In Ethiopia, integrated community case management (iCCM) is a key strategy for the Ministry of Health to address cases of malaria, pneumonia, diarrhoea and other illnesses within remote communities and act as first points of contact for many caregivers of sick children. Under current guidelines for iCCM, community health workers (CHWs) diagnose and treat sick children and conduct a follow-up visit after three days for all children seen, including children with unspecific fever who did not receive treatment, to assess illness resolution. However, in Ethiopia, caregivers are told to follow up at any point only if their child fails to respond to treatment (known as persisting fever) and there is no systematic follow-up on day 3. There is limited evidence of whether caregivers of children actually complete their follow-up assessment visit promptly if the child is not improving, and the outcome of the febrile children from whom treatment was withheld is unknown.
The purpose of this study is to assess the safety of an advised systematic three-day reassessment visit by CHWs of febrile children who have tested negative for malaria and who do not display danger signs, regardless of symptom resolution, compared with the current practice of a conditional follow-up visit at three days only if fever persists.