Evaluation Of The Integrated Care Model: Child Morbidity Reduction In Mashonaland East, Zimbabwe

Abstract

Zimbabwe has one of the highest prevalence rates on preventable child morbidity in the world. This is mainly attributable to the absence of an effective community health mobilisation structure that reaches all targeted households with correct and consistent social behaviour change interventions for better child and maternal health.
 To address this, a cluster randomised controlled trial was conducted to assess the effectiveness of a developed integrated community intervention approach in reducing child morbidity and improving maternal health outcomes. A total of 765 mother-child pairs (413 in the intervention and 352 in the control) from 2 districts in Mashonaland East province were recruited and followed up for 12 months. Only women with children aged 0 - 48 months at the beginning of the study were selected. Participants were selected (and recruited) through stratified random sampling from 30 villages/clusters (16 in the control and 14 in the intervention) out of the total of 43 villages in the 2 districts. The intervention arm received education on maternal and child health through an Integrated Care Model mobilisation system whereas participants in the control arm were mobilized and educated using the conventional mobilisation system. Baseline and end-line surveys were done to assess and compare baseline characteristics and secondary study outcomes. The primary outcome was child morbidity in the follow-up period of 12 months.
 The mean age of participating mothers was 28 years (SD = 6.8) and that of participating children was 18.2 months (SD = 4.0). The risk of child morbidity was 37.5% in the control and 22.0% in the intervention representing a relative risk of 1.7 [95% C.I (1.4-2.1)]. The incidence rate of child morbidity was 0.043 and 0.022 episodes per child year in the control and intervention arm respectively giving an incidence rate ratio of 2.0(p<0.001). This ratio meant that the chance of being a disease case in the control was double that in the intervention arm. Women in the intervention arm had statistically significant (p<0.001) higher knowledge about maternal and child health and better child care practices at the end of the study.
 There was strong evidence that the Integrated Care Model did not only reduce child morbidity but also improved maternal knowledge, health-seeking behaviour and care practices. Accordingly, governments in developing countries and countries in poor resource settings could strengthen their community health delivery systems by implementing this low-cost, sustainable and high-impact approach.