Assessing Early Access to Care and Child Survival during a Health System Strengthening Intervention in Mali: A Repeated Cross Sectional Survey
Open Access
- 11 December 2013
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 8 (12), e81304
- https://doi.org/10.1371/journal.pone.0081304
Abstract
In 2012, 6.6 million children under age five died worldwide, most from diseases with known means of prevention and treatment. A delivery gap persists between well-validated methods for child survival and equitable, timely access to those methods. We measured early child health care access, morbidity, and mortality over the course of a health system strengthening model intervention in Yirimadjo, Mali. The intervention included Community Health Worker active case finding, user fee removal, infrastructure development, community mobilization, and prevention programming. We conducted four household surveys using a cluster-based, population-weighted sampling methodology at baseline and at 12, 24, and 36 months. We defined our outcomes as the percentage of children initiating an effective antimalarial within 24 hours of symptom onset, the percentage of children reported to be febrile within the previous two weeks, and the under-five child mortality rate. We compared prevalence of febrile illness and treatment using chi-square statistics, and estimated and compared under-five mortality rates using Cox proportional hazard regression. There was a statistically significant difference in under-five mortality between the 2008 and 2011 surveys; in 2011, the hazard of under-five mortality in the intervention area was one tenth that of baseline (HR 0.10, pp = 0.0009). The percentage of children starting an effective antimalarial within 24 hours of symptom onset was nearly twice that reported at baseline (PR = 1.89, p = 0.0195). Community-based health systems strengthening may facilitate early access to prevention and care and may provide a means for improving child survival.This publication has 26 references indexed in Scilit:
- Does implementation of the IMCI strategy have an impact on child mortality? A retrospective analysis of routine data from EgyptBMJ Open, 2013
- A tipping point for child survival, health, and nutritionThe Lancet, 2012
- Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysisThe Lancet, 2011
- Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effectBMC Public Health, 2011
- Using the three delays model to understand why newborn babies die in eastern UgandaTropical Medicine & International Health, 2010
- Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970–2010: a systematic analysis of progress towards Millennium Development Goal 4The Lancet, 2010
- Global, regional, and national causes of child mortality in 2008: a systematic analysisThe Lancet, 2010
- Taskforce on Innovative International Financing for Health Systems: showing the way forwardBulletin of the World Health Organization, 2010
- The Global Health System: Strengthening National Health Systems as the Next Step for Global ProgressPLoS Medicine, 2010
- The role of community health workers in improving child health programmes in MaliBMC International Health and Human Rights, 2009