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Background: In 2010, Ethiopia began scaling up the integrated community case management (iCCM) of childhood illness strategy throughout the country allowing health extension workers (HEWs) to treat children in rural health posts. After 2 years of iCCM scale up, utilization of HEWs remains low. Little is known about factors related to the use of health services in this setting. This research aimed to elicit perceptions and experiences of caregivers to better understand reasons for low utilization of iCCM services.Methods: A rapid ethnographic assessment was conducted in eight rural health post catchment areas in two zones: Jimma and West Hararghe. In total, 16 focus group discussions and 78 in-depth interviews were completed with mothers, fathers, HEWs and community health volunteers.Results: In spite of the HEW being a core component of iCCM, we found that the lack of availability of HEWs at the health post was one of the most common barriers to the utilization of iCCM services mentioned by caregivers. Financial and geographic challenges continue to influence caregiver decisions despite extension of free child health services in communities. Acceptability of HEWs was often low due to a perceived lack of sensitivity of HEWs and concerns about medicines given at the health post. Social networks acted both to facilitate and hinder use of HEWs. Many mothers stated a preference for using the health post, but some were unable to do so due to objections or alternative care-seeking preferences of gatekeepers, often mothers-in-law and husbands.Conclusion: Caregivers in Ethiopia face many challenges in using HEWs at the health post, potentially resulting in low demand for iCCM services. Efforts to minimize barriers to care seeking and to improve demand should be incorporated into the iCCM strategy in order to achieve reductions in child mortality and promote equity in access and child health outcomes. [ABSTRACT FROM AUTHOR]

Background: In the absence of planned efforts to target the poor, child survival programs often favour the rich. Further evidence is needed urgently about which interventions and programme approaches are most effective in addressing inequities. The Lives Saved Tool (LiST) is available and can be used to model mortality levels across economic groups based on coverage levels for child survival interventions.Methods: We used LiST to model neonatal and under-5 mortality levels among the highest and the lowest wealth quintiles in Bangladesh based on national and wealth-quintile-specific coverage of child survival interventions. The cause-of-death structure among children under-5 was also modelled using the coverage levels. Modelled rates were compared to the rates measured directly from the 2004 Bangladesh Demographic and Health Survey and associated verbal autopsies.Results: Modelled estimates of mortality within wealth quintiles fell within the 95% confidence intervals of measured mortality for both neonatal and post-neonatal mortality. LiST also performed well in predicting the cause-of-death structure for these two age groups for the poorest quintile of the population, but less well for the richest quintile.Conclusions: LiST holds promise as a useful tool for assessing socio-economic inequities in child survival in low-income countries. [ABSTRACT FROM AUTHOR]