Today in Lusaka, Muso announced a startling discovery from our Proactive Community Case Management (ProCCM) Trial that could reshape how we protect children in the midst of conflict: over three years, communities in the study area achieved the largest, fastest improvement in child survival ever recorded in an active conflict zone.
Principal Investigator Kassoum Kayentao from the University of Bamako and Muso Senior Scientist presented the findings of the trial - one of the largest of its kind - at the International Conference for Public Health In Africa (CPHIA), on behalf of a global consortium of researchers.
Key study results found that:
The rate of child death plummeted, from 148/1000 to 55/1000, as patients in both arms of the study received care from professional Community Health Workers in their villages, upgraded clinics, and removal of all fees.
The trial found that home visits did not affect child survival, but significantly improved early and complete prenatal care.
The study followed 135,149 individuals over three years across 137 rural sites in Bankass, Mali, on the edge of the Sahara desert, and set out to answer a universal question: what is the impact of the house call, one of medicine’s oldest institutions? To test this, the study team provided communities with free health care, professional Community Health Workers in every village, and upgraded primary care clinics. Then, they randomly assigned half the patients to get home visits twice per month.
Members of the Muso team at CPHIA on November 28th in Lusaka, Zambia moments after Professor Kassoum Kayentao's presentation of the ProCCM Trial Results. From left to right: Dr. Kassoum Kayentao (Muso Senior Scientist and Principal Investigator from the University of Bamako), Dr. Hanane Akrim (New Country Engagement Specialist), Dr. Maud Akissi Amon-Tanoh (Senior Research Manager), Stephanie Rapp (Head of Institutions), and Dr. Christian Rusangwa (Director of Technical Assistance).
One year after the trial launched, the trial took a devastating turn. The study area, once a peaceful UNESCO World Heritage Site, became a center of a regional conflict. Entire villages were destroyed and communities displaced. The onset of conflict during the trial provided a rare window to understand how to better serve nearly one in six children who live in or near conflict zones today.
“The trial findings show that the consequences of war on children are not inevitable. These communities built systems of health care that proved more powerful than war,” said Ari Johnson, Muso CEO, Associate Professor at UCSF and an investigator on the trial.
“The achievement of these communities [in reducing child mortality rates] highlights that we can and must do much more for children and communities in conflict settings, investing more in care from community providers and quality clinics, provided with zero copays,” says Principal Investigator Kassoum Kayentao from the University of Bamako and Muso Senior Scientist.
“Before the ProCCM Trial, the evidence on community-based child health programs led to questions about how to optimally design CHW programs to improve child health. The mortality decline in both arms over the course of the trial suggests that removing user fees and improving access to front line treatments close to home can play a key role in reducing preventable deaths in the first five years of life,” says Co-Investigator and Corresponding Author, Emily Treleaven.
“Many lives have been saved in Bankass through the implementation of Muso’s model,” says Dr. Mohamed Berthé, Coordinator of Mali’s Health System Strengthening Implementation Unit (UMRSS). “The results of the ProCCM study are not merely statistics, they will allow us to craft policies that are not only impactful but also compassionate, ensuring that every person receives the care they deserve.”
Today, more than half the countries in sub-Saharan Africa are working to expand community and primary care as part of their work towards achieving Universal Health Care. Globally, child death rates are twice as high in conflict zones and fragile states, as war blocks children from accessing healthcare and nutrition, and drives up child mortality. These findings offer a roadmap for addressing some of the most pressing challenges for communities in conflict settings.
The Trial main effects findings on child mortality are currently undergoing peer review pending in preparation for upcoming publication. The Trial's findings on maternal health have been recently published in the British Medical Journal of Global Health, which can be found here.