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IntroductionBurkina Faso is facing a serious public health problem of chronic malnutrition and mortality in children under the age of 5. To tackle this situation, a number of child nutrition interventions have been implemented. This study aims to assess the impact of these interventions on the nutritional status of children aged 0–5 years between 2018 and 2022.MethodsThis study is a modeling of the impact of changes in the coverage of interventions with known effect sizes, using the LiST (Lives Saved Tool). The interventions used concern infant and young child feeding, the coverage of which was measured by the 2018 to 2022 editions of the NNS conducted in Burkina Faso using the SMART methodology. It covered the national level, the Center region and the Sahel region. Extracted intervention coverage levels were entered into LiST, according to six projections in two scenarios (scenario 1 and 2). The modeling results visualized in LiST were exported to Excel for formatting into tables and/or graphs.ResultsThe measured changes in the levels of infant and young child feeding interventions included in this study led to a reduction in the number of cases of chronic malnutrition in children under 6 months of age in the second scenario projections. However, no cases of chronic malnutrition were prevented among children in the 6–59 month age group under any of the six projections. On the contrary, opportunities to save cases of chronic malnutrition have been missed. These missed opportunities amount to 64,880 in scenario 1 and 39,556 in scenario 2 at national level. Nevertheless, 920 lives were saved nationwide, 232 in the Center region and 202 in the Sahel region.ConclusionThe study highlighted the need to strengthen the implementation of IYCF interventions, coupled with a significant improvement in the quality of NNS data collection, given the up and down nature of the indicators, which makes them difficult to use for decision-making.

Introduction Despite recommendations from the WHO, antenatal care (ANC) coverage remains low in many low-income and middle-income countries (LMICs). Community health workers (CHWs) can play an important role in expanding ANC coverage through pregnancy identification, provision of health education, screening for complications, delivery of therapeutic care and referral to higher levels of care. However, despite the success of CHW programmes in various countries, WHO has called for additional research to develop evidence-based models that optimise CHW service delivery and that can be replicated across geographies.Methods The ProCCM Trial was a cluster-randomised controlled trial to compare proactive home visits by CHWs (intervention, 69 village clusters) to the provision of CHW care at community fixed sites only (control, 68 village clusters) in the Bankass health district in Central Mali. In this study, we conducted a cost-effectiveness analysis of proactive CHW home visits in improving ANC utilisation, a secondary outcome of the ProCCM trial. We analysed five ANC outcomes: (1) number of ANC contacts, (2) at least one ANC contact, (3) at least four ANC contacts, (4) at least eight ANC contacts and (5) ANC initiated in the first trimester. We assumed two perspectives, a CHW programme’s and the Full ANC programme’s perspective, which included facility-based as well as community-based ANC. We estimated programme costs, incremental cost-effectiveness ratios (ICERs) and probabilities of the intervention being more cost-effective than the control at different willingness-to-pay (WTP) thresholds.Results Proactive home visits were cost-saving from the CHW programme’s perspective (ICERs: −$21.39 to −$79.20 per ANC utilisation outcome) and from the Full ANC programme perspective (ICERs: −$1.70 to −$6.30 per ANC utilisation outcome) compared with the fixed-site CHW care. The likelihood of the intervention being more cost-effective than the control was 100% at WTP thresholds $0 per ANC utilisation outcome and between $12.5 and $50.00 per ANC utilisation outcome in the CHW- and Full ANC programme perspectives, respectively.Conclusion Our results provide evidence that proactive home visits produce more value per dollar spent as a means of improving the uptake of ANC services compared with fixed-site CHW services.Trial registration number NCT02694055.

ABSTRACTGlobally, anaemia prevails as a public health issue, being also a concern in Mozambique, where about two-thirds of children 6–59 months of age are affected by this condition. We carried out this study to estimate anaemia prevalence and evaluate structural determinants and haematological parameters association among children aged 6–59 months attending pediatric inpatient and outpatient services in a Quaternary Health Facility in Maputo City Province, Mozambique. We collected data from 637 inpatients or outpatients who attended pediatric consultations at the Maputo Central Hospital. The overall rate of anaemia in children aged 6–59 months was 62.2% (396/637), with 30.9% moderate anaemia (197/637), 23.9% mild anaemia (152/637), and 7.4% severe anaemia (47/637). Among our study participants, critical factors for anaemia were those concerning the age group, child´s caregiver schooling, malaria and size of the liver.

Résumé Contexte Au Mali, où seulement 15% des femmes en âge de procréer utilisent les contraceptifs modernes, la compréhension des réalités des femmes et de la conception du système de santé aident à éclairer les stratégies pour atteindre l’objectif national de 30% d’ici 2023. Méthodes En utilisant les données d’enquête de base d’un essai randomisé en grappes, avec la géolocalisation précise de tous les ménages et centres de santé publiques, nous avons utilisé un modèle à plusieurs niveaux pour évaluer l’influence de l’individu, du ménage, de la communauté et du système de santé sur l’utilisation de la contraception moderne. Nous avons utilisé la régression logistique à effets mixtes pour mesurer l’autonomisation et ses sources socio-économiques (éducation, travail rémunéré), les influences intra-ménages sous forme d’une utilisatrice co-résidante et les facteurs structurels liés au système de santé. Résultats Moins de 5% des 14 032 femmes en âge de procréer utilisaient la contraception moderne au moment de l’enquête. Les femmes jouant un rôle dans la prise de décision, celles ayant une éducation formelle, un travail rémunéré, étaient plus susceptibles d’utiliser les contraceptifs modernes. Les femmes avaient trois fois plus de chances de faire la contraception moderne si elles vivaient dans un ménage avec une autre femme, généralement une coépouse, qui utilisait une méthode moderne. Comparées aux femmes les plus proches d’un centre de santé, celles qui vivaient entre 2 and 5 kilomètres étaient deux fois moins susceptibles d’utiliser un contraceptif moderne et celles entre 5 and 10 étaient plus susceptibles dans un tiers des cas. Conclusions Malgré une faible disponibilité des services dans toute la zone d’étude, certaines femmes—même celles en cohabitation—ont pu surmonter les barrières à l’utilisation des contraceptifs modernes. Lors de la planification et de la mise en œuvre de stratégies pour élargir l’accès à la contraception, les décideurs et les praticiens devraient tenir compte de l’autonomisation des femmes, des réseaux sociaux, et de la conception du système de santé. Les systèmes de santé accessibles et efficaces devraient reconsidérer l’approche conventionnelle de la prestation de services communautaires, en prenant en compte la distance même à moins de 5 kilomètres.

Background Proactive community case management (ProCCM) has shown promise to advance goals of universal health coverage (UHC). ProCCM community health workers (CHWs) face operational challenges when pursuing their goal of visiting every household in their service area at least twice monthly to proactively find sick patients. We developed a software extension (UHC Mode) to an existing CHW mobile application featuring user interface design improvements to support CHWs in planning daily home visits. We evaluated the effect of UHC Mode on minimum expected home visit coverage.Methods We conducted a parallel-group, two-arm randomised controlled trial of ProCCM CHWs in two separate regions in Mali. CHWs were randomly assigned to UHC Mode or the standard mobile application (control) with a 1:1 allocation. Randomisation was stratified by health catchment area. CHWs and other programme personnel were not masked to arm allocation. CHWs used their assigned intervention for 4 months. Using a difference-in-differences analysis, we estimated the mean change in minimum expected home visit coverage from preintervention to postintervention between arms.Results Enrolment occurred in January 2019. Of 199 eligible CHWs randomised to the intervention or control arm, 196 were enrolled and 195 were included in the analysis. Households whose CHW used UHC Mode had 2.41 times higher odds of minimum expected home visit coverage compared with households whose CHW used the control (95% CI 1.68 to 3.47; p

Abstract Background Mali is one of four countries implementing a National Evaluation Platform (NEP) to build local capacity to answer evaluation questions for maternal, newborn, child health and nutrition (MNCH&N). In 2014-15, NEP-Mali addressed questions about the potential impact of Mali’s MNCH&N plans and strategies, and identified priority interventions to achieve targeted mortality reductions. Methods The NEP-Mali team modeled the potential impact of three intervention packages in the Lives Saved Tool (LiST) from 2014 to 2023. One projection included the interventions and targets from Mali’s ten-year health strategy (PDDSS) for 2014-2023, and two others modeled intervention packages that included scale up of antenatal, intrapartum, and curative interventions, as well as reductions in stunting and wasting. We modeled the change in maternal, newborn and under-five mortality rates under these three projections, as well as the number of lives saved, overall and by intervention. Results If Mali were to achieve the MNCH&N coverage targets from its health strategy, under-5 mortality would be reduced from 121 per 1000 live births to 93 per 1000, far from the target of 69 deaths per 1000. Projections 1 and 2 produced estimated mortality reductions from 121 deaths per 1000 to 70 and 68 deaths per 1000, respectively. With respect to neonatal mortality, the mortality rate would be reduced from 39 to 32 deaths per 1000 live births under the current health strategy, and to 25 per 1000 under projections 1 and 2. Conclusions This study revealed that achieving the coverage targets for the MNCH&N interventions in the 2014-23 PDDSS would likely not allow Mali to achieve its mortality targets. The NEP-Mali team was able to identify two packages of MNCH&N interventions (and targets) that achieved under-5 and neonatal mortality rates at, or very near, the PDDSS targets. The Malian Ministry of Health and Public Hygiene is using these results to revise its plans and strategies.

Introduction Universal Health Coverage (UHC) is a critical goal under the Sustainable Development Goals (SDGs) for health. Achieving this goal for reproductive, maternal, newborn and child health (RMNCH) service coverage will require an understanding of national progress and how socioeconomic and demographic subgroups of women and children are being reached by health interventions.Methods We accessed coverage databases produced by the International Centre for Equity in Health, which were based on reanalysis of Demographic and Health Surveys, Multiple Indicator Cluster Surveys and Reproductive and Health Surveys. We limited the data to 58 countries with at least two surveys since 2008. We fitted multilevel linear regressions of coverage of RMNCH, divided into four main components—reproductive health, maternal health, child immunisation and child illness treatment—to estimate the average annual percentage point change (AAPPC) in coverage for the period 2008–2017 across these countries and for subgroups defined by maternal age, education, place of residence and wealth quintiles. We also assessed change in the pace of coverage progress between the periods 2000–2008 and 2008–2017.Results Progress in RMNCH coverage has been modest over the past decade, with statistically significant AAPPC observed only for maternal health (1.25, 95% CI 0.90 to 1.61) and reproductive health (0.83, 95% CI 0.47 to 1.19). AAPPC was not statistically significant for child immunisation and illness treatment. Progress, however, varied largely across countries, with fast or slow progressors spread throughout the low-income and middle-income groups. For reproductive and maternal health, low-income and lower middle-income countries appear to have progressed faster than upper middle-income countries. For these two components, faster progress was also observed in older women and in traditionally less well-off groups such as non-educated women, those living in rural areas or belonging to the poorest or middle wealth quintiles than among groups that are well off. The latter groups however continue to maintain substantially higher coverage levels over the former. No acceleration in RMNCH coverage was observed when the periods 2000–2008 and 2008–2017 were compared.Conclusion At the dawn of the SDGs, progress in coverage in RMNCH remains insufficient at the national level and across equity dimensions to accelerate towards UHC by 2030. Greater attention must be paid to child immunisation to sustain the past gains and to child illness treatment to substantially raise its coverage across all groups.

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.