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Oliphant NP, Ray N, Bensaid K, Ouedraogo A, Gali AY, Habi O, Maazou I, Panciera R, Muñiz M, Sy Z, Manda S, Jackson D, Doherty T. Optimising geographical accessibility to primary health care: a geospatial analysis of community health posts and community health workers in Niger. BMJ Glob Health 2021; 6:bmjgh-2021-005238. [PMID: 34099482 PMCID: PMC8186743 DOI: 10.1136/bmjgh-2021-005238] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/13/2021] [Indexed: 01/22/2023] Open
Abstract
Background Little is known about the contribution of community health posts and community health workers (CHWs) to geographical accessibility of primary healthcare (PHC) services at community level and strategies for optimising geographical accessibility to these services. Methods Using a complete georeferenced census of community health posts and CHWs in Niger and other high-resolution spatial datasets, we modelled travel times to community health posts and CHWs between 2000 and 2013, accounting for training, commodities and maximum population capacity. We estimated additional CHWs needed to optimise geographical accessibility of the population beyond the reach of the existing community health post network. We assessed the efficiency of geographical targeting of the existing community health post network compared with networks designed to optimise geographical targeting of the estimated population, under-5 deaths and Plasmodium falciparum malaria cases. Results The per cent of the population within 60-minute walking to the nearest community health post with a CHW increased from 0.0% to 17.5% between 2000 and 2013. An estimated 10.4 million people (58.5%) remained beyond a 60-minute catchment of community health posts. Optimal deployment of 7741 additional CHWs could increase geographical coverage from 41.5% to 82.9%. Geographical targeting of the existing community health post network was inefficient but optimised networks could improve efficiency by 32.3%–47.1%, depending on targeting metric. Interpretations We provide the first estimates of geographical accessibility to community health posts and CHWs at national scale in Niger, highlighting improvements between 2000 and 2013, geographies where gaps remained and approaches for optimising geographical accessibility to PHC services at community level.
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Affiliation(s)
- Nicholas Paul Oliphant
- School of Public Health, University of the Western Cape, Bellville, South Africa .,Technical Advice and Partnerships, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Nicolas Ray
- GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | | | | | - Asma Yaroh Gali
- Pathfinder International, Niamey, Niger.,General Directorate of Reproductive Health (former), Government of Niger Ministry of Public Health, Niamey, Niger
| | - Oumarou Habi
- Inspection of Statistical Services, National Institute of Statistics, Niamey, Niger.,Directorate of Surveys and Censuses (former), National Institute of Statistics, Niamey, Niger
| | - Ibrahim Maazou
- Directorate of Surveys and Censuses (former), National Institute of Statistics, Niamey, Niger
| | - Rocco Panciera
- Health Section, UNICEF Headquarters, New York, New York, USA
| | - Maria Muñiz
- Eastern and Southern Africa Regional Office, UNICEF, Nairobi, Kenya
| | - Zeynabou Sy
- GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Samuel Manda
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa.,Department of Statistics, University of Pretoria, Hatfield, South Africa
| | - Debra Jackson
- School of Public Health, University of the Western Cape, Bellville, South Africa.,London School of Hygiene and Tropical Medicine Centre for Maternal, Adolescent, Reproductive and Child Health, London, UK
| | - Tanya Doherty
- School of Public Health, University of the Western Cape, Bellville, South Africa.,Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
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Koffi AK, Maina A, Yaroh AG, Habi O, Bensaïd K, Kalter HD. Social determinants of child mortality in Niger: Results from the 2012 National Verbal and Social Autopsy Study. J Glob Health 2016; 6:010603. [PMID: 26955473 PMCID: PMC4766790 DOI: 10.7189/jogh.06.010603] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Understanding the determinants of preventable deaths of children under the age of five is important for accelerated annual declines – even as countries achieve the UN’s Millennium Development Goals and the target date of 2015 has been reached. While research has documented the extent and nature of the overall rapid decline in child mortality in Niger, there is less clear evidence to provide insight into the contributors to such deaths. This issue is the central focus of this paper. Methods We analyzed a nationally representative cross–sectional sample of 620 child deaths from the 2012 Niger Verbal Autopsy/Social Autopsy (VASA) Survey. We conducted a descriptive analysis of the data on preventive and curative care, guided by the coverage of proven indicators along the continuum of well child care and illness recognition and care–seeking for child illnesses encompassed by the BASICS/CDC Pathway to Survival model. Results Six hundred twenty deaths of children (1–59 months of age) were confirmed from the VASA survey. The majority of these children lived in households with precarious socio–economic conditions. Among the 414 children whose fatal illnesses began at age 0–23 months, just 24.4% were appropriately fed. About 24% of children aged 12–59 months were fully immunized. Of 601 children tracked through the Pathway to Survival, 62.4% could reach the first health care provider after about 67 minutes travel time. Of the 306 children who left the first health care provider alive, 161 (52.6%) were not referred for further care nor received any home care recommendations, and just 19% were referred to a second provider. About 113 of the caregivers reported cost (35%), distance (35%) and lack of transport (30%) as constraints to care–seeking at a health facility. Conclusion Despite Niger’s recent major achievements in reducing child mortality, the following determinants are crucial to continue building on the gains the country has made: improved socio–economic state of the poor in the country, investment in women’s education, adoption of the a law to prevent marriage of young girls before 18 years of age, and implementation of health programs that encourage breastfeeding and complementary feeding, immunization, illness recognition, prompt and appropriate care–seeking, and improved referral rates.
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Affiliation(s)
- Alain K Koffi
- The Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abdou Maina
- Institut National de la Statistique, Niamey, Niger
| | | | - Oumarou Habi
- Institut National de la Statistique, Niamey, Niger
| | - Khaled Bensaïd
- UNICEF/Niger country office, Niamey, Niger (retired staff)
| | - Henry D Kalter
- The Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Horii N, Habi O, Dangana A, Maina A, Alzouma S, Charbit Y. Community-based behavior change promoting child health care: a response to socio-economic disparity. J Health Popul Nutr 2016; 35:12. [PMID: 27098487 PMCID: PMC5025989 DOI: 10.1186/s41043-016-0048-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 04/08/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Early initiation of breastfeeding after birth is a key behavioral health factor known to decrease neonatal mortality risks. Yet, few demographic studies examined how a community-based intervention impacts postpartum breastfeeding among the socio-economically deprived population in Sub-Saharan Africa. A post-intervention evaluation was conducted in 2011 to measure the effect of a UNICEF-led behavior change communication program promoting child health care in rural Niger. METHODS A quantitative survey is based on a post hoc constitution of two groups of a study sample, exposed and unexposed households. The sample includes women aged 15-49 years, having at least one child less than 24 months born with vaginal delivery. Rate ratio for bivariate analysis and multivariate logistic regression were applied for statistical analysis. The outcome variable is the initiation of breastfeeding within the first hour of birth. Independent variables include other behavioral outcome variables, different types of communication actions, and socio-demographic and economic status of mothers. RESULTS The gaps in socio-economic vulnerability between the exposed and unexposed groups imply that mothers deprived from accessing basic health services and hygiene facilities are likely to be excluded from the communication actions. Mothers who practiced hand washing and used a traditional latrine showed 2.0 times more likely to initiate early breastfeeding compared to those who did not (95 % CI 1.4-2.7; 1.3-3.1). Home visits by community volunteers was not significant (AOR 1.2; 95 % CI 0.9-1.5). Mothers who got actively involved in exclusive breastfeeding promotion as peers were more likely to initiate breastfeeding within the first hour of birth (AOR 2.0; 95 % CI 1.4-2.9). CONCLUSIONS A multi-sectorial approach combining hygiene practices and optimal breastfeeding promotion led to supporting early initiation of breastfeeding. A peer promotion of child health care suggests a model of behavior change communication strategy as a response to socio-economic disparity.
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Affiliation(s)
- Naoko Horii
- Independent consultant in Behavior change communication, Maternal child health and nutrition, Paris, France.
| | - Oumarou Habi
- Census mapping division, National Institute of Statistics, Niamey, Niger
| | - Alio Dangana
- Census mapping division, National Institute of Statistics, Niamey, Niger
| | - Abdou Maina
- Census mapping division, National Institute of Statistics, Niamey, Niger
| | - Souleymane Alzouma
- Census mapping division, National Institute of Statistics, Niamey, Niger
| | - Yves Charbit
- Centre Population & Développement, Paris Descartes University, Paris, France
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Abstract
BACKGROUND The Millennium Development Goal 4 (MDG 4) is to reduce by two-thirds the mortality rate of children younger than 5 years, between 1990 and 2015. The 2012 Countdown profile shows that Niger has achieved far greater reductions in child mortality and gains in coverage for interventions in child survival than neighbouring countries in west Africa. Countdown therefore invited Niger to do an in-depth analysis of their child survival programme between 1998 and 2009. METHODS We developed new estimates of child and neonatal mortality for 1998-2009 using a 2010 household survey. We recalculated coverage indicators using eight nationally-representative surveys for that period, and documented maternal, newborn, and child health programmes and policies since 1995. We used the Lives Saved Tool (LiST) to estimate the child lives saved in 2009. FINDINGS The mortality rate in children younger than 5 years declined significantly from 226 deaths per 1000 livebirths (95% CI 207-246) in 1998 to 128 deaths (117-140) in 2009, an annual rate of decline of 5·1%. Stunting prevalence decreased slightly in children aged 24-35 months, and wasting declined by about 50% with the largest decreases in children younger than 2 years. Coverage increased greatly for most child survival interventions in this period. Results from LiST show that about 59,000 lives were saved in children younger than 5 years in 2009, attributable to the introduction of insecticide-treated bednets (25%); improvements in nutritional status (19%); vitamin A supplementation (9%); treatment of diarrhoea with oral rehydration salts and zinc, and careseeking for fever, malaria, or childhood pneumonia (22%); and vaccinations (11%). INTERPRETATION Government policies supporting universal access, provision of free health care for pregnant women and children, and decentralised nutrition programmes permitted Niger to decrease child mortality at a pace that exceeds that needed to meet the MDG 4. FUNDING Bill & Melinda Gates Foundation; World Bank; Governments of Australia, Canada, Norway, Sweden, and the UK; and UNICEF.
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Affiliation(s)
- Agbessi Amouzou
- Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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