatient facilities in the Matlab sub-district and their catchment areas were r and omised to either IMCI or st and ard care . Surveys were done in households and in health facilities at baseline and were repeated about 2 years after implementation . Data on use of health facilities were recorded . IMCI implementation included health worker training , health systems support , and community level activities guided by formative research . F 
    Output:
    
Of the seven models , that of CHW pneumonia case management ( Model 6 ) has the strongest evidence for an impact on mortality .