Does the provision of community health services offset the effects of poverty and low maternal educational attainment on childhood mortality? An analysis of the equity effect of the Navrongo experiment in Northern Ghana
Bibliographic Data
| ID | 15741353 |
|---|---|
| Authors | Ayaga A Bawah (0000-0003-4864-4182, University of Ghana, corresponding author), Jonathan F Phillips (0000-0002-6720-7204, Columbia University), Patrick Opoku Asuming (0000-0002-5010-3484, University of Ghana), Elizabeth F Jackson (Columbia University), Paul Walega (Navrongo Health Research Centre), Edmund Wedam Kanmiki (0000-0001-7175-5222, University of Ghana), Mallory C Sheff (0000-0002-2787-4045, Columbia University), Abraham Oduro (0000-0002-4191-7419, Ghana Health Service) |
| Year | 2018 |
| Volume | 7 |
| Pages | 100335-100335 |
| Publication date | 2018-12-06 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | SSM - Population Health (JOURNAL) |
| Journal identifiers | ISSN: 2352-8273 • E-ISSN: 2352-8273 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.ssmph.2018.100335 |
| PMID | 30623010 |
| OpenAlex | W2905537147 |
| Language | EN |
| Citations received | 3 |
| References cited | 46 |
The Government of Ghana has instituted a National Poverty Reduction Program with an initiative known as the Community-based Health Planning and Services (CHPS) as its core health development strategy. CHPS was derived from a plausibility trial of the Navrongo Health Research Centre testing four contrasting primary health care strategies: i) Training unpaid volunteers to promote health in communities, ii) placing nurses in communities with training and supplies for treating childhood illnesses, iii) combining the nurse and volunteer approaches, and iv) sustaining a comparison condition whereby clinic services were provided without community resident workers. This paper presents an age-conditional proportional hazard analysis of the long term impact of community health worker exposure among 94,599 children who were ever under age five over the January 1, 1995 to December 2010 period, adjusting for age conditional effects of shifts in exposure type as CHPS was scaled up in Navrongo project area over the 1995-2000 period. Results show that children whose parents are uneducated and relatively poor experience significantly higher mortality risks than children of the educated and less poor. Conditional hazard regression models assess the impact of CHPS on health equity by estimating the interaction of equity indicators with household exposure to CHPS service operations, adjusting for age conditional exposure to original Community Health and Family Planning Project (CHFP) service strategies as scale-up progressed. The association of mortality risk among children with uneducated and relatively impoverished mothers is offset by exposure to community health nursing services. If exposure is limited to volunteer-provided services alone, survival benefits arise only among children of relatively advantaged households. Findings lend support to policies that promote the CHPS nurse approach to community-based services as a core health component of poverty reduction programs
Community health · Disadvantaged · Economic growth · Economics · Educational attainment · Environmental health · Equity (law · Health care · Political science · Population · Poverty · Public health · Socioeconomic status · Sociology · Child Nutrition and Water Access · Demography · Global Maternal and Child Health · Medicine · Nursing · Poverty, Education, and Child Welfare · Gerontology
Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015
Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities
Making health systems more equitable
Million community health workers in sub-Saharan Africa by 2015
Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries
Achieving health equity
Applying an equity lens to child health and mortality
Achieving child survival goals
Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh
Cause-specific childhood mortality in Africa and Asia
Cause-specific mortality in Africa and Asia
Determinants of child mortality, health, and nutrition in a developing country
Constraints to the potential impact of child survival in developing countries
The Ghana Community-based Health Planning and Services Initiative for scaling up service delivery innovation
Child Health
Community-Based Participatory Research Contributions to Intervention Research
Integration of Social Epidemiology and Community-Engaged Interventions to Improve Health Equity
Measuring living standards with proxy variables
Maternal education and child health
Estimating wealth effects without expenditure data—or tears
The Impact of the Navrongo Project on Contraceptive Knowledge and Use, Reproductive Preferences, and Fertility
Bridging the Gap Between Evidence‐based Innovation and National Health‐sector Reform in Ghana
The Navrongo Community Health and Family Planning Project
The Long‐Term Fertility Impact of the Navrongo Project in Northern Ghana
Education as a Factor in Mortality Decline An Examination of Nigerian Data
Health Programs, Maternal Education, and Differential Child Mortality in Matlab, Bangladesh
Measuring Health Equity in Small Areas
The Household Registration System
| Unique citing works | 3 |
|---|---|
| Citations per year | 0,5 |
| Citation span | 2020 - 2026 (7) |
| Citation velocity | current |
| Highly cited | No |
| Citation types | Neutral: 3 |