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Ghosh R, Konipo AN, Treleaven E, Rozenshteyn S, Beckerman J, Whidden C, Johnson A, Kayentao K, Liu J. Factors influencing pregnancy care and institutional delivery in rural Mali: a secondary baseline analysis of a cluster-randomised trial. BMJ Open 2024; 14:e084315. [PMID: 38594181 PMCID: PMC11015193 DOI: 10.1136/bmjopen-2024-084315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVE The vast majority of the 300 000 pregnancy-related deaths every year occur in South Asia and sub-Saharan Africa. Increased access to quality antepartum and intrapartum care can reduce pregnancy-related morbidity and mortality worldwide. We used a population-based cross-sectional cohort design to: (1) examine the sociodemographic risk factors and structural barriers associated with pregnancy care-seeking and institutional delivery, and (2) investigate the influence of residential distance to the nearest primary health facility in a rural population in Mali. METHODS A baseline household survey of Malian women aged 15-49 years was conducted between December 2016 and January 2017, and those who delivereda baby in the 5 years preceding the survey were included. This study leverages the baseline survey data from a cluster-randomised controlled trial to conduct a secondary analysis. The outcomes were percentage of women who received any antenatal care (ANC) and institutional delivery; total number of ANC visits; four or more ANC visits; first ANC visit in the first trimester. RESULTS Of the 8575 women in the study, two-thirds received any ANC in their last pregnancy, one in 10 had four or more ANC visits and among those that received any ANC, about one-quarter received it in the first trimester. For every kilometre increase in distance to the nearest facility, the likelihood of the outcomes reduced by 5 percentage points (0.95; 95% CI 0.91 to 0.98) for any ANC; 4 percentage points (0.96; 95% CI 0.94 to 0.98) for an additional ANC visit; 10 percentage points (0.90; 95% CI 0.86 to 0.95) for four or more ANC visits; 6 percentage points (0.94; 95% CI 0.94 to 0.98) for first ANC in the first trimester. In addition, there was a 35 percentage points (0.65; 95% CI 0.56 to 0.76) decrease in likelihood of institutional delivery if the residence was within 6.5 km to the nearest facility, beyond which there was no association with the place of delivery. We also found evidence of increase in likelihood of receiving any ANC care and its intensity increased with having some education or owning a business. CONCLUSION The findings suggest that education, occupation and distance are important determinants of pregnancy and delivery care in a rural Malian context. TRIAL REGISTRATION NUMBER NCT02694055.
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Affiliation(s)
- Rakesh Ghosh
- Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
| | | | - Emily Treleaven
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Sasha Rozenshteyn
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Caroline Whidden
- MUSO, Route de 501 Lodgements SEMA, Bamako, Mali
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Ari Johnson
- MUSO, Route de 501 Lodgements SEMA, Bamako, Mali
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Kassoum Kayentao
- MUSO, Route de 501 Lodgements SEMA, Bamako, Mali
- Malaria Research & Training Centre, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Jenny Liu
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
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Whidden C, Treleaven E, Liu J, Padian N, Poudiougou B, Bautista-Arredondo S, Fay MP, Samaké S, Cissé AB, Diakité D, Keita Y, Johnson AD, Kayentao K. Proactive community case management and child survival: protocol for a cluster randomised controlled trial. BMJ Open 2019; 9:e027487. [PMID: 31455700 PMCID: PMC6720240 DOI: 10.1136/bmjopen-2018-027487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Community health workers (CHWs)-shown to improve access to care and reduce maternal, newborn, and child morbidity and mortality-are re-emerging as a key strategy to achieve health-related Sustainable Development Goals (SDGs). However, recent evaluations of national programmes for CHW-led integrated community case management (iCCM) of common childhood illnesses have not found benefits on access to care and child mortality. Developing innovative ways to maximise the potential benefits of iCCM is critical to achieving the SDGs. METHODS AND ANALYSIS An unblinded, cluster randomised controlled trial in rural Mali aims to test the efficacy of the addition of door-to-door proactive case detection by CHWs compared with a conventional approach to iCCM service delivery in reducing under-five mortality. In the intervention arm, 69 village clusters will have CHWs who conduct daily proactive case-finding home visits and deliver doorstep counsel, care, referral and follow-up. In the control arm, 68 village clusters will have CHWs who provide the same services exclusively out of a fixed community health site. A baseline population census will be conducted of all people living in the study area. All women of reproductive age will be enrolled in the study and surveyed at baseline, 12, 24 and 36 months. The survey includes a life table tracking all live births and deaths occurring prior to enrolment through the 36 months of follow-up in order to measure the primary endpoint: under-five mortality, measured as deaths among children under 5 years of age per 1000 person-years at risk of mortality. ETHICS AND DISSEMINATION The trial has received ethical approval from the Ethics Committee of the Faculty of Medicine, Pharmacy and Dentistry, University of Bamako. The results will be disseminated through peer-reviewed publications, national and international conferences and workshops, and media outlets. TRIAL REGISTRATION NUMBER NCT02694055; Pre-results.
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Affiliation(s)
| | - Emily Treleaven
- Population Studies Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jenny Liu
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Nancy Padian
- School of Public Health, University of California, Berkeley, San Francisco, California, USA
| | | | - Sergio Bautista-Arredondo
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Mexico
| | - Michael P Fay
- Biostatistics Research Branch, National Institutes of Allergy and Infectious Disease, Bethesda, Maryland, USA
| | - Salif Samaké
- Ministry of Health & Social Affairs, Bamako, Mali
| | | | | | | | - Ari D Johnson
- Research, Monitoring & Evaluation, Muso, Bamako, Mali
- ZSFG Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kassoum Kayentao
- Research, Monitoring & Evaluation, Muso, Bamako, Mali
- Malaria Research & Training Centre, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
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Johnson AD, Thiero O, Whidden C, Poudiougou B, Diakité D, Traoré F, Samaké S, Koné D, Cissé I, Kayentao K. Proactive community case management and child survival in periurban Mali. BMJ Glob Health 2018; 3:e000634. [PMID: 29607100 PMCID: PMC5873643 DOI: 10.1136/bmjgh-2017-000634] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 11/12/2022] Open
Abstract
The majority of the world's population lives in urban areas, and regions with the highest under-five mortality rates are urbanising rapidly. This 7-year interrupted time series study measured early access to care and under-five mortality over the course of a proactive community case management (ProCCM) intervention in periurban Mali. Using a cluster-based, population-weighted sampling methodology, we conducted independent cross-sectional household surveys at baseline and at 12, 24, 36, 48, 60, 72 and 84 months later in the intervention area. The ProCCM intervention had five key components: (1) active case detection by community health workers (CHWs), (2) CHW doorstep care, (3) monthly dedicated supervision for CHWs, (4) removal of user fees and (5) primary care infrastructure improvements and staff capacity building. Under-five mortality rate was calculated using a Cox proportional hazard survival regression. We measured the percentage of children initiating effective antimalarial treatment within 24 hours of symptom onset and the percentage of children reported to be febrile within the previous 2 weeks. During the intervention, the rate of early effective antimalarial treatment of children 0-59 months more than doubled, from 14.7% in 2008 to 35.3% in 2015 (OR 3.198, P<0.0001). The prevalence of febrile illness among children under 5 years declined after 7 years of the intervention from 39.7% at baseline to 22.6% in 2015 (OR 0.448, P<0.0001). Communities where ProCCM was implemented have achieved an under-five mortality rate at or below 28/1000 for the past 6 years. In 2015, under-five mortality was 7/1000 (HR 0.039, P<0.0001). Further research is needed to elucidate the mechanisms of action and generalizability of ProCCM.
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Affiliation(s)
- Ari D Johnson
- Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, USA
- Muso, Bamako, Mali, San Francisco, California, USA
| | - Oumar Thiero
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Malaria Research and Training Centre, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | | | | | | | - Salif Samaké
- Ministry of Public Health and Hygiene, Bamako, Mali
| | | | | | - Kassoum Kayentao
- Muso, Bamako, Mali, San Francisco, California, USA
- Malaria Research and Training Centre, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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