UCSF

“…..When the study began in 2008, one in seven children in the Bamako region died before the age of five. By 2015, that had fallen to one in 142, which is comparable to the rate in the United States. This level would meet the UN’s goal of reducing deaths among children under five to no more than 25 deaths per 1,000 live births by 2030…..

The intervention sent health workers to people’s homes to ask about children’s well-being, provided care at the doorstep and triaged the sickest patients to health care facilities. The community health care workers provided counseling, diagnosed malaria for people of all ages, as well as pneumonia, diarrheal disease and malnutrition for children under five. They treated the uncomplicated cases, and referred patients with danger signs or conditions that were outside their scope of practice to primary health centers.

Over the course of the study, the percentage of young children who had fevers was cut in half and the number of patient visits in the home and the clinic increased by ten times.

The workers offered antimalarial treatment, and the number of children with fevers who received antimalarial treatment within 24 hours of the onset of their symptoms more than doubled, from about 15 percent to just over 35 percent.

The intervention also strengthened government primary care facilities with more infrastructure, training, and staff. And workers were on call, in case someone needed their services. They also made follow-up visits to help patients adhere to their therapy, particularly in the case of diarrheal disease, and searched for sick newborns, pregnant women and those who had just given birth and needed care, to evacuate them to primary care facilities for treatment.

The approach, which the researchers called Proactive Community Case Management, cost between $6 and $13 dollars per person, per year, over what the government was already spending on health care.

During the seven years of the study, the childhood mortality rate in Mali was falling, although not by much, and in 2015, it was still among the highest in the world at 114 deaths per 1,000 live births. By contrast, that same year, the area of the intervention had a child mortality rate of 7 deaths per 1,000 live births. The researchers are currently at work on a large-scale randomized trial that will follow 100,000 people at 137 different sites to see if door-to-door home visits by community health workers lowers childhood mortality……”