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.
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 targets
IHME DECOMPOSITION RESULTS
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
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.
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.
Early infant diagnosis increased from 9% in 2008 to 13% in 2016.
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.
Maternal-to-child transmission rate was 5% in 2010.
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,
IHME DECOMPOSITION RESULTS
Synthesis of Research Evidence
ACCEPTABILITY
92% of children attended 6 of 7 weighing sessions (CNP program results prior to 2000).
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.
Successful integration of community-based management of malnutrition into the Nutrition Enhancement Program (NEP).
FIDELITY
In 2014, NEP adhered strictly to the principles and standards outlined in the program’s implementation manual.
Proportion of caregivers who recognized 2 or more danger signs in sick children increased from 55% in 2002 to 77% in 2005.
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.
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.
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.
Cases of neonatal tetanus reduced to achieve goal.
IHME DECOMPOSITION RESULTS
Other factors
DECOMPOSITION RESULTS
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. 6% of overall reduction in under-five mortality attributed to WASH and other environmental factors.
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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.