Ezran C., Bonds M.H., Miller A.C., Cordier, L.F., Haruna, J., Mwanawabenea, D., Randriamanambintsoa, M., Razanadrakato, H.T.R., Ouenzar, M.A., Razafinjato, B.R., Murray, M., Garchitorena, A. (2019). PLOS Medicine, 16(8): e1002869.

Abstract:

Sary eo an-damosina: Mba hahatratrarana ny Tanjona Fampandrosoana Maharitra mifandraika amin'ny fahasalamana (SDGs) amin'ny taona 2030, dia tsy maintsy mifanaraka amin'ny tombontsoa amin'ny kalitaon'ny tolotra atolotra ny tombom-barotra azo avy amin'ny fahazoana fitsaboana fototra. Na dia eo aza ny marimaritra iray manodidina ny filàna miatrika ny kalitao, ny fanadihadiana momba ny fiantraikan'ny rafitra ara-pahasalamana manamafy ny rafitra ara-pahasalamana (HSS) dia nifantoka betsaka tamin'ny fepetran'ny fahazoana fitsaboana. Eto isika dia mandinika ny fiovana eo amin'ny votoatin'ny fikarakarana ny reny sy ny zanaka ho toy ny proxy ho an'ny kalitaon'ny fahasalamana, mba hanombatombanana tsara kokoa ny fahombiazan'ny fidirana an-tsehatra HSS any amin'ny distrika ambanivohitr'i Madagasikara. Ny fidirana an-tsehatra dia mikendry ny hanatsara ny fahavononan'ny rafitra amin'ny ambaratonga rehetra amin'ny fikarakarana (ara-pahasalamana, toeram-pitsaboana fototra, hopitalin'ny distrika) amin'ny alalan'ny fanavaozana ny fotodrafitrasa, ny mpiasa, ny fitaovana, ary ny fiofanana, no sady manaisotra ny sakana ara-pitaovana sy ara-bola amin'ny fitsaboana (ohatra, ny tambajotram-piarakodia sy ny tsy fahafahana mampiasa vola).

Methods and findings: We carried out a district-representative open longitudinal cohort study, with surveys administered to 1,522 households in the Ifanadiana district of Madagascar at the start of the HSS intervention in 2014, and again to 1,514 households in 2016. We examined changes in healthcare seeking behavior and outputs for sick-child care among children <5 years old, as well as for antenatal care and perinatal care among women aged 15–49. We used a difference-in-differences (DiD) analysis to compare trends between the intervention group (i.e., people living inside the HSS catchment area) and the non-intervention comparison group (i.e., the rest of the district). In addition, we used health facility–based surveys, monitoring service availability and readiness, to assess changes in the operational capacities of facilities supported by the intervention. The cohort study included 657 and 411 children (mean age = 2 years) reported to be ill in the 2014 and 2016 surveys, respectively (27.8% and 23.8% in the intervention group for each survey), as well as 552 and 524 women (mean age = 28 years) reported to have a live birth within the previous two years in the 2014 and 2016 surveys, respectively (31.5% and 29.6% in the intervention group for each survey). Over the two-year study period, the proportion of people who reported seeking care at health facilities experienced a relative change of +51.2% (from 41.4% in 2014 to 62.5% in 2016) and −7.1% (from 30.0% to 27.9%) in the intervention and non-intervention groups, respectively, for sick-child care (DiD p-value = 0.01); +11.4% (from 78.3% to 87.2%), and +10.3% (from 67.3% to 74.2%) for antenatal care (p-value = 0.75); and +66.2% (from 23.1% to 38.3%) and +28.9% (from 13.9% to 17.9%) for perinatal care (p-value = 0.13). Most indicators of care content, including rates of medication prescription and diagnostic test administration, appeared to increase more in the intervention compared to in the non-intervention group for the three areas of care we assessed. The reported prescription rate for oral rehydration therapy among children with diarrhea changed by +68.5% (from 29.6% to 49.9%) and −23.2% (from 17.8% to 13.7%) in the intervention and non-intervention groups, respectively (p-value = 0.05). However, trends observed in the care content varied widely by indicator and did not always match the large apparent increases observed in care seeking behavior, particularly for antenatal care, reflecting important gaps in the provision of essential health services for individuals who sought care. The main limitation of this study is that the intervention catchment was not randomly allocated, and some demographic indicators were better for this group at baseline than for the rest of the district, which could have impacted the trends observed.

Famaranana: Tamin'ny alalan'ny fampiasana ny vondron'olona iray ao amin'ny distrika mba hanombatombanana ny votoatin'ny fikarakarana ny mponina, dia nahita fitomboana goavana izahay nandritra ny roa taona nanaovana fanadihadiana momba ny tahan'ny taratasim-panafody ho an'ny ankizy marary sy ny Fikambanana Iraisam-pirenena misahana ny Fahasalamana (OMS) izay notombanaina tao amin'ny vondrona fidirana an-tsehatra, miaraka amin'ny fanovana kely kokoa hita ao amin'ny vondrona tsy miditra an-tsehatra. Na dia eo aza ny fanatsarana mifandraika amin'ny fidirana an-tsehatra ataon'ny HSS, ity fanadihadiana ity dia manasongadina ny filàna fanatsarana bebe kokoa ny kalitao any amin'ny faritra sasany ao amin'ny rafi-pitsaboana ao amin'ny distrika. Asehonay ny fomba ahafahana mampiasa ny votoaty momba ny fikarakarana, refesina amin'ny alalan'ny fanadihadiana mifototra amin'ny mponina mahazatra, ho toy ny singa iray amin'ny fanombanana ny HSS, ahafahan'ireo mpitarika ara-pahasalamana manara-maso ny fivoarana sy mamantatra ary miatrika ny banga manokana amin'ny fanomezana tolotra izay mihoatra ny fahafahana miditra amin'ny fitsaboana.