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Assessing Early Access to Care and Child Survival during a Health System Strengthening Intervention in Mali: A Repeated Cross Sectional Survey

Author

Listed:
  • 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

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

Suggested Citation

  • 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 , 2013. "Assessing Early Access to Care and Child Survival during a Health System Strengthening Intervention in Mali: A Repeated Cross Sectional Survey," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-9, December.
    • Handle: RePEc:plo:pone00:0081304
    DOI: 10.1371/journal.pone.0081304
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    References listed on IDEAS

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    1. Julio Frenk, 2010. "The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress," PLOS Medicine, Public Library of Science, vol. 7(1), pages 1-3, January.
    2. Terra de Souza, A. C. & Peterson, K. E. & Andrade, F. M. O. & Gardner, J. & Ascherio, A., 2000. "Circumstances of post-neonatal deaths in Ceara, Northeast Brazil: mothers' health care-seeking behaviors during their infants' fatal illness," Social Science & Medicine, Elsevier, vol. 51(11), pages 1675-1693, December.
    3. Ardeshir Sepehri & Robert Chernomas, 2001. "Are user charges efficiency- and equity-enhancing? A critical review of economic literature with particular reference to experience from developing countries," Journal of International Development, John Wiley & Sons, Ltd., vol. 13(2), pages 183-209.
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    Cited by:

    1. Jacky MATHONNAT & Martine AUDIBERT, 2017. "Fonds fiduciaires et programmes verticaux : quelles contributions aux politiques sectorielles ?," Working Paper 3ac299f5-d41f-4885-b3d6-2, Agence française de développement.
    2. Barnish, Maxwell S. & Tan, Si Ying & Robinson, Sophie & Taeihagh, Araz & Melendez-Torres, G.J., 2023. "A realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes," Social Science & Medicine, Elsevier, vol. 339(C).
    3. Sautmann,Anja & Brown,Samuel & Kline,Dean Mark, 2020. "Subsidies, Information, and the Timing of Children’s Health Care in Mali," Policy Research Working Paper Series 9486, The World Bank.

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