Proactive community case management and child survival in periurban Mali
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The majority of the world’s population lives in urban areas, and regions with the highest under-five mortality rates are urbanising rapidly. This 7-year interrupted time series study measured early access to care and under-five mortality over the course of a proactive community case management (ProCCM) intervention in periurban Mali. Using a cluster-based, population-weighted sampling methodology, we conducted independent cross-sectional household surveys at baseline and at 12, 24, 36, 48, 60, 72 and 84 months later in the intervention area. The ProCCM intervention had five key components: (1) active case detection by community health workers (CHWs), (2) CHW doorstep care, (3) monthly dedicated supervision for CHWs, (4) removal of user fees and (5) primary care infrastructure improvements and staff capacity building. Under-five mortality rate was calculated using a Cox proportional hazard survival regression. We measured the percentage of children initiating effective antimalarial treatment within 24 hours of symptom onset and the percentage of children reported to be febrile within the previous 2 weeks. During the intervention, the rate of early effective antimalarial treatment of children 0–59 months more than doubled, from 14.7% in 2008 to 35.3% in 2015 (OR 3.198, P<0.0001). The prevalence of febrile illness among children under 5 years declined after 7 years of the intervention from 39.7% at baseline to 22.6% in 2015 (OR 0.448, P<0.0001). Communities where ProCCM was implemented have achieved an under-five mortality rate at or below 28/1000 for the past 6 years. In 2015, under-five mortality was 7/1000 (HR 0.039, P<0.0001). Further research is needed to elucidate the mechanisms of action and generalizability of ProCCM.
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After promising findings from recent observational studies, ProCCM and the causal effects of proactive case detection on access to care and child mortality are being evaluated in rural Mali.
“After promising findings from recent observational studies,11 ProCCM and the causal effects of proactive case detection on access to care and child mortality are being evaluated in rural Mali.12”
Community case management of childhood illness, using proactive frequent home visitation, has shown promising results for reducing under-five mortality in Mali and improving access to care in Senegal, where CHWs are well supplied with needed medicines.
“Community case management of childhood illness, using proactive frequent home visitation, has shown promising results as a strategy for reducing under-five mortality in Mali and for improving access to care in Senegal, in which CHWs are well supplied with the medicines they need [43, 44].”
From Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” (2021) · cites this paper as [43]
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Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All”
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Self-citation
- Authors
- Johnson, A. D., Thiero, O., Whidden, C., Poudiougou, B., Diakité, D., Traoré, F., Samaké, S., Koné, D., Cissé, I., & Kayentao, K.
- Affiliations
- University of California, San Francisco (US)
- Tulane University (US)
- Muso, Bamako, Mali, San Francisco, California, USA
- Ministère de la Santé et de l'Hygiène Publique (ML)
- Université des Sciences, des Techniques et des Technologies de Bamako (ML)
- Corresponding author
- Johnson, Ari D
- Venue
- BMJ Global Health
- Publisher
- BMJ
- Published
- 2018-03
- Volume
- 3
- Issue
- 2
- Pages
- e000634
- ISSN
- 2059-7908 (ISSN-L)
- PMC
- PMC5873643
- OpenAlex
- W2791379118
- Cited by
- 76
- References
- 62
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 13 · 2023: 8 · 2022: 17 · 2021: 11 · 2020: 5 · 2019: 7 · 2018: 7
- FWCI
- 1.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Global Health (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Child Relief International Foundation
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Keywords
- under-five mortality, child survival, community health workers, malaria treatment, febrile illness, urbanization, Mali
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