Child Health and Paediatrics, Department of Child Health, Eldoret, Kenya.
Paediatrics, School of Medicine College of Health Sciences Moi University, Eldoret, Kenya.
Reprod Health. 2017 Aug 29;14(1):105. doi: 10.1186/s12978-017-0358-6.
Maternal, fetal and neonatal mortality are higher in low-income compared to high-income countries due to weak health systems including poor access and utilization of health services. Despite enormous recent improvements in maternal, neonatal and under 5 health indicators, more rapid progress is needed to meet the targets including the Development Goal 3(SDG). In Kenya these indicators are still high and comprehensive systems are needed to attain the targets of the SDG 3 by 2030. We describe the structure and methods of a study to assess the impact of an innovative system approach on maternal, neonatal and under-five children outcomes. This will be implemented in two clusters in the Counties of Busia and Bungoma in Kenya. There will be 4 control clusters in Kakamega, UasinGishu, Trans Nzoia and Elgeyo Marakwet Counties in Kenya. The study population will be pregnant women, newborns and under-five children identified over the study period. The objective of the study is to improve access, utilization and quality of Maternal and Child Health care through a predesigned Enhanced Health Care System (EHC) that embodies six WHO pillars of the health system and community owned initiatives including Community Based Organisations and Income Generating Activities.
METHODS/DESIGN: A five year quasi-experimental design will be used to compare the outcomes of the implementation of the EHC using the Find Link Treat and retain (FLTR) strategy in one cluster, community owned initiatives in one cluster and four control clusters at baseline and at the end of the study. A Baseline survey will be conducted in year one and an endline in the fifth year in which maternal, neonatal and underfive childhood outcomes will be compared.
The expected findings from the study include showing trends in improvement in the intervention clusters for morbidity, mortality, health service utilization and access indicators. Use of the health systems approach in health care provision is expected to provide a holistic improvement in the quality of care in the study populations in the intervention clusters that will lead to improved health indicators including morbidity and mortality. It is expected that the findings will inform health policy of the national and county governments in Kenya and worldwide.
由于卫生系统薄弱，包括获得和利用卫生服务的机会有限，低收入国家的孕产妇、胎儿和新生儿死亡率高于高收入国家。尽管最近在孕产妇、新生儿和五岁以下儿童健康指标方面取得了巨大进展，但仍需更快的进展来实现包括发展目标 3（可持续发展目标）在内的目标。在肯尼亚，这些指标仍然很高，需要建立全面的系统，才能在 2030 年实现可持续发展目标 3 的目标。我们描述了一项评估创新系统方法对孕产妇、新生儿和五岁以下儿童结局影响的研究的结构和方法。该研究将在肯尼亚布西亚县和邦戈马县的两个集群中实施。肯尼亚的卡卡梅加、乌萨伊古舒、跨纳罗亚和埃尔格约马拉克韦特县将有 4 个对照集群。研究人群将是在研究期间确定的孕妇、新生儿和五岁以下儿童。该研究的目的是通过预先设计的增强医疗保健系统（EHC）来改善孕产妇和儿童保健的可及性、利用和质量，该系统体现了世界卫生组织卫生系统的六个支柱和社区拥有的举措，包括社区组织和创收活动。
方法/设计：将使用为期五年的准实验设计来比较在一个集群中实施 EHC 的结果，该集群使用查找链接治疗和保留（FLTR）策略，一个集群使用社区拥有的举措，以及四个对照集群在基线和研究结束时的结果。将在第一年进行基线调查，并在第五年进行期末调查，比较孕产妇、新生儿和五岁以下儿童的结局。
研究的预期发现包括显示干预集群在发病率、死亡率、卫生服务利用和获得指标方面改善的趋势。在医疗保健提供中使用卫生系统方法有望全面改善干预集群中研究人群的护理质量，从而改善包括发病率和死亡率在内的健康指标。预计研究结果将为肯尼亚和全球的国家和县政府的卫生政策提供信息。
