Assessing early access to care and child survival during a health system strengthening intervention in Mali: a repeated cross sectional survey.
<h4>Background</h4>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 chil...
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2013
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oai:doaj.org-article:58d39850569b4947ac71eaa5d36a97e92021-11-18T08:42:32ZAssessing early access to care and child survival during a health system strengthening intervention in Mali: a repeated cross sectional survey.1932-620310.1371/journal.pone.0081304https://doaj.org/article/58d39850569b4947ac71eaa5d36a97e92013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24349053/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods and findings</h4>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, p<0.0001). After three years of the intervention, the prevalence of febrile illness among children under five was significantly lower, from 38.2% at baseline to 23.3% in 2011 (PR = 0.61, p = 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).<h4>Conclusions</h4>Community-based health systems strengthening may facilitate early access to prevention and care and may provide a means for improving child survival.Ari D JohnsonDana R ThomsonSidney AtwoodIan AlleyJessica L BeckermanIchiaka KonéDjoumé DiakitéHamed DialloBoubacar TraoréKlenon TraoréPaul E FarmerMegan MurrayJoia MukherjeePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 12, p e81304 (2013) |
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Medicine R Science Q |
| spellingShingle |
Medicine R Science Q Ari D Johnson Dana R Thomson Sidney Atwood Ian Alley Jessica L Beckerman Ichiaka Koné Djoumé Diakité Hamed Diallo Boubacar Traoré Klenon Traoré Paul E Farmer Megan Murray Joia Mukherjee Assessing early access to care and child survival during a health system strengthening intervention in Mali: a repeated cross sectional survey. |
| description |
<h4>Background</h4>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.<h4>Methods and findings</h4>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, p<0.0001). After three years of the intervention, the prevalence of febrile illness among children under five was significantly lower, from 38.2% at baseline to 23.3% in 2011 (PR = 0.61, p = 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).<h4>Conclusions</h4>Community-based health systems strengthening may facilitate early access to prevention and care and may provide a means for improving child survival. |
| format |
article |
| author |
Ari D Johnson Dana R Thomson Sidney Atwood Ian Alley Jessica L Beckerman Ichiaka Koné Djoumé Diakité Hamed Diallo Boubacar Traoré Klenon Traoré Paul E Farmer Megan Murray Joia Mukherjee |
| author_facet |
Ari D Johnson Dana R Thomson Sidney Atwood Ian Alley Jessica L Beckerman Ichiaka Koné Djoumé Diakité Hamed Diallo Boubacar Traoré Klenon Traoré Paul E Farmer Megan Murray Joia Mukherjee |
| author_sort |
Ari D Johnson |
| title |
Assessing early access to care and child survival during a health system strengthening intervention in Mali: a repeated cross sectional survey. |
| title_short |
Assessing early access to care and child survival during a health system strengthening intervention in Mali: a repeated cross sectional survey. |
| title_full |
Assessing early access to care and child survival during a health system strengthening intervention in Mali: a repeated cross sectional survey. |
| title_fullStr |
Assessing early access to care and child survival during a health system strengthening intervention in Mali: a repeated cross sectional survey. |
| title_full_unstemmed |
Assessing early access to care and child survival during a health system strengthening intervention in Mali: a repeated cross sectional survey. |
| title_sort |
assessing early access to care and child survival during a health system strengthening intervention in mali: a repeated cross sectional survey. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2013 |
| url |
https://doaj.org/article/58d39850569b4947ac71eaa5d36a97e9 |
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