Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Dec 11;8(12):e81304.
doi: 10.1371/journal.pone.0081304. eCollection 2013.

Assessing early access to care and child survival during a health system strengthening intervention in Mali: a repeated cross sectional survey

Ari D Johnson  1 , Dana R Thomson  2 , Sidney Atwood  3 , Ian Alley  4 , Jessica L Beckerman  1 , Ichiaka Koné  4 , Djoumé Diakité  4 , Hamed Diallo  5 , Boubacar Traoré  5 , Klenon Traoré  5 , Paul E Farmer  6 , Megan Murray  7 , Joia Mukherjee  6
Affiliations

Assessing early access to care and child survival during a health system strengthening intervention in Mali: a repeated cross sectional survey

Ari D Johnson et al. PLoS One. .

Abstract

Background: 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.

Methods and findings: 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).

Conclusions: Community-based health systems strengthening may facilitate early access to prevention and care and may provide a means for improving child survival.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Patient Visits Before and After the Launch of the Health System Strengthening Intervention.
Figure 2
Figure 2. Under-Five Mortality in Muso Catchment Area Compared to Trends in Under-Five Mortality in Urban Areas and Nationally.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. You D, Bastian P, Wu J, Wardlaw T, on behalf of the United Nations Inter-agency Group for Child Mortality Estimation (2013) Levels and Trends in Child Mortality: Report 2013. Available: http://www.childmortality.org/files_v14/download/UNICEF%202013%20IGME%20.... Accessed 2013 Sep 22.
    1. Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, et al. (2011) Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet 378(9797): 1139–1165. - PubMed
    1. Rajaratnam JK, Marcus JR, Flaxman AD, Wang H, Levin-Rector A, et al. (2010) Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970–2010: a systematic analysis of progress towards Millennium Development Goal 4. Lancet 375(9730): 1988–2008. - PubMed
    1. Lake A (2012) A tipping point for child survival, health, and nutrition. Lancet 380: 1286–1287. - PubMed
    1. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, et al. (2010) Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375(9730): 1969–87. - PubMed

Publication types