Integrated Community Based Health Systems Strengthening Preliminary Study in Kozah Togo

Study Overview
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Brief Summary
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This preliminary study aims to inform the design and delivery of the integrated facility and community-based health systems strengthening (ICBHSS) model in four Kozah District health facilities over a period of 48 months. Specific aims include: (1) Assess maternal and child health outcomes and health service utilization rates in the 4 ICBHSS model intervention sites catchment areas; (2) Identify barriers to and facilitators of access and quality services related to ICBHSS model; and (3) Assess changes in health care services coverage, effectiveness, and adoption of ICBHSS model.

Detailed Description
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Intervention: The investigators have adapted an integrated facility and community-based health systems strengthening (ICBHSS) model to improve primary healthcare services in Togo. The ICBHSS model includes a bundle of evidence based interventions including (1) community engagement meetings and feedback; (2) the elimination of facility user fees for children under five and pregnant women; (3) pro-active community based IMCI using Community Health Workers (CHWs) with additional services including linkage to family planning and counseling, HIV testing & referrals; (4) clinical mentoring and enhanced supervision at public sector facilities; and (5) improved supply chain management and facility structures. Study: The investigators will conduct a mixed methods assessment, using the RE-AIM framework to evaluate the impact and implementation of the ICBHSS initiative in Kozah district. It will include: (1) a repeated cross-sectional study to obtain annual coverage, effectiveness, and adoption metrics using a population-based household survey as well as (2) qualitative key informant interviews and focus group discussions conducted at 12 months for each intervention health facility. The primary outcome will be under 5 year old mortality rate, with secondary outcomes including under-one mortality rate, maternal mortality rate, as well as maternal and child health service utilization.

Official Title
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Integrated Community Based Health Systems Strengthening in Northern Togo: A Preliminary Mixed-Methods Study in Kozah District

Conditions
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Maternal-Child Health Services, Health Service Utilization

Intervention / Treatment
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* Other: ICBHSS model


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female of reproductive age (aged 15-49 years) Individuals aged 15-17 years will only be included if they have children and/or are pregnant Lives in selected household within study catchment area Informed consent is obtained for participants 18-49 Waiver of parental permission is obtained for 15-17 year-old participants Exclusion Criteria: -

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 49 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Four facilities in Kozah District<br>Baseline estimated population of 33,412 served by four public sector facilities in Kozah District. | Other: ICBHSS model<br>* Bundle of evidence-based interventions that include the following 5 components: Community engagement meetings and feedback; Elimination of public sector facility user fees for children under five and pregnant women; Pro-active community based IMCI using trained, equipped, supervised, and salaried Community Health Workers (CHWs) with additional services including linkage to family planning and counseling, HIV testing & referrals; Clinical mentoring and enhanced supervision by a trained peer coach at public sector facilities; Basic infrastructure improvements and supply chain management training of pharmacy managers<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Under-five year old mortality rate, annual | The under-five mortality rate (expressed as a rate per 1,000 live births) is the probability of a child dying in a specified year between birth and 5 years of age. | 72 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Under-one year old mortality rate, annual | The under-one mortality rate (expressed as a rate per 1,000 live births) is the probability of a child dying in a specified year between birth and 1 year of age. | 72 months | 
| Maternal mortality rate, annual | The maternal mortality rate (expressed as a rate per 100,000 live births) is the probability of a mother dying in a specified year within 42 days of pregnancy termination. | 72 months | 
| Annual proportion of children under age five reported to be febrile in the prior two weeks who received an effective antimalarial treatment within 24 hours of symptom onset. | The number of febrile children under-five who received an effective antimalarial treatment within 24 hours of symptom onset out of the total number of children under age five reported to be febrile in the prior two weeks. | 72 months | 
| Annual proportion of children under age five reported to have a cough in the prior two weeks who received an effective pneumonia treatment within 24 hours of symptom onset. | The number of children under-five who received an effective pneumonia treatment within 24 hours of symptom onset out of the total number of children under age five reported to have a cough in the prior two weeks. | 72 months | 
| Annual proportion of children under age five reported to have diarrhea in the prior two weeks who received an effective treatment for diarrheal disease within 24 hours of symptom onset. | The number of children under-five who received an effective treatment for diarrheal disease within 24 hours of symptom onset out of the total number of children under age five reported to have diarrhea in the prior two weeks. | 72 months | 
| Maternal facility based birth delivery incidence rate, annual | The proportion of women reported to have delivered in a health facility. | 72 months | 
| Protocol Adherence by IH community health workers in iCCM and maternal consultations | The average adherence by IH community health workers to evidence-based protocols for iCCM and maternal consultations as measured by CHW supervisor check-list. | 72 months | 
| Protocol adherence by clinical staff at IH intervention facilities in iCCM and maternal consultations | The average adherence by public sector clinical staff at IH intervention sites to evidence-based protocols for iCCM and maternal consultations as measured by IH clinical mentor supervision check-list. | 72 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Child Mortality, Reproductive, Maternal, Newborn, and Child Health, Community Health Workers, Implementation Research, Preliminary Research, Health Systems Strengthening