Integrated Community Based Health Systems Strengthening in Northern Togo: A Preliminary Mixed-Methods Study in Kozah District
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Maternal-Child Health Services
- Sponsor
- Integrate Health
- Enrollment
- 1500
- Locations
- 1
- Primary Endpoint
- Under-five year old mortality rate, annual
- Last Updated
- 6 years ago
Overview
Brief Summary
This preliminary study aims to inform the design and delivery of the integrated facility and community-based health systems strengthening (ICBHSS) model in four Kozah District health facilities over a period of 48 months. Specific aims include: (1) Assess maternal and child health outcomes and health service utilization rates in the 4 ICBHSS model intervention sites catchment areas; (2) Identify barriers to and facilitators of access and quality services related to ICBHSS model; and (3) Assess changes in health care services coverage, effectiveness, and adoption of ICBHSS model.
Detailed Description
Intervention: The investigators have adapted an integrated facility and community-based health systems strengthening (ICBHSS) model to improve primary healthcare services in Togo. The ICBHSS model includes a bundle of evidence based interventions including (1) community engagement meetings and feedback; (2) the elimination of facility user fees for children under five and pregnant women; (3) pro-active community based IMCI using Community Health Workers (CHWs) with additional services including linkage to family planning and counseling, HIV testing \& referrals; (4) clinical mentoring and enhanced supervision at public sector facilities; and (5) improved supply chain management and facility structures. Study: The investigators will conduct a mixed methods assessment, using the RE-AIM framework to evaluate the impact and implementation of the ICBHSS initiative in Kozah district. It will include: (1) a repeated cross-sectional study to obtain annual coverage, effectiveness, and adoption metrics using a population-based household survey as well as (2) qualitative key informant interviews and focus group discussions conducted at 12 months for each intervention health facility. The primary outcome will be under 5 year old mortality rate, with secondary outcomes including under-one mortality rate, maternal mortality rate, as well as maternal and child health service utilization.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Female of reproductive age (aged 15-49 years)
- •Individuals aged 15-17 years will only be included if they have children and/or are pregnant
- •Lives in selected household within study catchment area
- •Informed consent is obtained for participants 18-49
- •Waiver of parental permission is obtained for 15-17 year-old participants
Exclusion Criteria
- Not provided
Outcomes
Primary Outcomes
Under-five year old mortality rate, annual
Time Frame: 72 months
The under-five mortality rate (expressed as a rate per 1,000 live births) is the probability of a child dying in a specified year between birth and 5 years of age.
Secondary Outcomes
- Maternal mortality rate, annual(72 months)
- Maternal facility based birth delivery incidence rate, annual(72 months)
- Protocol adherence by clinical staff at IH intervention facilities in iCCM and maternal consultations(72 months)
- Annual proportion of children under age five reported to have a cough in the prior two weeks who received an effective pneumonia treatment within 24 hours of symptom onset.(72 months)
- Protocol Adherence by IH community health workers in iCCM and maternal consultations(72 months)
- Under-one year old mortality rate, annual(72 months)
- Annual proportion of children under age five reported to be febrile in the prior two weeks who received an effective antimalarial treatment within 24 hours of symptom onset.(72 months)
- Annual proportion of children under age five reported to have diarrhea in the prior two weeks who received an effective treatment for diarrheal disease within 24 hours of symptom onset.(72 months)