Abstract
Objective: The purpose of this qualitative case study was to assess the feasibility of scaling up exclusive breastfeeding for 6 months, antibiotics for pneumonia and integrated management of childhood illness (IMCI) child interventions in three districts of the Cusco region, Peru. Methods: During field visits, constraints, synergies and solutions to the implementation of the selected interventions were collected through observational recording and interviews of mothers, health workers, and health managers/decision makers. Results are presented for each intervention according to the health system level where they occurred: mother/community, health worker, health centre, and political/managerial levels. Findings: This case study demonstrates that it is feasible to scale up exclusive breastfeeding, antibiotics for pneumonia and IMCI interventions in poverty-stricken rural areas of a low-income country. Factors that helped and hindered the implementation were identified for each intervention. Conclusions: The need for a coherent multi-sector approach that includes regulation, implementation and monitoring of health policies and education of all involved stakeholders was apparent. This study also demonstrates that global health interventions need to undergo local adaptation. Identifying local constraints and facilitating factors in a systematic way as proposed in this study is a useful step to increase their effectiveness and reach at the local level and to identify areas for improvement in the original intervention policies.
Highlights
The global mortality rate in children younger than 5 years fell by 28%, from an estimated 90 deaths per 1000 live births in 1990, to 65 deaths per 1000 live births in 20081
The purpose was to find out implementation characteristics of exclusive breastfeeding for 6 months, antibiotics for pneumonia and Integrated Management of Childhood Illness (IMCI) child interventions in order to scale them up
Exclusive breastfeeding for 6 months intervention Mother/community level Most barriers (55%) to exclusive breastfeeding (EBF) for 6 months correspond to the mother/community level (Table 2)
Summary
The global mortality rate in children younger than 5 years fell by 28%, from an estimated 90 deaths per 1000 live births in 1990, to 65 deaths per 1000 live births in 20081. Continued success towards achieving the Millennium Development Goal to reduce child mortality by twothirds of the 1990 rate depends on renewed efforts to prevent and control pneumonia, diarrhoea, malaria and malnutrition[1,3]. According to the Countdown Report (2010), the median coverage of exclusive breastfeeding in the 68 Countdown countries was only 34%1. Antibiotics for pneumonia was identified as a treatment intervention, that if implemented with 99% coverage could reduce under-five mortality by 6%5,6. According to the Countdown Report (2010) the median coverage of antibiotics for pneumonia in the 68 Countdown countries was 27%1. Substantial progress has been made in reducing mortality and improving coverage, two major challenges remain: how to improve the quality of health interventions, and how to reach the most disadvantaged children[7,8]
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