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Assessing the performance of the family folder system for collecting community-based health information in Tigray Region, North Ethiopia: a capture–recapture study
Ministry of Health, Addis Ababa, Ethiopia; Department of health promotion and disease prevention, Tigray Health Bureau, Mekelle, Tigray, Ethiopia.
Tigray Health Bureau, Meklle, Tigray, Ethiopia.
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0003-2478-9598
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2024 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 2, article id e067735Article in journal (Refereed) Published
Abstract [en]

Objectives: To assess completeness and accuracy of the family folder in terms of capturing community-level health data.

Study design: A capture–recapture method was applied in six randomly selected districts of Tigray Region, Ethiopia.

Participants: Child health data, abstracted from randomly selected 24 073 family folders from 99 health posts, were compared with similar data recaptured through household survey and routine health information made by these health posts.

Primary and secondary outcome measures: Completeness and accuracy of the family folder data; and coverage selected child health indicators, respectively.

Results: Demographic data captured by the family folders and household survey were highly concordant, concordance correlation for total population, women 15–49 years age and under 5-year child were 0.97 (95% CI 0.94 to 0.99, p<0.001), 0.73 (95% CI 0.67 to 0.88) and 0.91 (95% CI 0.85 to 0.96), respectively. However, the live births, child health service indicators and child health events were more erratically reported in the three data sources. The concordance correlation among the three sources, for live births and neonatal deaths was 0.094 (95% CI −0.232 to 0.420) and 0.092 (95% CI −0.230 to 0.423) respectively, and for the other parameters were close to 0.

Conclusion: The family folder system comprises a promising development. However, operational issues concerning the seamless capture and recording of events and merging community and facility data at the health centre level need improvement.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024. Vol. 14, no 2, article id e067735
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-221656DOI: 10.1136/bmjopen-2022-067735ISI: 001185044000061PubMedID: 38331856Scopus ID: 2-s2.0-85184682042OAI: oai:DiVA.org:umu-221656DiVA, id: diva2:1842248
Available from: 2024-03-04 Created: 2024-03-04 Last updated: 2024-05-20Bibliographically approved
In thesis
1. Bridging gaps in under-five child health: a comprehensive assessment of their social determinants and the health system performance in Tigray, Ethiopia
Open this publication in new window or tab >>Bridging gaps in under-five child health: a comprehensive assessment of their social determinants and the health system performance in Tigray, Ethiopia
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Att överbrygga klyftor inom barnhälsa för barn under fem år : En omfattande bedömning av deras sociala determinanter och hälsosystemets prestanda i Tigray, Etiopien
Abstract [en]

Background: Achieving the Sustainable Development targets related to child health necessitates a deep understanding of the multifaceted factors influencing their health.

Aim: To comprehensively examine the social determinants of the access to, and quality of, child health services, and the performance of the health system in the region of Tigray.

Methods: The study was conducted in six randomly selected rural districts of Tigray. The study employed focus group discussions and interviews (sub-study I), a retrospective case-control study (sub-study-II), a capture recapture method (sub-study III), and a two-stage mortality survey (sub-study IV).

Results: Sub-study I: underscored a good knowledge on the causes and management of common childhood morbidity, and that the health posts were conveniently located and provided trusted services. However, several barriers to using health services were identified. These included cultural beliefs, seasonal mobility, economic constraints, limited decision-making power for women, and accessibility challenges.Sub-study II: Revealed that only 76% of eligible children born to HIV-positive mothers were tested, with 17% testing positive for HIV, and only 29% of them linked to anti-retroviral treatment.Sub-study III showed that the concordance correlation coefficient between the Family Folder data and the household survey for the total population, reproductive age women, and under-five year child population were all above 0.73, while they were close to zero for other child health parameters. Tracing and recording neonatal deaths, and the aggregation of data at various levels were the major operational challanges.Sub-study IV identified infectious diseases (52.9%), neonatal causes (35.6%), nutritional disorders (6.6%) and external causes (4.3%) as the major causes of child death. The cause for 76 (16.2%) children was indeterminate. Tracing neonatal deaths and logistical challenges, especially in remote areas were the major operational issues of conducting the mortality survey.

Conclusion: In spite of the improvements in health literacy, access to cost-free reproductive, maternal, neonatal and child health services and improved utilization, various interrelated social determinants, including cultural beliefs, financial barriers and health system-related factors continue to hinder the optimal utilization of essential child health services. Moreover, the health system’s performance in the prevention of mother-to-child transmission of HIV and its effect in reducing mortality among exposed children is generally poor. Policymakers in the region should focus on tackling those social determinants, including the health system, to improve children´s health. The community health information system showed promising potential. However, the operational issue of capturing neonatal deaths adequately and the process by which community data can be aggregated upwards through the health system has to be improved. The study underscored the viability of implementing a cause-specific mortality survey using health extension workers, and the need to standardize data collection tools and logistics before implementation on a larger scale.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2024. p. 94
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2307
Keywords
Under-five children, family folder, community, health information, verbal autopsy, health extension program, health system, Tigray, Ethiopia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-224584 (URN)978-91-8070-404-5 (ISBN)978-91-8070-403-8 (ISBN)
Public defence
2024-08-30, NUS By 5B. plan 3, Umeå universitetssjukhus Rum Alicante, 09:00 (English)
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Note

Paper III listed in thesis with title "Assessing the performance of the FF system for collecting community-based health information In Tigray Region, North Ethiopia: A capture-recapture study". Correct title of publication: Assessing the performance of the family folder system for collecting community-based health information in Tigray Region, North Ethiopia: a capture-recapture study".

Available from: 2024-05-24 Created: 2024-05-20 Last updated: 2024-05-22Bibliographically approved

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Abraha Derbew, AtakeltiKinsman, JohnMyléus, AnnaByass, Peter

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