TY - JOUR
T1 - An integrated primary care initiative for child health in northern Togo
AU - Fiori, Kevin P.
AU - Lauria, Molly E.
AU - Singer, Amanda W.
AU - Jones, Heidi E.
AU - Belli, Hayley M.
AU - Aylward, Patrick T.
AU - Agoro, Sibabe
AU - Gbeleou, Sesso
AU - Sowu, Etonam
AU - Grunitzky-Bekele, Meskerem
AU - Goodwin, Alicia Singham
AU - Morrison, Melissa
AU - Ekouevi, Didier K.
AU - Hirschhorn, Lisa R.
N1 - Publisher Copyright:
Copyright © 2021 by the American Academy of Pediatrics
PY - 2021/9/1
Y1 - 2021/9/1
N2 - OBJECTIVES: To determine if the Integrated Community-Based Health Systems-Strengthening (ICBHSS) initiative was effective in expanding health coverage, improving care quality, and reducing child mortality in Togo. METHODS: Population-representative cross-sectional household surveys adapted from the Demographic Household Survey and Multiple Indicator Cluster Surveys were conducted at baseline (2015) and then annually (2016–2020) in 4 ICBHSS catchment sites in Kara, Togo. The primary outcome was under-5 mortality, with health service coverage and health-seeking behavior as secondary outcomes. Costing analyses were calculated by using “top-down” methodology with audited financial statements and programmatic data. RESULTS: There were 10 022 household surveys completed from 2015 to 2020. At baseline (2015), under-5 mortality was 51.1 per 1000 live births (95% confidence interval [CI]: 35.5–66.8), and at the study end period (2020), under-5 mortality was 35.8 (95% CI: 23.4–48.2). From 2015 to 2020, home-based treatment by a community health worker increased from 24.1% (95% CI: 21.9%–26.4%) to 45.7% (95% CI: 43.3%–48.2%), and respondents reporting prenatal care in the first trimester likewise increased (37.5% to 50.1%). Among respondents who sought care for a child with fever, presenting for care within 1 day increased from 51.9% (95% CI: 47.1%–56.6%) in 2015 to 80.3% (95% CI: 74.6%–85.0%) in 2020. The estimated annual additional intervention cost was $8.84 per person. CONCLUSIONS: Our findings suggest that the ICBHSS initiative, a bundle of evidence-based interventions implemented with a community-based strategy, improves care access and quality and was associated with reduction in child mortality.
AB - OBJECTIVES: To determine if the Integrated Community-Based Health Systems-Strengthening (ICBHSS) initiative was effective in expanding health coverage, improving care quality, and reducing child mortality in Togo. METHODS: Population-representative cross-sectional household surveys adapted from the Demographic Household Survey and Multiple Indicator Cluster Surveys were conducted at baseline (2015) and then annually (2016–2020) in 4 ICBHSS catchment sites in Kara, Togo. The primary outcome was under-5 mortality, with health service coverage and health-seeking behavior as secondary outcomes. Costing analyses were calculated by using “top-down” methodology with audited financial statements and programmatic data. RESULTS: There were 10 022 household surveys completed from 2015 to 2020. At baseline (2015), under-5 mortality was 51.1 per 1000 live births (95% confidence interval [CI]: 35.5–66.8), and at the study end period (2020), under-5 mortality was 35.8 (95% CI: 23.4–48.2). From 2015 to 2020, home-based treatment by a community health worker increased from 24.1% (95% CI: 21.9%–26.4%) to 45.7% (95% CI: 43.3%–48.2%), and respondents reporting prenatal care in the first trimester likewise increased (37.5% to 50.1%). Among respondents who sought care for a child with fever, presenting for care within 1 day increased from 51.9% (95% CI: 47.1%–56.6%) in 2015 to 80.3% (95% CI: 74.6%–85.0%) in 2020. The estimated annual additional intervention cost was $8.84 per person. CONCLUSIONS: Our findings suggest that the ICBHSS initiative, a bundle of evidence-based interventions implemented with a community-based strategy, improves care access and quality and was associated with reduction in child mortality.
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U2 - 10.1542/peds.2020-035493
DO - 10.1542/peds.2020-035493
M3 - Review article
C2 - 34452981
AN - SCOPUS:85114431559
SN - 0031-4005
VL - 148
JO - Pediatrics
JF - Pediatrics
IS - 3
M1 - e2020035493
ER -