2026-10-14T05:34:24Z https://api.figshare.com/v2/oai

oai:figshare.com:article/34015842 2026-09-28T17:25:44Z category_7 category_21 category_734 category_106 category_135 portal_5 item_type_3 month_year_09_2026

<p>Quality care outcomes.</p> Hawa I. Obaje (25132572) Emily E. White (18086741) Mardieh Dennis (4519927) Dominik Jockers (18086735) Till Bärnighausen (36281) Avi Kenny (2901992) Jeffrey W. Rozelle (25132575) Robert G. Karlay Jr. (25132578) Savior F. Mendin (25132581) Lekilay G. Tehmeh (25132584) Brittney Varpilah (7902899) Ben Grant (12981458) Marion Subah (12981464) Richard Harris (117780) S. Olasford Wiah (23209070) Nelson Dunbar (4866721) C. Sanford Wesseh (12289762) Lisa R. Hirschhorn (9521029) Mark J. Siedner (9230121) John D. Kraemer (2902004) Medicine Biotechnology Biological Sciences not elsewhere classified Science Policy Computational Biology qualified healthcare provider priority conditions improved one liberian county grand bassa county experimental observational stepped based delivery increased also compared data 315 female respondents wedge impact evaluation program catchment area national cha program death among children 0 versus 56 death histories 743 children unadjusted u5mr trained providers residents living relative hazard olds decreased market providers initial implementation household census health facilities five mortality fitted mixed early impact contributed person collect birth childhood treatment already underway additional interventions 31 ). <div><p>Liberia instituted a National Community Health Assistant Program (NCHAP) to increase primary healthcare access for residents living >5 km from health facilities. We evaluated the impact of this program on under-five mortality in rural Grand Bassa County as it was rolled out, between 2018 and 2022. The program was implemented in a stepped manner two districts at-a-time across Grand Bassa County from 2018 to 2022, allowing for a quasi-experimental observational stepped-wedge impact evaluation. We conducted a household census in 2022 to collect birth and death histories from all mothers in the program catchment area. We fitted mixed-effects Cox proportional hazards models to estimate the relative hazard of death among children <5 in the before- and under-intervention periods. We also compared data from the 2022 survey with a 2018 baseline household survey to estimate changes in care-seeking and healthcare service delivery coverage. We surveyed 22,315 female respondents about 32,743 children <5 who contributed person-time to the analysis. We found no difference in <5 mortality between the before- and under-intervention periods (unadjusted U5MR under intervention was higher at 62.0 versus 56.3 deaths per live births; adjusted hazard ratio 1.03 (95%CI 0.82-1.31). Care-seeking from a qualified healthcare provider for fever, diarrhea, or acute respiratory infection increased (27.0% to 53.7%; p < 0.001); and care-seeking decreased from drugstores (16.4% to 4.9%, p < 0.001) and black-market providers (42.4% to 22.7%, p < 0.001). Full vaccination among 12–23-month-olds decreased (16.2% in 2018 to 3.5% in 2022 (p < 0.001)) while facility-based delivery increased (41.0% to 57.1% (p < 0.001)). We detected no reduction in under-five mortality during initial implementation of the national CHA program in one Liberian county. Coverage of childhood treatment for high-priority conditions improved, and we observed a shift in care-seeking to trained providers. These results suggest potential program benefits, but additional interventions, some of which are already underway, will be needed to reduce under-five mortality.</p></div> 2026-09-28T17:25:35Z Dataset Dataset 10.1371/journal.pgph.0005681.t004 https://figshare.com/articles/dataset/_p_Quality_care_outcomes_p_/34015842 CC BY 4.0