Assessing the Integrated Community-Based Health Systems Strengthening initiative in northern Togo: a pragmatic effectiveness-implementation study protocol.

BACKGROUND: Over the past decade, prevalence of maternal and child morbidity and mortality in Togo, particularly in the northern regions, has remained high despite global progress. The causes of under-five child mortality in Togo are diseases with effective and low-cost prevention and/or treatment strategies, including malaria, acute lower respiratory infections, and diarrheal diseases. While Togo has a national strategy for implementing the integrated management of childhood illness (IMCI) guidelines, including a policy on integrated community case management (iCCM), challenges in implementation and low public sector health service utilization persist. There are critical gaps to access and quality of community health systems throughout the country. An integrated facility- and community-based initiative, the Integrated Community-Based Health Systems Strengthening (ICBHSS) initiative, seeks to address these gaps while strengthening the public sector health system in northern Togo. This study aims to evaluate the effect and implementation strategy of the ICBHSS initiative over 48 months in the catchment areas of 21 public sector health facilities. METHODS: The ICBHSS model comprises a bundle of evidence-based interventions targeting children under five, women of reproductive age, and people living with HIV through (1) community engagement and feedback; (2) elimination of point-of-care costs; (3) proactive community-based IMCI using community health workers (CHWs) with additional services including family planning, HIV testing, and referrals; (4) clinical mentoring and enhanced supervision; and (5) improved supply chain management and facility structures. Using a pragmatic type II hybrid effectiveness-implementation study, we will evaluate the ICBHSS initiative with two primary aims: (1) determine effectiveness through changes in under-five mortality rates and (2) assess the implementation strategy through measures of reach, adoption, implementation, and maintenance. We will conduct a mixed-methods assessment using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. This assessment consists of four components: (1) a stepped-wedge cluster randomized control trial using a community-based household survey, (2) annual health facility assessments, (3) key informant interviews, and (4) costing and return-on-investment assessments for each randomized cluster. DISCUSSION: Our research is expected to contribute to continuous quality improvement initiatives, optimize implementation factors, provide knowledge regarding health service delivery, and accelerate health systems improvements in Togo and more broadly. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03694366 , registered 3 October 2018.

[Eclampsia perinatal mortality at the Tokoin University Hospital Center (Lome-Togo): report on 91 newborns]. / Mortalité périnatale par éclampsie au CHU-Tokoin (Lomé-Togo): à propos de 91 nouveau-nés.

UNLABELLED: A one-year (January 1-december 31, 1998) case control study was carried out at the Gynaecology and Obstetrics ward and at the Paediatrics ward of the Lomé-Tokoin Teaching Hospital (Togo). Through following parameters (delivery, sex, pregnancy age at delivery, birth weight, early neonate period issue, moment and number of fits) newborns from 89 mothers with eclampsia were compared to those from 445 pregnant women without high blood pressure admitted during the study period. After every woman with eclampsia (study group) the five following without high blood pressure (control group) were included in the study. Relative risk (95% confidence interval) and chi 2-test (5% significant degree) were calculated in the comparison of some parameters. RESULTS: The perinatal mortality rate was 28.6% (26 out of 91 newborns) in the study group versus 8.8% (44 out of 455) in the control group (relative risk = 2.91; chi 2 = 27.87; p = 0.0001). Birth weight, pregnancy age at delivery and fits number before delivery influenced significantly perinatal mortality rate; meanwhile the lower was the relative risk of eclamptic fits onset, the more frequent were ante-natal visits. CONCLUSION: The perinatal mortality rate due to eclamptic might be reduced through frequent ante-natal visits, sustained ante- and post-natal care specially adequate management of eclamptic patients and their newborns.