[Improving provision of mother-and-child care in Chad at the community level: A quasi-experimental study]

Rev Epidemiol Sante Publique. 2021 Aug;69(4):193-203. doi: 10.1016/j.respe.2021.04.137. Epub 2021 May 21.
[Article in French]

Abstract

Background: Chad is among the countries with the highest maternal and infant mortality rates in the world. An initiative aimed at improving mother-and-child health services was implemented from 2016 to 2019 in three rural health districts in southern Chad, with strong community input, while concomitantly increasing the supply and demand for care. The objective of this study is to evaluate the effects of this program on health service use.

Methods: Interrupted time-series analyses with a control group was used to measure the effects of the intervention by applying a quasi-experimental approach. Monthly attendance data were collected from the registries of the 18 health centres that participated in the program and 18 centres that did not participate (control group), before (18 months) and after (24 months) the start of implementation.

Results: On average, there were 10.98 (95% CI: 6.57-15.39, P<0.001) additional paediatric visits and 0.68 additional deliveries (95% CI: 0.42-0.95, P<0.001) each month in the participation group compared to the control group. Community involvement decisively contributed to the change.

Conclusion: During the 24 months of implementation, the initiative significantly increased the use of essential mother-and-child health services in Chad. This study highlights the benefits of a strong partnership with communities trained and involved in health system activities, with the objective of achieving universal health coverage.

Keywords: Chad; Community health; Exemption de paiement; Impact evaluation; Interrupted Time series; Maternal and Child Health; Santé communautaire; Santé maternelle et infantile; Séries chronologique interrompues; Tchad; User fees exemption; Évaluation des effets.

MeSH terms

  • Chad / epidemiology
  • Child
  • Child Care
  • Child Health Services*
  • Community Participation
  • Female
  • Humans
  • Infant
  • Mothers*