An integrated primary care initiative for child health in northern Togo

Kevin P. Fiori, Molly E. Lauria, Amanda W. Singer, Heidi E. Jones, Hayley M. Belli, Patrick T. Aylward, Sibabe Agoro, Sesso Gbeleou, Etonam Sowu, Meskerem Grunitzky-Bekele, Alicia Singham Goodwin, Melissa Morrison, Didier K. Ekouevi, Lisa R. Hirschhorn

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


OBJECTIVES: To determine if the Integrated Community-Based Health Systems-Strengthening (ICBHSS) initiative was effective in expanding health coverage, improving care quality, and reducing child mortality in Togo. METHODS: Population-representative cross-sectional household surveys adapted from the Demographic Household Survey and Multiple Indicator Cluster Surveys were conducted at baseline (2015) and then annually (2016–2020) in 4 ICBHSS catchment sites in Kara, Togo. The primary outcome was under-5 mortality, with health service coverage and health-seeking behavior as secondary outcomes. Costing analyses were calculated by using “top-down” methodology with audited financial statements and programmatic data. RESULTS: There were 10 022 household surveys completed from 2015 to 2020. At baseline (2015), under-5 mortality was 51.1 per 1000 live births (95% confidence interval [CI]: 35.5–66.8), and at the study end period (2020), under-5 mortality was 35.8 (95% CI: 23.4–48.2). From 2015 to 2020, home-based treatment by a community health worker increased from 24.1% (95% CI: 21.9%–26.4%) to 45.7% (95% CI: 43.3%–48.2%), and respondents reporting prenatal care in the first trimester likewise increased (37.5% to 50.1%). Among respondents who sought care for a child with fever, presenting for care within 1 day increased from 51.9% (95% CI: 47.1%–56.6%) in 2015 to 80.3% (95% CI: 74.6%–85.0%) in 2020. The estimated annual additional intervention cost was $8.84 per person. CONCLUSIONS: Our findings suggest that the ICBHSS initiative, a bundle of evidence-based interventions implemented with a community-based strategy, improves care access and quality and was associated with reduction in child mortality.

Original languageEnglish (US)
Article numbere2020035493
Issue number3
StatePublished - Sep 1 2021

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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