Background: According to KDHS 2008/9 the under 5-mortality rate has dropped from 115 per 1000 in 2003 KDHS, to 74 per 1000 in 2008, this represents an annual decline rate of 0.9%. Unless this rate is accelerated to at least 4.5%, Kenya is unlikely to meet MDG 4 by 2015. Integrated community case management (iCCM) coupled together with the administration of vitamin A supplements (VAS), is an important and viable option of reducing the mortality of children under the age of five due to pneumonia, malaria and diarrhea. Implementation of the iCCM in Kenya still remains inadequate. The main challenges to implementation include: inadequate training among the CHWs including little follow up post training in iCCM.

The main objective is to determine whether trained, supervised and well supplied community health workers in hard to reach areas such as Homabay County can administer Vitamin A Supplements (VAS) and correctly perform iCCM and increase the proportion of children under five years receiving antibiotics for pneumonia, artementher-lumefantrine for malaria and zinc and oral rehydration therapy for diarrhoea by 20% compared to the baseline. On the other hand, despite efforts to improve vitamin A status among children through supplementation, advocacy for dietary diversification, bio fortification, industrial and home fortification of essential food commodities, VAD still remains a major public health problem in Kenya.  Studies have shown that about 42% of children under the age of five years in Sub Saharan Africa are at risk of VAD with Kenya at 76%. Achievement of Millennium Development Goal 4 of reducing under five mortality by two third by 2015, requires addressing or enhancing factors that contribute to child survival and development. Such factors include vitamin A supplementation and the integration of iCCM which will go a long way in reducing both maternal and child deaths.

Methodology: The study will employ a pre and post design to compare iCCM and VAS health and process outcomes in Homabay County in Nyanza Province, Kenya during the intervention period, with those during a pre-intervention period. We will implement iCCM and VAS in a stepwise manner using a four-prong approach. The four prongs are 1) Sensitization of national, district, health center and community teams on iCCM and VAS 2) Training of the Community Health Extension Workers (CHEWS), CHWs and health care workers 3) Supervision and motivation of CHWs and 4) Commodity provision and accountability.