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Lives Saved Tool (LiST) Analysis of Care Group versus Non-Care Group
Child Survival Projects
Christine Marie George, PhD, International Health, JHSPH
Emilia Vignola, MSPH, International Health, JHSPH
Jim Ricca, MD, MPH, ICF Macro
Jamie Perin, PhD, International Health, JHSPH
Henry Perry, MD, PhD, MPH, International Health, JHSPH
Presenter’s Name
Date
Study Rationale
• Many evaluations of Care Group projects exist, but no systematic assessment of them
• More evidence of effectiveness of Care Groups is needed
Presenter’s Name
Date
Research Questions
• Do Care Group CSHGP projects achieve greater improvement in high-impact child survival coverage indicators than non-Care Group projects?
• Do Care Group projects achieve greater reductions in the under-five mortality rate than non-Care Group projects?
Presenter’s Name
Date
Lives Saved Tool (LiST) version 4.68
Presenter’s Name
Date
High-impact coverage indicators modelled in LiST
•Coverage of 4 antenatal care visits•Multiple micronutrient consumption during pregnancy•Skilled birth attendance•Postnatal preventive care•Exclusive breastfeeding •Appropriate complementary feeding•Handwashing
•Presence of a latrine•Antibiotic treatment of pneumonia•Oral rehydration therapy for diarrhea•Insecticide-treated bed net coverage; malaria treatment; •IPTp coverage•Measles, tetanus and full • immunization coverage•Vitamin A supplementation
Presenter’s Name
Date
Validation of LiST
Several reports now have validated LiST as a measurement tool for estimating mortality impact
Ricca et al., BMC Public Health 2011•World Relief’s Vurhonga project in Chokwe District, Gaza Province, Mozambique, 1999 to 2003.•An independent evaluation collecting pregnancy history data estimated an under-five mortality declined of 37%. Using project-collected coverage data, LiST produced a corresponding estimate of 39%.
Presenter’s Name
Date
Previous Studies using LiST
Ricca et al., Health Policy and Planning 2013
Community-based intervention packages facilitated by NGOs demonstrate plausible•12 child survival programs were evaluated•When population coverage changes were modelled in LiST, they were estimated to give a child mortality improvement in the project area that exceeded concurrent secular trend in the subnational DHS region in 11 of 12 cases.
Presenter’s Name
Date
Child Survival Project Selection
Selection criteria
Care Group projects found at:
http://www.caregroupinfo.org/blog/implementors• Non-Care Group projects found at the USAID
Evaluations Database
http://www.usaid.gov/results-and-data/progress-data/evaluations
Presenter’s Name
Date
Care Group Eligibility Criteria
Selection criteria: Care Groups• DHS or MICS available for the country where the
Care Group project was conducted within 3 years of both the project baseline and endline
• A Non-Care Group child survival project conducted in the same country within 3 years of the Care Group project.
Presenter’s Name
Date
Non Care Group Eligibility Criteria
Selection criteria: Non-Care Group projects• There must be a DHS or MICS survey available
within 3 years of their baseline and endline survey• A Care Group project in the same country meeting
the criteria for inclusion
Presenter’s Name
Date
Excluded Child Survival Programs
26 Child Survival Projects in 8 Countries were Assessed for Eligibility
Care Group projects in three countries were excluded• Liberia (MTI), no matching non-Care Group project• Guatemala (Curamericas), no recent DHS survey
available• Zambia (SAWSO), no recent DHS survey available
Non-Care Group projects excluded in one country• Malawi (PSI) – only nationally implemented• Malawi (STC) – no true baseline or endline surveys
available
Presenter’s Name
Date
Eligible Child Survival Programs
• 9 Care Group and 12 Non-Care Group child survival projects met these study eligibility criteria.
Care Group
projectsNon-Care Group
projectsCambodia 3 3
Kenya 1 2Malawi 2 1
Mozambique 3 1Rwanda 1 2
Presenter’s Name
Date
Projects included in the analysis
Country Region Organization Type Project Period
Target area children 0-59 months
Cambodia Kampong Thum
Adventist Development Relief Agency
Non-Care Group 2001-2006 17,477
Cambodia Battambang Catholic Relief
ServicesNon-Care
Group 2001-2006 24,896
CambodiaKampong Chhnang
International Relief and
DevelopmentNon-Care
Group 2006-2010 6,217
Cambodia Siem Reap Red Cross Care Group 2005-2008 43,610
CambodiaKompong
Cham World Relief Care Group 1998-2002 12,167a
CambodiaKompong
Cham World Relief Care Group 2003-2007 12,875
Presenter’s Name
Date
Projects included in the analysis
Country Region Organization Type Project Period
Target area children 0-59
months
KenyaWestern Province
African Medical and Research
Foundation Non-Care Group 2005-2010 31,644Kenya Rift Valley HealthRight Non-Care Group 2006-2010 48,844
Kenya Coast Plan Care Group 2004-2009 46,354
MalawiSouthern Region
International Eye Foundation Non-Care Group 2002-2006 42,500
Malawi Northern Region World Relief Care Group 2000-2004 36,732
Malawi Northern Region World Relief Care Group 2005-2009 32,025
Presenter’s Name
Date
Projects included in the analysis
Country Region Organization Type Project Period
Target area children 0-59
months
Mozambique SofalaFood for the
Hungry Care Group 2006-2010 60,666
Mozambique SofalaFood for the
Hungry Care Group 2009-2010 83,778
Mozambique
Manica and Sofala
ProvincesHealth Alliance
International Non-Care Group 2002-2007 97,200
Mozambique Gaza Province World Relief Care Group 2004-2009 33,451
Presenter’s Name
Date
Projects included in the analysis
Country Region Organization Type Project Period
Target area children 0-59 months
RwandaButare
Province ConcernNon-Care
Group 2001-2006 24,494
Rwanda Kibungo
International Rescue
CommitteeNon-Care
Group 2001-2005 109,700
Rwanda Cyangugu World Relief Care Group 2001-2006 24,021
Presenter’s Name
Date
Modelling in LiST
• Assumption: beginning under 5 mortality rate for the project area is assumed to be the same as that for the region of the project (based on DHS data)
• LiST estimates the under-5 mortality rate at the end of the project according to changes in coverage of key child survival indicators
• The average annual change in under-5 mortality rate is calculated taking into account the length of the project
Presenter’s Name
Date
High Impact Child Survival Indicator Coverage Changes
ANC4: 4 antenatal care visits; TT2: 2 doses of tetanus toxoid; IFA: multiple micronutrient supplementation (iron and folic acid); IPTp: intermittent preventive treatment of malaria in pregnancy; SBA: skilled birth attendance; EBF: exclusive breastfeeding; Comp Feed: complementary feeding; PPV: postnatal preventive visit; Vit A: Vitamin A supplementation; ITN: insecticide-treated net; Meas: measles vaccination; Full Vacc: full vaccination with EPI vaccines; Hand Wash: hand washing with soap; ORT: oral rehydration therapy; Abx Pneum: antibiotics for pneumonia; Mal Treat: effective anti-malarial treatment
Presenter’s Name
Date
Under Age 5 Mortality Rates (U5MR)
Country
Care Group Projects
(N)
Non-Care Group Projects
(N)
Cambodia -5.52% (3) -4.23% (3)
Kenya -3.78% (1) -3.21% (2)
Malawi -3.23% (2) -3.64% (1)
Mozambique -5.18% (3) -3.66% (1)
Rwanda -5.70% (1) -0.94% (2)
Average -4.68 -3.14
Estimated mean annual percent change in U5MR
Presenter’s Name
Date
Summary findings
• Overall increase in coverage was significantly higher for Care Group compared to Non Care Group projects (p=0.0007)
• Care Group projects had an estimated mean annual under-5 mortality rate decline that was 49% greater than the non-Care Group projects (p=0.0796).
Presenter’s Name
Date
Limitations
• Small number of projects included in the analysis• Lack of direct measures of mortality
Presenter’s Name
Date
Next steps
• Since there are increasing numbers of Care Group projects with data for baseline and endline coverage, a future similar analysis with larger number of projects would be useful
• The growing evidence that Care Groups are effective suggests that there is now a need for randomized controlled trials involving Care Groups.
Presenter’s Name
Date
Acknowledgments
We are grateful for the support of the LiST Team•Yvonne Tam, MPH•Neff Walker, PhD•Ingrid Friberg, PhD
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Date
Discussion
Is the effect due to the Care Group methodology?• Not clear what specifically it is about the Care Group
methodology that makes it effective (or is it the net combination of characteristics of the methodology?)
Presenter’s Name
Date
Alternative explanations
• The organizations that implement Care Groups are more effective than organizations implementing non-Care Group projects
• The contexts in which Care Group projects are implemented are more conducing to achieving higher coverage levels (even after controlling for the country of intervention)
Presenter’s Name
Date
Mean Annual Percent Reduction in Under Age 5 Mortality (U5MR)