Synthesis of Research Evidence
ACCEPTABILITY
Care-seeking behavior remained unchanged for diarrhea, fever, or respiratory infections. This might be a result of introduction of CB-IMCI and consequent care-seeking from CHWs as opposed to health facilities.
FEASIBILITY
FB-IMCI was able to be implemented in facilities, with the last scale-up phase beginning in 2013.
FIDELITY
Service Provision Assessment data from 2012–2013 showed high levels of malaria readiness: 99% of facilities offered malaria diagnosis and treatment services, 78% had at least one trained provider, 85% had guidelines available.2
Data assessing quality of care unavailable.
EFFECTIVENESS/REACH
Reduction in death rate due to malaria, diarrhea, and pneumonia among children under 5. However, incidence also dropped so contribution of IMCI could not be determined. Drop in incidence could have resulted from ITN use (malaria) and improvement in WASH (diarrhea).
Testing all cases of fever in children, in the rainy season, resulted in 85% increase in number of confirmed malaria cases.
Final scale-up phase began in 2013, but rates of care-seeking remained under universal coverage targets3
IHME DECOMPOSITION RESULTS
Synthesis of Research Evidence
ACCEPTABILITY
Community ownership demonstrated in funding the building of health huts and purchase of medicines for program use. Perception that program is well adapted to local context.
Care-seeking rates improved for fever.
Care-seeking rates did not improve for diarrhea or pneumonia.
FEASIBILITY
Supply chain strategies remained vertical (malaria only).
FIDELITY
90% quality diagnosis and management.
Program reporting not integrated in health management information system, limited supervision, and stockouts of diarrhea and ARI supplies.
EFFECTIVENESS/REACH
Only 23% of ARI cases within districts were managed by CHWs.
Ultimate goal was not met – 86% district coverage achieved with 3,240 CHWs (3 per district).
IHME DECOMPOSITION RESULTS
Synthesis of Research Evidence
ACCEPTABILITY
Low uptake of ORT and zinc suggested low acceptability, althoug may have been due to other challenges (e.g. frequent stockouts for zinc).
FEASIBILITY
ORT and zinc program implemented but with limited coverage
FIDELITY
EFFECTIVENESS/REACH
Following the integration of ORT into CB-IMCI in 2003, children with diarrhea who received ORT or recommended home fluids decreased from 33% in 1997 to 26% in 2005.4
In 2016, 20% of children who had diarrhea received ORT; of those, 21% received ORT – packet or liquids.
In 2009, zinc was added to CB-IMCI. In 2010, 0.3% of diarrhea cases were treated with zinc supplements, increasing to 7% in 2016.5
Synthesis of Research Evidence
ACCEPTABILITY
Household ownership of ITNs increased from 20% (2005) to 63% (2010) to 82% (2016).
FEASIBILITY
In 2012, ITNs were rolled out in Senegal.
FIDELITY
Proportion of children under 5 who slept under a net the night before the DHS increased from 7% (2005) to 35% (2010) to 67% (2016).
In 2016, after the study period ended, research found the distribution of nets in some regions (e.g., Dakar, Thies) was delayed during the mass distribution campaign.
EFFECTIVENESS/REACH
Decline in prevalence of malaria (parasitemia) from 8% (2008) to 3% (2010) to 1.2% (2014) among children (although may not be solely attributed to ITNs).
Household ownership of ITNs increased from 20% (2005) to 63% (2010) to 82% (2016).
IHME DECOMPOSITION RESULTS
Synthesis of Research Evidence
ACCEPTABILITY
Post-introduction evaluation showed high acceptability – mothers understood benefits of vaccine.
High coverage reflected high acceptability as well.
FEASIBILITY
Interviewees reported high levels of rigor and quality of the preparation phase: “The plan had gone as planned… no major changes… preparation work was well done.”
Post-introduction evaluation conducted 1 year after introduction found few challenges with trainings.
FIDELITY
Post-introduction evaluation of PCV conducted 1 year after introduction found issues with analysis of vaccination data and cold-chain management.
EFFECTIVENESS/REACH
PCV coverage among 1-year-olds went from 81% (2014) to 89% (2015) to 93% (2016).
IHME DECOMPOSITION RESULTS
Synthesis of Research Evidence
ACCEPTABILITY
High coverage achieved.
FEASIBILITY
High coverage achieved.
FIDELITY
Post-introduction evaluation showed vaccines were exposed to temperatures outside recommended range.6
EFFECTIVENESS/REACH
Coverage of third dose of Hib vaccine increased from 18% (2005) to 89% (2010) to 93% (2016).7 Coverage of third dose of pentavalent vaccine increased from 80% (2011) to 90% (2016).
Deaths due to meningitis among children under 5 decreased, although the proportional contribution to under-5 mortality did not change.8
Hospitalizations due to Haemophilus influenzae meningitis in Dakar Region declined by 98% from 2002 to 2008.
IHME DECOMPOSITION RESULTS
Synthesis of Research Evidence
ACCEPTABILITY
Overall coverage data suggests high acceptability while low coverage of outreach in outbreak areas suggests otherwise; this may have been due to other barriers besides poor acceptability.
FEASIBILITY
Overall, moderate coverage achieved.
Low coverage of outreach suggested low feasibility.
FIDELITY
EFFECTIVENESS/REACH
Coverage improved from pre-2000, although it remained mostly static, ranging from 76% (2005) to 82% (2011) to 81% (2016).9
Even in targeted areas where outbreaks occurred, coverage was still low.10
Interviews indicate strong surveillance and response system.
IHME DECOMPOSITION RESULTS
Synthesis of Research Evidence
ACCEPTABILITY
High coverage achieved.
FEASIBILITY
High coverage achieved.
FIDELITY
EFFECTIVENESS/REACH
Proportion of rotavirus-positive diarrhea hospitalizations significantly declined from 42% pre-introduction to 10% (2015–2016) and 17% (2016–2017).11
Coverage of last dose of rotavirus vaccine increased from 83% (2015) to 96% (2016)12
IHME DECOMPOSITION RESULTS
Synthesis of Research Evidence
ACCEPTABILITY
High coverage achieved.
FEASIBILITY
High coverage achieved.
FIDELITY
EFFECTIVENESS/REACH
The proportion of children under 5 who received vitamin A supplements remained at 78% in 2010 and 2016, but increased in between those years.13
IHME DECOMPOSITION RESULTS
Synthesis of Research Evidence
ACCEPTABILITY
Generally low coverage (e.g., HIV+ children receiving ART) suggested low acceptability, although could have reflected challenges with implementation.
FEASIBILITY
PMTCT and ART for pediatrics program implemented nationally, but with challenges.
FIDELITY
According to a 2014 study, lack of training and supervision continued to be key shortcomings of PMTCT.14
EFFECTIVENESS/REACH
HIV testing at ANC and receiving results remained low, ranging from 32% in 2005 to 52% in 2015. Similarly, 22% of women had knowledge of PMTCT in 2005 compared with only 28% in 2016.15
Early infant diagnosis increased from 9% in 2008 to 13% in 2016.16,17 Remains low because it requires sophisticated laboratories, trained technicians, and is expensive.17
The rate of HIV+ pregnant women receiving ART increased from 23% in 2010 to 57% in 2016.
New cases of children (ages 0–14) with HIV was less than 1,000 from 2003 to 2016, whereas HIV-exposed children who were uninfected increased from 15,000 in 2003 to 30,000 in 2016.18
Maternal-to-child transmission rate was 5% in 2010.19
Senegalese Antiretroviral Drug Access Initiative (including children) was extended to the country’s 11 regions.
In 2015 only 25% of children ages 0–14 received treatment,20 an increase from 2.6% in 2005.
IHME DECOMPOSITION RESULTS
Synthesis of Research Evidence
ACCEPTABILITY
92% of children attended 6 of 7 weighing sessions (CNP program results prior to 2000).21
Interviewees noted that the multisectoral (+) The effectiveness and efficiency of the Community Nutrition approach was an asset for nutrition program.
FEASIBILITY
The effectiveness and efficiency of the Community Nutrition Program was limited; it was discontinued in 2000.22
Successful integration of community-based management of malnutrition into the Nutrition Enhancement Program (NEP).22
FIDELITY
In 2014, NEP adhered strictly to the principles and standards outlined in the program’s implementation manual.23
Proportion of caregivers who recognized 2 or more danger signs in sick children increased from 55% in 2002 to 77% in 2005.24
The Cellule de Lutte Contre la Malnutrition had a strong system of monitoring, which highlighted regular progress.
EFFECTIVENESS/REACH
Chronic malnutrition decreased from 29% to 21% between 2000 and 2015.25
IHME DECOMPOSITION RESULTS
Synthesis of Research Evidence
ACCEPTABILITY
Data on effectiveness and coverage indicates mixed acceptability.
FEASIBILITY
Maternal Tetanus Program implemented; goal of less than 1 case per 1,000 live births achieved.
FIDELITY
EFFECTIVENESS/REACH
In 2014, there were 3,406 bajenou gokhs, compared with a target of 12,000 (target required to reach 1 per 100 households).
Women who attended at least 1 ANC session was high – 83% in 1997, increasing after 2000 to 96% in 2016.26
Attendance of 4+ ANC sessions was very low – 13% in 1992, 40% in 2005, and 53% in 2016. According to interviewees, persistently low ANC4+ rates resulted from various factors such as cultural norms and late access to ANC.
Rate of women receiving at least 2 doses of tetanus toxoid increased from 45% in 2000 to 84% in 2015; the rate of newborns protected at birth increased from 62% in 2000 to 82% in 2016.27
Cases of neonatal tetanus reduced to achieve goal.
IHME DECOMPOSITION RESULTS
Synthesis of Research Evidence
ACCEPTABILITY
FEASIBILITY
By 2006, FDCP had been scaled up to all regions in Senegal, except Dakar where it was rolled out in 2012.
FIDELITY
Implementation data of FDCP after the pilot were unavailable for the team to review.
A 2009 evaluation of facilities that were provided resuscitation devices showed the equipment was not used in approximately half of facilities.28
The Helping Babies Breathe program experienced challenges due to lack of coaching for health workers, absence of standards for neonatology units, and limited monitoring and evaluation, according to interviews.
EFFECTIVENESS/REACH
Facility-based deliveries increased steadily, up from 49% in 1999 to 77% in 2016.27
Fresh stillborn rate remained steady, from 3.3% in 2004 to 3.1% in 2005.29
Maternal mortality rate per 100,000 live births declined from 488 deaths per 100,000 live births in 2000 to 315 in 2015, an annual reduction rate of 2.9%.30
Cesarean section rate remained the same – 4% in 2005, 5% in 2010, and 5% in 2016.
Although still low, 40% of facilities carried an aspiration tube in 2012,31 increasing to 51% in 2016.27
By 2019, interviewees noted that neonatal corners had been rolled out nationally in Senegal.
According to Service Provision Assessment data, resuscitation was performed at 68% of facilities in 2012 and remained constant by 2016 (64%).
In 2015, 60% of providers reported ever receiving training for resuscitation, and 32% reported receiving continuing education in the previous 24 months.
Drop in death rates due to asphyxia suggests effectiveness.
IHME DECOMPOSITION RESULTS
Other factors
DECOMPOSITION RESULTS16% of overall reduction in under-five mortality attributed to WASH and other environmental factors.
|
LIVES SAVED TOOL23,160 lives saved and 15% of total lives saved attributed to WASH interventions. LiST estimates a total of 155,000 lives saved and a reduction in under-5 mortality rate of 29%. The modeled results capture 45% of the observed decline in mortality as estimated by IGME. The additional estimated decline (per IGME estimates) could be attributed to other factors that are not measurable or that fall outside of direct health system interventions (e.g., economic development, women’s empowerment). |
Contextual factors including economic growth, improvements in gender equity and women's empowerment, education, and improvements in sanitation
The primary research findings suggest additional contextual factors that contributed to under-5 mortality reductions in Senegal that were outside of the health system interventions – these include improvements in gender equity and economic growth.
-
1
Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease 2017. Seattle, WA: IHME; 2018. http://ghdx.healthdata.org/gbd-2017. Accessed July 3, 2019.
-
2
National Agency of Statistics and Demography (ANSD) [Senegal] and ICF International. Sénégal: Enquête Continue sur la Prestation des Services de Soins de Santé (ECPSS) du Sénégal 2012-2013. Calverton, Maryland: ANSD and ICF International; 2013. https://dhsprogram.com/pubs/pdf/SPA18/SPA18.pdf. Accessed July 3, 2019.
-
3
Victora C, et al. Analysis of Senegal DHS Survey Data. Brazil: International Center for Equity in Health, Federal University of Pelotas; 2018.
-
4
Treatment of diarrhea: Either ORS or RHF [Senegal]. STATcompiler. Rockville, MD: The DHS Program. https://www.statcompiler.com/en/. Accessed August 24, 2018.
-
5
Government of Canada and Teck launch child health initiative with governments of Ethiopia and Burkina Faso. Teck and The Micronutrient Initiative. http://www.cesl.com/document/DocumentViewer.aspx?portal=tc&path=_ces_portal_meta/downloads/Media/2013/13-5-TR.pdf. Published February 19, 2013. Accessed January 9, 2018.
-
6
Fleming JA, Dieye Y, Ba O, et al. Effectiveness of Haemophilus influenzae type b conjugate vaccine for prevention of meningitis in Senegal. Pediatr Infect Dis J. 2011;30(5):430-432. https://doi.org/10.1097/INF.0b013e318203aaa0. Accessed January 9, 2017.
-
7
World Health Organization immunization data. http://apps.who.int/gho/data/node.main. Accessed July 3, 2019.
-
8
GBD results tool. Institute for Health Metrics and Evaluation (IHME) website. Seattle, WA. http://ghdx.healthdata.org/gbd-results-tool. Accessed January 10, 2018.
-
9
Measles vaccination received [Senegal]. STATcompiler. Rockville, MD: The DHS Program.
-
10
UNICEF. UNICEF Annual Report 2013–Senegal. UNICEF; 2014. p. 6-7. https://www.unicef.org/about/annualreport/files/Senegal_COAR_2013.pdf. Accessed January 19, 2018.
-
11
Diop A, Thiongane A, Mwenda JM, et al. Impact of rotavirus vaccine on acute gastroenteritis in children under 5 years in Senegal: experience of sentinel site of the Albert Royer Children's Hospital in Dakar. Vaccine. 2018;36(47):7192-7197. https://doi.org/10.1016/j.vaccine.2017.10.061. Abstract accessed January 10, 2018.
-
12
Measles vaccination received [Senegal]. STATcompiler. Rockville, MD: The DHS Program. https://www.statcompiler.com/en/. Accessed August 24, 2018.
-
13
Children consuming vitamin A supplements [Senegal]. STATcompiler. Rockville, Maryland: The DHS Program. https://www.statcompiler.com/en/. Accessed August 24, 2018.
-
14
Cisse C, Sokhna C, Boulanger D, et al. Integration of prevention of mother-to-child HIV transmission into maternal health services in Senegal. Med Sante Trop. 2017;27(2):200-208. https://doi.org/10.1684/mst.2017.0684. Accessed January 12, 2018.
-
15
Knowledge of prevention of mother to child transmission of HIV. STATcompiler. Rockville, MD: The DHS Program. https://www.statcompiler.com/en/. Accessed August 24, 2018.
-
16
Country factsheet: Senegal 2018. UNAIDS website. http://www.unaids.org/en/regionscountries/countries/senegal. Accessed July 3, 2019.
-
17
Clayden P. Early infant diagnosis. i-base website. http://i-base.info/htb/14000. Published October 1, 2010. Accessed July 3, 2019.
-
18
AIDSinfo. UNAIDS website. http://aidsinfo.unaids.org/. Accessed July 3, 2019.
-
19
Republique du Senegal, Conseil National de Lutte Contre le SIDA (CNLS). Rapport de situation sur la riposte nationale a l’epidemie de VIH/SIDA Senegal: 2013-2014. Dakar, Senegal: CNLS; 2015. http://www.unaids.org/sites/default/files/country/documents/SEN_narrative_report_2015.pdf. Accessed July 3, 2019.
-
20
AIDS Data. UNAIDS (2016)
-
21
Gartner A, Maire B, Kameli Y, Traissac P, Delpeuch F. Process evaluation of the Senegal-Community Nutrition Project: an adequacy assessment of a large scale urban project. Trop Med Int Health. 2006;11, 955–966. https://doi.org/10.1111/j.1365-3156.2006.01644.x. Accessed July 3, 2019.
-
22
Kampman H, Zongrone A, Rawat R, Becquey E. How Senegal created an enabling environment for nutrition: A story of change. Glob Food Sec. 2017;13:57-65. https://doi.org/10.1016/j.gfs.2017.02.005. Accessed July 1, 2019.
-
23
Scaling Up Nutrition. Senegal Country Profile. http://scalingupnutrition.org/wp-content/uploads/2014/05/Senegal-Profile-EN-72DPI-1.pdf. Accessed July 3, 2019.
-
24
Vaillancourt D. A Decade of World Bank Support to Senegal’s Nutrition Program: Analysis and Perspective - 15 Years of Experience in the Development of Nutrition Policy in Senegal. Washington, DC: World Bank; 2016. https://openknowledge.worldbank.org/handle/10986/30483. Accessed July 3, 2019.
-
25
Lutte contre la malnutrition: Le Prn jugé très satisfaisant. [Interview of Abdoulaye Ka, Director of Fighting Malnutrition Unit (CLM)]. Le Quotidien. June, 14, 2017. https://www.lequotidien.sn/lutte-contre-la-malnutrition-le-prn-juge-tres-satisfaisant/. Accessed July 3, 2019.
-
26
Antenatal visits for pregnancy: 1 visit (Three years preceding the survey) [Senegal]. STATcompiler. Rockville, MD: The DHS Program. https://www.statcompiler.com/en/. Accessed July 15, 2019.
-
27
National Agency of Statistics and Demography (ANSD) [Senegal] and ICF. Sénégal: Enquête Démographique et de Santé Continue (EDS-Continue) 2016. Rockville, Maryland: ANSD and ICF; 2017. https://dhsprogram.com/pubs/pdf/FR331/FR331.pdf. Accessed January 11, 2018.
-
28
Sylla A, Diouf S, Thiam A, et al. Assessment of the state and future of basic neonatal resuscitation equipment, in first-line health facilities in Senegal after 3 years. Archives de Pédiatrie. 2012;19(4), 355-360. https://doi.org/10.1016/J.ARCPED.2012.01.009. Accessed July 3, 2019.
-
29
Immpact, Regional Center for Training and Research in Reproductive Health (CEFOREP), Ministry of Preventive Health and Medicine, and UNFPA. Strategies for Maternal Mortality Reduction in Senegal: Evaluation of the Free Delivery Policy and Delegation of Tasks. Aberdeen: University of Aberdeen; 2008. https://assets.publishing.service.gov.uk/media/57a08bbd40f0b64974000d32/SenegalFactSheet.pdf. Accessed July 3, 2019.
-
30
WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division. Maternal Mortality Estimation Inter-Agency Group. Maternal mortality in 1990-2015: Senegal. https://www.who.int/gho/maternal_health/countries/sen.pdf. Accessed July 3, 2019.
-
31
National Agency of Statistics and Demography (ANSD) [Senegal] and ICF International. Sénégal: Enquête Continue sur la Prestation des Services de Soins de Santé (ECPSS) du Sénégal 2012-2013. Calverton, Maryland: ANSD and ICF International; 2013. https://dhsprogram.com/pubs/pdf/SPA18/SPA18.pdf. Accessed July 3, 2019.
-
32
Johns Hopkins Bloomberg School of Public Health. Lives Saved Tool. Baltimore, MD; 2018.