Lives Saved Tool (LiST) Analysis of
Care Group versus Non-Care Group
Child Survival Projects
Christine Marie George, PhD, ...
Presenter’s Name
Date
Study Rationale
• Many evaluations of Care Group projects exist,
but no systematic assessment of the...
Presenter’s Name
Date
Research Questions
• Do Care Group CSHGP projects achieve greater
improvement in high-impact child s...
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 micr...
Presenter’s Name
Date
Validation of LiST
Several reports now have validated LiST as a
measurement tool for estimating mort...
Presenter’s Name
Date
Previous Studies using LiST
Ricca et al., Health Policy and Planning 2013
Community-based interventi...
Presenter’s Name
Date
Child Survival Project Selection
Selection criteria
Care Group projects found at:
http://www.caregro...
Presenter’s Name
Date
Care Group Eligibility Criteria
Selection criteria: Care Groups
• DHS or MICS available for the coun...
Presenter’s Name
Date
Non Care Group Eligibility Criteria
Selection criteria: Non-Care Group projects
• There must be a DH...
Presenter’s Name
Date
Excluded Child Survival Programs
26 Child Survival Projects in 8 Countries were
Assessed for Eligibi...
Presenter’s Name
Date
Eligible Child Survival Programs
• 9 Care Group and 12 Non-Care Group child survival
projects met th...
Presenter’s Name
Date
Projects included in the analysis
Country Region Organization Type Project Period
Target area
childr...
Presenter’s Name
Date
Projects included in the analysis
Country Region Organization Type Project Period
Target area
childr...
Presenter’s Name
Date
Projects included in the analysis
Country Region Organization Type Project Period
Target area
childr...
Presenter’s Name
Date
Projects included in the analysis
Country Region Organization Type Project Period
Target area
childr...
Presenter’s Name
Date
Modelling in LiST
• Assumption: beginning under 5 mortality rate for
the project area is assumed to ...
Presenter’s Name
Date
High Impact Child Survival Indicator Coverage Changes
ANC4: 4 antenatal care
visits; TT2: 2 doses of...
Presenter’s Name
Date
Under Age 5 Mortality Rates (U5MR)
Country
Care Group
Projects
(N)
Non-Care Group
Projects
(N)
Cambo...
Presenter’s Name
Date
Summary findings
• Overall increase in coverage was significantly
higher for Care Group compared to ...
Presenter’s Name
Date
Limitations
• Small number of projects included in the analysis
• Lack of direct measures of mortali...
Presenter’s Name
Date
Next steps
• Since there are increasing numbers of Care Group
projects with data for baseline and en...
Presenter’s Name
Date
Acknowledgments
We are grateful for the support of the LiST Team
•Yvonne Tam, MPH
•Neff Walker, PhD
...
Presenter’s Name
Date
Discussion
Is the effect due to the Care Group methodology?
• Not clear what specifically it is abou...
Presenter’s Name
Date
Alternative explanations
• The organizations that implement Care Groups are
more effective than orga...
Presenter’s Name
Date
Mean Annual Percent Reduction in
Under Age 5 Mortality (U5MR)
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Lives Saved Tool (LiST) Analysis of Care Group Versus Non-Care Group Child Survival Projects

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  • Child Survival and Health Grants Program (CSHGP)
  • (http://www.jhsph.edu/departments/international-health/centers-and-institutes/institute-for-international-programs/list/)
    International Programs at the Johns Hopkins Bloomberg School, and supported by a Gates Foundation grant to the US Fund for UNICEF, has developed a user-friendly tool to estimate the impact of scaling-up maternal, newborn and child health interventions.
  • Multiple Indicator Cluster Survey
  • Multiple Indicator Cluster Survey
    A non-Care Group child survival project conducted in the same country within 3 years of the Care Group project where there was also a DHS and MICS survey available within 3 years of baseline and endline.
  • 2 projects that qualified were later excluded (1 was national in scope without adequate data and 1 had evaluation data that was not representative of the project area)
    2 Care Group projects implemented the activities in a staged fashion (expanding to a major portion of the project area after 2-3 years)
  • The number of projects implementing each intervention is displayed above the bars. 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
  • rank sum test
  • rank sum test
  • Lives Saved Tool (LiST) Analysis of Care Group Versus Non-Care Group Child Survival Projects

    1. 1. 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
    2. 2. 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
    3. 3. 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?
    4. 4. Presenter’s Name Date Lives Saved Tool (LiST) version 4.68
    5. 5. 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
    6. 6. 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%.
    7. 7. 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.
    8. 8. 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
    9. 9. 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.
    10. 10. 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
    11. 11. 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
    12. 12. 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  projects Non-Care Group  projects Cambodia 3 3 Kenya 1 2 Malawi 2 1 Mozambique 3 1 Rwanda 1 2
    13. 13. 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 Services Non-Care Group 2001-2006 24,896 Cambodia Kampong Chhnang International Relief and Development Non-Care Group 2006-2010 6,217 Cambodia Siem Reap Red Cross Care Group 2005-2008 43,610 Cambodia Kompong Cham World Relief Care Group 1998-2002 12,167a Cambodia Kompong Cham World Relief Care Group 2003-2007 12,875
    14. 14. Presenter’s Name Date Projects included in the analysis Country Region Organization Type Project Period Target area children 0-59 months Kenya Western Province African Medical and Research Foundation Non-Care Group 2005-2010 31,644 Kenya Rift Valley HealthRight Non-Care Group 2006-2010 48,844 Kenya Coast Plan Care Group 2004-2009 46,354 Malawi Southern 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
    15. 15. Presenter’s Name Date Projects included in the analysis Country Region Organization Type Project Period Target area children 0-59 months Mozambique Sofala Food for the Hungry Care Group 2006-2010 60,666 Mozambique Sofala Food for the Hungry Care Group 2009-2010 83,778 Mozambique Manica and Sofala Provinces Health Alliance International Non-Care Group 2002-2007 97,200 Mozambique Gaza Province World Relief Care Group 2004-2009 33,451
    16. 16. Presenter’s Name Date Projects included in the analysis Country Region Organization Type Project Period Target area children 0- 59 months Rwanda Butare Province Concern Non-Care Group 2001-2006 24,494 Rwanda Kibungo International Rescue Committee Non-Care Group 2001-2005 109,700 Rwanda Cyangugu World Relief Care Group 2001-2006 24,021
    17. 17. 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
    18. 18. 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
    19. 19. 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
    20. 20. 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).
    21. 21. Presenter’s Name Date Limitations • Small number of projects included in the analysis • Lack of direct measures of mortality
    22. 22. 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.
    23. 23. Presenter’s Name Date Acknowledgments We are grateful for the support of the LiST Team •Yvonne Tam, MPH •Neff Walker, PhD •Ingrid Friberg, PhD
    24. 24. Presenter’s Name 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?)
    25. 25. 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)
    26. 26. Presenter’s Name Date Mean Annual Percent Reduction in Under Age 5 Mortality (U5MR)

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