Research pillars

Research study spotlight

Summary

The risk of death is 29% less for children under five when receiving care from Integrate Health’s Integrated Primary Care Program (IPCP). The IPCP expanded service readiness, care quality, and caregiver engagement across four districts between 2018-2022. Implemented at an annual average cost of $10.28 per person, the study demonstrated that a package of evidence-based, integrated primary care interventions can be effectively scaled.

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Purpose

The study evaluated the effectiveness and implementation of the Integrated Primary Care Program (IPCP) in reducing under-five mortality rate (U5M) in Togo when implemented at scale.

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Results

Across four districts, analysis of 50,404 household surveys showed that the IPCP lowered the risk of under-five mortality by 29%, alongside marked improvements in health center readiness and service availability. Qualitative interviews highlighted caregiver trust as a key driver of success, and the program delivered these gains at an average cost of just $10.28 per person per year.

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Takeaways

Our findings suggest that successful implementation of the IPCP, a package of evidence-based interventions with integrated implementation strategies, reduces under-five mortality, improves care quality, and can be delivered at scale.

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Rural ambulance service improves access to emergency care
Summary

An ambulance referral service in northern Togo significantly improved access to emergency obstetric care for women in rural communities. The service used motorized tricycles stationed at village health centers, operated free of charge around the clock by community-nominated drivers. Coverage of women with obstetric complications increased substantially over three years as the program expanded across multiple districts.

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Purpose

The study aimed to describe the implementation of Integrate Health’s rural ambulance service and assess its effectiveness in expanding access to emergency obstetric care for women in northern Togo.

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Results

The ambulance service transported thousands of pregnant and postpartum women, including many with serious complications such as hemorrhage and complicated births. Coverage of women needing emergency care grew steadily each year as the service expanded. Smaller, more accessible districts achieved the highest coverage rates.

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Takeaways

A well-designed rural ambulance service can dramatically improve access to life-saving emergency obstetric care in high maternal mortality settings. Success depends on services being free and available at all times, using appropriate vehicles for rural terrain, positioning services within communities, and integrating with existing primary care programs and CHWs.

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Determinants of under-five child mortality in northern Togo
Summary

Under-five mortality has decreased compared to earlier national estimates but remains higher in Togo than in many similar countries. Prior death of a sibling emerged as the strongest predictor of child mortality, while receipt of prenatal care significantly reduced this risk. These findings highlight critical opportunities for reducing child deaths through improved maternal and child healthcare.

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Purpose

The study aimed to identify structural and intermediary factors associated with under-five mortality in northern Togo to inform priorities for accelerating progress toward global child survival goals.

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Results

Among over 20,000 births reported in the previous decade, children whose mothers had experienced a prior sibling death were five times more likely to die before age five. Other significant risk factors included certain ethnicities, young maternal age, male sex, multiple births, higher birth order, and shorter intervals between births. Receiving prenatal care reduced the risk of child death.

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Takeaways

Prior death of a sibling is a powerful predictor of child mortality and may indicate household-level risks that should be targeted for intervention. Improving access to quality prenatal care represents a critical opportunity to reduce child deaths. Addressing disparities related to maternal age, birth spacing, and ethnic groups can help accelerate progress toward reducing under-five mortality in low-resource settings.

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Summary

Millions of children die annually from preventable or treatable conditions in low- and middle-income settings. Approaches that focus on improving access and quality of evidence-based practices have contributed to declines in some but not all settings.

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Purpose

The purpose of this study was to determine whether our Integrated Primary Care Program was effective in expanding health coverage, improving care quality, and reducing child mortality in the Kozah district in northern Togo. When we launched the Integrated Primary Care Program in 2015, the Kozah district had high rates of child mortality, 51.1 per 1000 live births. The Integrated Primary Care Program seeks to reduce child mortality through a bundle of evidence-based interventions.

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Results

Findings from the study suggest that Integrate Health’s Integrated Primary Care Program contributed to a 30% decline in under-five mortality over a five-year period (from 51.1 per 1000 live births in 2015 to 35.8 in 2020). In addition, improvements in care access and quality were observed, including increases in the proportion of women who reported Community Health Worker (CHW) home visits (49.3% to 58.7%), treatment by CHWs (24.1% to 45.7%), and increases in prenatal care (37.5% to 50.1%).

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Takeaways

Community-based approaches to healthcare delivery, coupled with public sector health system-strengthening in strong collaboration with government partners, are the path forward to reducing neonatal and child mortality in low-income countries.

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Summary

This study explored how the COVID-19 pandemic disrupted maternal and child health service use in one district in northern Togo using routine health system data and key informant interviews. It combined quantitative time-series analysis with qualitative insights from healthcare workers, community health workers (CHWs), and community members. The findings indicated that, despite initial concerns, health service use showed only short-term declines during the COVID-19 pandemic and community-based care remained largely sustained.

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Purpose

The study assessed disruptions in community-based maternal and child health services during the first year of the COVID-19 pandemic. The study explored community perceptions and experiences with health service use during the pandemic.

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Results

Only short-term declines in utilization of maternal and child health services were found at health centers, with no persistent drop in community-based care provided by Community Health Workers (CHWs). Qualitative interviews confirmed sustained care use and highlighted regular communication from CHWs, infection prevention measures, and collaboration between community leaders and healthcare staff as key drivers of success.

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Takeaways

Integrated primary care systems with an adequately trained, supervised, and supplied health workforce can maintain essential maternal and child health services even during major shocks like pandemics. CHWs’ role as trusted community members along with their consistent, clear communication were essential to service continuation.

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