The 'Health-2-Go' programme's impact on all-cause mortality and clinic utilisation for children 5 and under: a retrospective cohort analysis of an iCCM intervention in Ghana's Barekese Subdistrict.

Abstract

Introduction: The 'Health-2-Go' programme, which incorporates the integrated community case management strategy, aims to enhance healthcare access in rural Ghana by deploying trained and equipped community-based agents to manage the diagnosis and treatment of basic illness for children aged 5 and under. This study evaluates the intervention's impact on all-cause mortality and clinical healthcare utilisation among children 5 and under in the Barekese Subdistrict in the Atwima Nwabiagya North District of the Ashanti Region of Ghana.

Methods: A retrospective cohort study was conducted using data from 2530 children across nine communities exposed to Health-2-Go and six comparison communities with no Health-2-Go exposure. Child mortality data were collected via a verbally administered household census, and clinical healthcare utilisation data were extracted from clinic records. We used Cox proportional hazards regression models to estimate the impact of exposure to Health-2-Go on child mortality and negative binomial regression models to assess exposure to Health-2-Go on changes in 5 and under clinic visits resulting in a malaria diagnosis.

Results: Exposure to Health-2-Go was significantly associated with a 67.7% reduction in the hazard of death (HR=0.323; p=0.015; 95% CI 0.130, 0.803). The programme's impact on healthcare utilisation showed a significant 83% reduction in unnecessary clinic visits for uncomplicated malaria among children 5 and under (IRR=0.17; p=0.027; 95% CI 0.04, 0.82). No significant association was found between programme exposure and the expected number of clinic visits for severe malaria among children 5 and under.

Conclusions: The Health-2-Go programme demonstrates substantial potential in reducing child mortality and improving healthcare access in low-resource and 'hard-to-reach' settings in rural Ghana. Further prospective research is recommended to confirm these findings and explore the long-term sustainability of the programme.