Coverage Of Evidence-based Interventions Research Articles

Lessons from Peru to reduce under-5 mortality: understanding program implementation and context

BackgroundHealth policymakers aiming to reduce under-5 mortality (U5M) often lack data regarding how successful interventions in other countries were implemented. The Exemplars in U5M Study identified countries that achieved significant reductions in amenable U5M. This case study in Peru used implementation research to explore the contextual factors and strategies that contributed to the successful implementation of key evidence-based interventions (EBIs).MethodsThis research utilized a hybrid implementation research framework and a mixed-methods approach to understand the factors associated with EBI implementation and the successful reduction of U5M between 2000–2015. A desk review of existing literature on EBIs and U5M in Peru was completed, and in-depth interviews were performed with key Peruvian informants to understand the implementation strategies employed and the contextual factors that facilitated or were barriers to success. For the purposes of this analysis, three EBIs were selected and evaluated: antenatal care visits (ANC), facility-based deliveries, and infant vaccination.ResultsBetween 2000–2015, the percent of mothers attending at least four antenatal care visits rose from 69% to 96.9%, and the percent of facility-based deliveries increased from 56 to 91%. Three doses of the tetanus/diphtheria/pertussis vaccine, widely acknowledged as a key global health indicator, reached 90% by 2015. Key informants noted that economic growth, financial reforms, strong national commitment to reduce poverty in Peru, and national prioritization of maternal and child health, were important contextual factors that contributed to the successful reduction of U5M. They noted key strategies that helped achieve success during the implementation of EBIs, including utilization of data for decision-making, adaptation driven by cultural sensitivity to address gaps in coverage, and a focus on equity and anti-poverty initiatives with the participation of government, civil society, and political parties to assure continuity of policies.ConclusionSeveral EBIs contributed to the successful reduction of U5M in Peru between 2000–2015. Strategies such as the focus on equity throughout the study period contributed to an increase in coverage of EBIs like ANC visits, facility-based deliveries and infant vaccination which worked to reduce U5M. Understanding how Peru successfully implemented programs that reduced preventable infant and child deaths could be useful to replicating this substantial public health success in other low- and middle-income countries.

Malaria prevalence, knowledge, attitude, and practice among febrile patients attending Chagni health center, Northwest Ethiopia: a cross-sectional study

BackgroundEthiopia has achieved considerable progresses in the prevention and control of malaria in the past decades; hitherto it is a formidable health concern and socio-economic impediment. This study aimed at assessing the magnitude, knowledge, attitudes and practices towards malaria among febrile patients attending Chagni health center, northwest Ethiopia.MethodsHealth facility-based cross-sectional study was conducted to estimate the prevalence of malaria and KAP towards malaria among febrile patients at Chagni health center in Chagni Town during September 2017 to February 2018. In order to determine the magnitude of malaria, finger prick blood samples were collected and thick and thin smears were prepared and microscopically examined for the presence of malaria parasites. A pre-tested structured questionnaire was also applied to assess KAP of suspected malaria patients, attending the health center. Data were analyzed using SPSS version 20.0.ResultsPrevalence of malaria among febrile patients, who visited the sampled health facility, was 7.3%. Of these, Plasmodium falciparum, P. vivax, and mixed infections accounted for 55, 44.3 and 0.7% of the cases, respectively. This study also revealed that 97% of the respondents had ever heard about malaria and recognized it as a serious health problem. Mosquito bite was identified as the main malaria transmission. Taking drug (86.3%), use of mosquito nets (73.3%), drain stagnated water (68%), and house spay with insecticides (66%) were mentioned as the main malaria prevention methods. Mosquito net coverage and utilizations in the prior night were 98 and 75%, respectively. Indoor residual spraying (IRS) coverage was 99%, of which 77.5% of study participants’ houses have been sprayed in the last 6 months.ConclusionsThe current study revealed that prevalence of malaria among febrile illnesses in the study area was relatively low (7.3%) with a high proportion of P. falciparum. Besides, participants had adequate knowledge, encouraging attitudes, and good practices about prevention and control of malaria. However, some misconceptions on malaria disease, its transmission, and prevention have been noted that actually require due attention by the concerned stakeholders. The findings of this study could be used as important inputs for the implementation of effective malaria prevention and control methods, including community health education programs, and scaling up coverage of evidence-based interventions.

Data Resource Profile: Countdown to 2015: Maternal, Newborn and Child Survival

The Countdown to 2015 country profiles present, in one place, comprehensive evidence to enable an assessment of a country’s progress in improving reproductive, maternal, newborn and child health. Profiles are available for each of the 75 countries that together account for more than 95% of all maternal and child deaths. The two-page profiles are updated approximately every 2 years with new data and analyses. Profile data include demographics, mortality, nutritional status, coverage of evidence-based interventions, within-countries inequalities in coverage, measures of health system functionality, supportive policies and financing indicators. The main sources of data for the coverage, nutritional status and equity indicators are the US Agency for Internal Development (USAID)-supported demographic and health surveys and the United Nations Children’s Fund (UNICEF)-supported multiple indicator cluster surveys. Data on coverage are first summarized and checked for quality by UNICEF, and data on equity in intervention coverage are summarized and checked by the Federal University of Pelotas. The mortality estimates are developed by the Inter-agency Group for Child Mortality Estimation and the Maternal Mortality Estimation Inter-Agency Group. The financing data are abstracted from datasets maintained by the Organization for Economic Co-operation and Development Assistance Committee, and the policies and health systems data are derived from a special compilation prepared by the World Health Organization. Associated country profiles include equity-specific profiles and one-page profiles prepared annually that report on the 11 indicators selected by the Commission on Information and Accountability for Women’s and Children’s Health.