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

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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

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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?

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Date
Lives Saved Tool (LiST) version 4.68

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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

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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%.

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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.

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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

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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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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).

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Date
Limitations
• Small number of projects included in the analysis
• Lack of direct measures of mortality

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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.

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Acknowledgments
We are grateful for the support of the LiST Team
•Yvonne Tam, MPH
•Neff Walker, PhD
•Ingrid Friberg, PhD

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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?)

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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)

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Date
Mean Annual Percent Reduction in
Under Age 5 Mortality (U5MR)