Integrated community case management (iCCM) aims to reduce child mortality in areas with poor access to health
care. iCCM was implemented in 2009 in Kono district, Sierra Leone, a postconflict area with high under-five
mortality rates (U5MRs). We evaluated iCCM’s impact and effects on child health using cluster surveys in 2010
(midterm) and 2013 (endline) to compare indicators on child mortality, coverage of appropriate treatment, timely
access to care, quality of care, and recognition of community health workers (CHWs). The sample size was powered
to detect a 28% decline in U5MR. Clusters were selected proportional to population size. All households were
sampled to measure mortality and systematic random sampling was used to measure coverage in a subset of
households. We used program data to evaluate utilization and access; 5,257 (2010) and 3,649 (2013) households
were surveyed. U5MR did not change significantly (4.54 95% confidence interval [CI]: 3.47–5.60] to 3.95 [95% CI:
3.06–4.83] deaths per 1,000 per month (P = 0.4)) though a relative change smaller than 28% could not be detected.
CHWs were the first source of care for 52% (2010) and 50.9% (2013) of children. Coverage of appropriate
treatment of fever by CHWs or peripheral health units increased from 45.5% [95% CI: 39.2–52.0] to 58.2% [95%
CI: 50.5–65.5] (P = 0.01); changes for diarrhea and pneumonia were not significant. The continued reliance on the
CHW as the first source of care and improved coverage for the appropriate treatment of fever support iCCM’s role
in Kono district.