Evaluation of the effectiveness of care groups in expanding population coverage of Key child survival interventions and reducing under-5 mortality: a comparative analysis using the lives saved tool (LiST).
BACKGROUND
Globally, less than half of Countdown Countries will achieve the Millennium Development Goal of reducing the under-5 mortality rate (U5MR) by two-thirds by 2015. There is growing interest in community-based delivery mechanisms to help accelerate progress. One promising approach is the use of a form of participatory mothers' groups, called Care Groups, for expanding coverage of key child survival interventions, an essential feature for achieving mortality impact.


METHODS
In this study we evaluate the effectiveness of Care Group projects conducted in 5 countries in Africa and Asia in comparison to other United States Agency for International Development-funded child survival projects in terms of increasing coverage of key child survival interventions and reducing U5MR (estimated using the Lives Saved Tool, or LiST). Ten Care Group and nine non-Care Group projects were matched by country and year of program implementation.


RESULTS
In Care Group project areas, coverage increases were more than double those in non-Care Group project areas for key child survival interventions (p = 0.0007). The mean annual percent change in U5MR modelled in LiST for the Care Group and non-Care Group projects was -4.80% and -3.14%, respectively (p = 0.09).


CONCLUSIONS
Our findings suggest that Care Groups may provide a promising approach to significantly increase key child survival interventions and increase reductions in U5MR. Evaluations of child survival programs should be a top priority in global health to build a greater evidence base for effective approaches for program delivery.
Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5535, Baltimore, MD, 21205-2103, USA. cgeorg19@jhu.edu.
Christine Marie
CM
George
Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5535, Baltimore, MD, 21205-2103, USA. evignol1@jhu.edu.
Emilia
E
Vignola
Jhpiego, Maternal Child Health Integrated Program (MCHIP), Washington, DC, USA. jricca@jhpiego.net.
Jim
J
Ricca
Food for the Hungry, Hunger Corps, Phoenix, Arizona, USA. tdavis@fh.org.
Tom
T
Davis
Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5535, Baltimore, MD, 21205-2103, USA. jperin@jhu.edu.
Jamie
J
Perin
Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5535, Baltimore, MD, 21205-2103, USA. yvonneyotam@jhu.edu.
Yvonne
Y
Tam
Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5535, Baltimore, MD, 21205-2103, USA. hperry2@jhu.edu.
Henry
H
Perry
D000349:Africa; D001208:Asia; D002662:Child Health Services / Q000458:organization & administration*; D046688:Child Mortality / Q000639:trends*; D002669:Child Welfare / Q000639:trends*; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration*; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015397:Program Evaluation; D014481:United States