家访与社区卫生工作者的固定地点护理与儿童存活率:一项分组随机试验,马里。

IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Bulletin of the World Health Organization Pub Date : 2024-09-01 Epub Date: 2024-06-25 DOI:10.2471/BLT.23.290975
Jenny Liu, Emily Treleaven, Caroline Whidden, Saibou Doumbia, Naimatou Kone, Amadou Beydi Cisse, Aly Diop, Mohamed Berthé, Mahamadou Guindo, Brahima Mamadou Koné, Michael P Fay, Ari D Johnson, Kassoum Kayentao
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In both arms, user fees were removed and primary health centres received staffing and infrastructure improvements before trial start. Using lifetime birth histories from women aged 15-49 years surveyed annually, we estimated incidence rate ratios (IRR) for intention-to-treat and per-protocol effects on under-five mortality using Poisson regression models.</p><p><strong>Findings: </strong>Over three years, we observed 52 970 person-years (27 332 in intervention arm; 25 638 in control arm). During the trial, 909 children in the intervention arm and 827 children in the control arm died. The under-five mortality rate declined from 142.8 (95% CI: 133.3-152.9) to 56.7 (95% CI: 48.5-66.4) deaths per 1000 live births in the intervention arm; and from 154.3 (95% CI: 144.3-164.9) to 54.9 (95% CI: 45.2-64.5) deaths per 1000 live births in the control arm. 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引用次数: 0

摘要

目的检验训练有素的社区保健员(CHWs)主动家访对儿童存活率的影响:我们在马里农村地区的 137 个村庄集群开展了一项双臂、平行、无掩蔽的集群随机试验。从 2017 年 2 月到 2020 年 1 月,共有 31 761 名儿童在试验开始时或出生时注册。各村集群要么接受由保健社工定期家访提供的初级保健服务(干预),要么接受由保健社工在固定地点提供的保健服务(对照)。在干预和对照组中,都取消了使用费,并在试验开始前改善了初级保健中心的人员配备和基础设施。利用每年调查的 15-49 岁妇女的终生生育史,我们使用泊松回归模型估算了意向治疗和按方案治疗对五岁以下儿童死亡率影响的发病率比(IRR):在三年时间里,我们观察了 52 970 人年(干预组 27 332 人年;对照组 25 638 人年)。试验期间,干预组有 909 名儿童死亡,对照组有 827 名儿童死亡。干预组的五岁以下儿童死亡率从每 1000 例活产死亡 142.8 例(95% CI:133.3-152.9 例)下降到 56.7 例(95% CI:48.5-66.4 例);对照组从每 1000 例活产死亡 154.3 例(95% CI:144.3-164.9 例)下降到 54.9 例(95% CI:45.2-64.5 例)。意向治疗(IRR:1.02;95% CI:0.88-1.19)和按方案估计(IRR:1.01;95% CI:0.87-1.18)显示,研究臂之间没有差异:尽管主动家访并未降低五岁以下儿童死亡率,但系统强化措施可能有助于降低两组研究中的五岁以下儿童死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Home visits versus fixed-site care by community health workers and child survival: a cluster-randomized trial, Mali.

Objective: To test the effect of proactive home visits by trained community health workers (CHWs) on child survival.

Methods: We conducted a two arm, parallel, unmasked cluster-randomized trial in 137 village-clusters in rural Mali. From February 2017 to January 2020, 31 761 children enrolled at the trial start or at birth. Village-clusters received either primary care services by CHWs providing regular home visits (intervention) or by CHWs providing care at a fixed site (control). In both arms, user fees were removed and primary health centres received staffing and infrastructure improvements before trial start. Using lifetime birth histories from women aged 15-49 years surveyed annually, we estimated incidence rate ratios (IRR) for intention-to-treat and per-protocol effects on under-five mortality using Poisson regression models.

Findings: Over three years, we observed 52 970 person-years (27 332 in intervention arm; 25 638 in control arm). During the trial, 909 children in the intervention arm and 827 children in the control arm died. The under-five mortality rate declined from 142.8 (95% CI: 133.3-152.9) to 56.7 (95% CI: 48.5-66.4) deaths per 1000 live births in the intervention arm; and from 154.3 (95% CI: 144.3-164.9) to 54.9 (95% CI: 45.2-64.5) deaths per 1000 live births in the control arm. Intention-to-treat (IRR: 1.02; 95% CI: 0.88-1.19) and per-protocol estimates (IRR: 1.01; 95% CI: 0.87-1.18) showed no difference between study arms.

Conclusion: Though proactive home visits did not reduce under-five mortality, system-strengthening measures may have contributed to the decline in under-five mortality in both arms.

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来源期刊
Bulletin of the World Health Organization
Bulletin of the World Health Organization 医学-公共卫生、环境卫生与职业卫生
CiteScore
11.50
自引率
0.90%
发文量
317
审稿时长
3 months
期刊介绍: The Bulletin of the World Health Organization Journal Overview: Leading public health journal Peer-reviewed monthly journal Special focus on developing countries Global scope and authority Top public and environmental health journal Impact factor of 6.818 (2018), according to Web of Science ranking Audience: Essential reading for public health decision-makers and researchers Provides blend of research, well-informed opinion, and news
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