Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia
Introduction Ethiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capaci...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-09-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e040868.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841555774300487680 |
|---|---|
| author | Joanna Schellenberg Della Berhanu Lars Åke Persson Muluemebet Abera Wordofa Araya Abrha Medhanyie Fisseha Ashebir Gebregizabher Habtamu Beyene Ephrem Tekle Lemango Abebe Bekele Theodros Getachew Mezgebu Yitayal Yemisrach Behailu Okwaraji Atkure Defar Fitsum W/Gebriel Alem Desta Dawit Wolde Daka Alemayehu Hunduma Tigist Getahun Amare Tariku Woldemariam Desta Wolassa |
| author_facet | Joanna Schellenberg Della Berhanu Lars Åke Persson Muluemebet Abera Wordofa Araya Abrha Medhanyie Fisseha Ashebir Gebregizabher Habtamu Beyene Ephrem Tekle Lemango Abebe Bekele Theodros Getachew Mezgebu Yitayal Yemisrach Behailu Okwaraji Atkure Defar Fitsum W/Gebriel Alem Desta Dawit Wolde Daka Alemayehu Hunduma Tigist Getahun Amare Tariku Woldemariam Desta Wolassa |
| author_sort | Joanna Schellenberg |
| collection | DOAJ |
| description | Introduction Ethiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capacity strengthening of primary care workers and reinforcement of district accountability of child health services. We report the intervention’s effectiveness on care utilisation for common childhood illnesses.Methods We included a representative sample of 5773 households with 2874 under-five children at baseline (December 2016 to February 2017) and 10 788 households and 5639 under-five children at endline surveys (December 2018 to February 2019) in intervention and comparison areas. Health facilities were also included. We assessed the effect of the intervention using difference-in-differences analyses.Results There were 31 intervention activities; many were one-off and implemented late. In eight districts, activities were interrupted for 4 months. Care-seeking for any illness in the 2 weeks before the survey for children aged 2–59 months at baseline was 58% (95% CI 47 to 68) in intervention and 49% (95% CI 39 to 60) in comparison areas. At end-line it was 39% (95% CI 32 to 45) in intervention and 34% (95% CI 27 to 41) in comparison areas (difference-in-differences −4 percentage points, adjusted OR 0.49, 95% CI 0.12 to 1.95). The intervention neither had an effect on care-seeking among sick neonates, nor on household participation in community engagement forums, supportive supervision of primary care workers, nor on indicators of district accountability for child health services.Conclusion We found no evidence to suggest that the intervention increased the utilisation of care for sick children. The lack of effect could partly be attributed to the short implementation period of a complex intervention and implementation interruption. Future funding schemes should take into consideration that complex interventions that include behaviour change may need an extended implementation period.Trial registration number ISRCTN12040912. |
| format | Article |
| id | doaj-art-ad16e9fbdfb44f18a387aee79552d3de |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-ad16e9fbdfb44f18a387aee79552d3de2025-01-08T04:50:10ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2020-040868Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of EthiopiaJoanna Schellenberg0Della Berhanu1Lars Åke Persson2Muluemebet Abera Wordofa3Araya Abrha Medhanyie4Fisseha Ashebir Gebregizabher5Habtamu Beyene6Ephrem Tekle Lemango7Abebe Bekele8Theodros Getachew9Mezgebu Yitayal10Yemisrach Behailu Okwaraji11Atkure Defar12Fitsum W/Gebriel13Alem Desta14Dawit Wolde Daka15Alemayehu Hunduma16Tigist Getahun17Amare Tariku Woldemariam18Desta Wolassa1917 Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UKHealth System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, EthiopiaDepartment of Disease Control, Faculty of infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK3 Department of Population and Family Health, Jimma University, Jimma, EthiopiaSchool of Public Health, Mekelle University College of Health Sciences, Mekelle, EthiopiaTigray Regional Health Bureau, Mekelle, EthiopiaSouthern Nations, Nationalities & Peoples Regional Health Bureau, Hawassa, EthiopiaMaternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, EthiopiaUniversity of Global Health Equity, Kigali, RwandaHealth System and Reproductive Health Research Directtorate, Ethiopian Public Health Institute, Addis Ababa, EthiopiaDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaLondon School of Hygiene and Tropical Medicine, London, UKHealth System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, EthiopiaCollege of Medicine and Health Sciences, Hawassa University, Hawassa, EthiopiaSchool of Public Health, College of Health Sciences, Mekelle University, Mekelle, EthiopiaDepartment of Health Policy and Management, Jimma University, Jimma, EthiopiaDepartment of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, EthiopiaInstitute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaDepartment of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaHealth Systems and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, EthiopiaIntroduction Ethiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capacity strengthening of primary care workers and reinforcement of district accountability of child health services. We report the intervention’s effectiveness on care utilisation for common childhood illnesses.Methods We included a representative sample of 5773 households with 2874 under-five children at baseline (December 2016 to February 2017) and 10 788 households and 5639 under-five children at endline surveys (December 2018 to February 2019) in intervention and comparison areas. Health facilities were also included. We assessed the effect of the intervention using difference-in-differences analyses.Results There were 31 intervention activities; many were one-off and implemented late. In eight districts, activities were interrupted for 4 months. Care-seeking for any illness in the 2 weeks before the survey for children aged 2–59 months at baseline was 58% (95% CI 47 to 68) in intervention and 49% (95% CI 39 to 60) in comparison areas. At end-line it was 39% (95% CI 32 to 45) in intervention and 34% (95% CI 27 to 41) in comparison areas (difference-in-differences −4 percentage points, adjusted OR 0.49, 95% CI 0.12 to 1.95). The intervention neither had an effect on care-seeking among sick neonates, nor on household participation in community engagement forums, supportive supervision of primary care workers, nor on indicators of district accountability for child health services.Conclusion We found no evidence to suggest that the intervention increased the utilisation of care for sick children. The lack of effect could partly be attributed to the short implementation period of a complex intervention and implementation interruption. Future funding schemes should take into consideration that complex interventions that include behaviour change may need an extended implementation period.Trial registration number ISRCTN12040912.https://bmjopen.bmj.com/content/10/9/e040868.full |
| spellingShingle | Joanna Schellenberg Della Berhanu Lars Åke Persson Muluemebet Abera Wordofa Araya Abrha Medhanyie Fisseha Ashebir Gebregizabher Habtamu Beyene Ephrem Tekle Lemango Abebe Bekele Theodros Getachew Mezgebu Yitayal Yemisrach Behailu Okwaraji Atkure Defar Fitsum W/Gebriel Alem Desta Dawit Wolde Daka Alemayehu Hunduma Tigist Getahun Amare Tariku Woldemariam Desta Wolassa Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia BMJ Open |
| title | Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia |
| title_full | Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia |
| title_fullStr | Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia |
| title_full_unstemmed | Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia |
| title_short | Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia |
| title_sort | does a complex intervention targeting communities health facilities and district health managers increase the utilisation of community based child health services a before and after study in intervention and comparison areas of ethiopia |
| url | https://bmjopen.bmj.com/content/10/9/e040868.full |
| work_keys_str_mv | AT joannaschellenberg doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT dellaberhanu doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT larsakepersson doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT muluemebetaberawordofa doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT arayaabrhamedhanyie doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT fissehaashebirgebregizabher doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT habtamubeyene doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT ephremteklelemango doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT abebebekele doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT theodrosgetachew doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT mezgebuyitayal doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT yemisrachbehailuokwaraji doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT atkuredefar doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT fitsumwgebriel doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT alemdesta doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT dawitwoldedaka doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT alemayehuhunduma doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT tigistgetahun doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT amaretarikuwoldemariam doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia AT destawolassa doesacomplexinterventiontargetingcommunitieshealthfacilitiesanddistricthealthmanagersincreasetheutilisationofcommunitybasedchildhealthservicesabeforeandafterstudyininterventionandcomparisonareasofethiopia |