Effects of scaling up various community-level interventions on child mortality in Burundi, Kenya, Rwanda, Uganda and Tanzania: a modeling study.

ABSTRACT

BACKGROUND: Improving child health remains one of the most significant health challenges in sub-Saharan Africa, a region that accounts for half of the global burden of under-five mortality despite having approximately 13% of the world population and 25% of births globally. Improving access to evidence-based community-level interventions has increasingly been advocated to contribute to reducing child mortality and, thus, help low-and middle-income countries (LMICs) achieve the child health related Sustainable Development Goal (SDG) target. Nevertheless, the coverage of community-level interventions remains suboptimal. In this study, we estimated the potential impact of scaling up various community-level interventions on child mortality in five East African Community (EAC) countries (i.e., Burundi, Kenya, Rwanda, Uganda and the United Republic of Tanzania). METHODS: We identified ten preventive and curative community-level interventions that have been reported to reduce child mortality Breastfeeding promotion, complementary feeding, vitamin A supplementation, Zinc for treatment of diarrhea, hand washing with soap, hygienic disposal of children's stools, oral rehydration solution (ORS), oral antibiotics for treatment of pneumonia, treatment for moderate acute malnutrition (MAM), and prevention of malaria using insecticide-treated nets and indoor residual spraying (ITN/IRS). Using the Lives Saved Tool, we modeled the impact on child mortality of scaling up these 10 interventions from baseline coverage (2016) to ideal coverage (99%) by 2030 (ideal scale-up scenario) relative to business as usual (BAU) scenario (forecasted coverage based on prior coverage trends). Our outcome measures include number of child deaths prevented. RESULTS: Compared to BAU scenario, ideal scale-up of the 10 interventions could prevent approximately 74,200 (sensitivity bounds 59,068-88,611) child deaths by 2030 including 10,100 (8210-11,870) deaths in Burundi, 10,300 (7831-12,619) deaths in Kenya, 4350 (3678-4958) deaths in Rwanda, 20,600 (16049-25,162) deaths in Uganda, and 28,900 (23300-34,002) deaths in the United Republic of Tanzania. The top four interventions (oral antibiotics for pneumonia, ORS, hand washing with soap, and treatment for MAM) account for over 75.0% of all deaths prevented in each EAC country 78.4% in Burundi, 76.0% in Kenya, 81.8% in Rwanda, 91.0% in Uganda and 88.5% in the United Republic of Tanzania. CONCLUSIONS: Scaling up interventions that can be delivered at community level by community health workers could contribute to substantial reduction of child mortality in EAC and could help the EAC region achieve child health-related SDG target. Our findings suggest that the top four community-level interventions could account for more than three-quarters of all deaths prevented across EAC countries. Going forward, costs of scaling up each intervention will be estimated to guide policy decisions including health resource allocations in EAC countries.