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Ezran C., Bonds M. H., Miller A. C., Cordier L. F., Haruna J., Mwanawabenea D., Randriamanambintsoa M., Razanadrakato H. T. R., Ouenzar M. A., Razafinjato B. R., Murray M., Garchitorena Andres. (2019). Assessing trends in the content of maternal and child care following a health system strengthening initiative in rural Madagascar : a longitudinal cohort study. PLoS Medicine, 16 (8), e1002869 [23 p.]. ISSN 1549-1277

Fichier PDF disponiblehttp://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers19-10/010077075.pdf[ PDF Link ]

Lien direct chez l'éditeur doi:10.1371/journal.pmed.1002869

Titre
Assessing trends in the content of maternal and child care following a health system strengthening initiative in rural Madagascar : a longitudinal cohort study
Année de publication2019
Type de documentArticle référencé dans le Web of Science WOS:000489050500017
AuteursEzran C., Bonds M. H., Miller A. C., Cordier L. F., Haruna J., Mwanawabenea D., Randriamanambintsoa M., Razanadrakato H. T. R., Ouenzar M. A., Razafinjato B. R., Murray M., Garchitorena Andres.
SourcePLoS Medicine, 2019, 16 (8), p. e1002869 [23 p.]. p. e1002869 [23 p.] ISSN 1549-1277
RésuméAuthor summary Why was this study done? One of the largest contributors to preventable deaths in low- and middle-income countries is poor quality of care delivered by the public health system. Yet, given the multiple dimensions of care quality, there are currently no standard measures to evaluate impacts in this domain. While health system strengthening (HSS) initiatives strive to simultaneously increase access to healthcare and improve care quality, few studies have evaluated the impact of HSS initiatives on both targets. Our study sought to determine whether an HSS intervention in a rural health district of Madagascar, one of the world's poorest countries, improved the quality of maternal and child care at the population level. What did the researchers do and find? We used data from a district-representative open longitudinal cohort that followed over 1,500 households between 2014 and 2016, in order to compare trends in the content of care as a proxy for care quality, inside and outside the intervention catchment, through difference-in-differences analyses. We also analysed data from a Service Availability and Readiness Assessment (SARA) conducted in health facilities supported by the HSS intervention. Our data set included self-reported information on health seeking behaviors and care content for common illnesses of children under five ( = 657 in 2014; 411 in 2016), and for maternal care before and during live births that occurred in the previous two years ( = 552 in 2014; 524 in 2016). nnWe found that compared to the non-intervention group, the intervention group experienced a larger improvement in most care content outputs for childhood illnesses (e.g., 24.4% more children with diarrhea were prescribed oral rehydration therapy after two years than in the non-intervention area) and for perinatal care, whereas trends in antenatal care content were more similar in both populations. Despite progress, there remained important gaps in the provision of essential health services for individuals in both the intervention and non-intervention groups. What do these findings mean? The study provides evidence that HSS initiatives can successfully increase access to healthcare in target populations while also improving the quality of certain primary care services provided. The approach used here can be adapted to other local HSS initiatives to stimulate more comprehensive impact evaluations. Evidence from this study can help guide investments in integrated primary care systems that are needed globally to improve maternal and child care. The interpretation of the study findings is limited by the absence of randomization in the allocation of the intervention's programs and by the reliance on self-reported answers. Background In order to reach the health-related Sustainable Development Goals (SDGs) by 2030, gains attained in access to primary healthcare must be matched by gains in the quality of services delivered. Despite the broad consensus around the need to address quality, studies on the impact of health system strengthening (HSS) have focused predominantly on measures of healthcare access. Here, we examine changes in the content of maternal and child care as a proxy for healthcare quality, to better evaluate the effectiveness of an HSS intervention in a rural district of Madagascar. The intervention aimed at improving system readiness at all levels of care (community health, primary health centers, district hospital) through facility renovations, staffing, equipment, and training, while removing logistical and financial barriers to medical care (e.g., ambulance network and user-fee exemptions). Methods and findings We carried out a district-representative open longitudinal cohort study, with surveys administered to 1,522 households in the Ifanadiana district of Madagascar at the start of the HSS intervention in 2014, and again to 1,514 households in 2016. We examined changes in healthcare seeking behavior and outputs for sick-child care among children <5 years old, as well as for antenatal care and perinatal care among women ag
Plan de classementSanté : généralités [050] ; Santé : aspects socioculturels, économiques et politiques [056]
Descr. géo.MADAGASCAR
LocalisationFonds IRD [F B010077075]
Identifiant IRDfdi:010077075
Lien permanenthttp://www.documentation.ird.fr/hor/fdi:010077075

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