Abstract
IntroductionEthiopia 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.MethodsWe 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.ResultsThere 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.ConclusionWe 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 numberISRCTN12040912.
Highlights
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
The Optimising the Health Extension Programme (OHEP) intervention started in some districts in 2016 and was fully operational from the start of 2017 until October 2018
This study found that the OHEP intervention neither had any effect on care-seeking for any illness nor on treatment for diarrhoea or possible pneumonia in children 2–59 months of age
Summary
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. 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. The Ethiopian Demographic and Health Surveys (DHS) showed infant mortality rates at 77, 48 and 43 deaths per 1000 live births, in 2005, 2016 and 2019 reports, respectively.[2,3,4] Between 2005 and 2016, neonatal mortality decreased from 39 to 29 deaths per 1000 live births, but in 2019 had stagnated at around 30. The HEWs are supported by the Women’s Development Army leaders, a network of volunteer women established in 2011, who, along with other development goals, promote healthy practices in the community.[6 7]
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