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December 11, 2013

Harvard and UCSF Study shows extraordinary child survival results from Mali

A new study led by researchers at Harvard, University of California San Francisco, and the Malian Ministry of Health published in PLOS | ONE  today, shows a ten-fold decrease in under-five child mortality in Yirimadjo, Mali (pop. 56,000), in the three years following the roll-out of a new model health system.  

The new model includes a health system, designed by Tostan partner, Muso, coupled with Tostan's three-year empowering education program delivered in national languages.  Muso’s health system focuses on providing ultra-rapid access to medicines and prevention tools already proven to save lives, while Tostan’s Community Empowerment Program provides in-depth human rights learning and health education on prevention, symptoms and treatment, as well as literacy, organizational and leadership skills to promote positive behavior change and to mobilize community members to connect patients with treatment quickly.  

Tostan implemented its three-year Community Empowerment Program in 14 neighborhoods in Yirimadjo with over 1,000 class participants (adults and adolescents). The communities studied human rights and responsibilities, preventative healthcare and positive health practices and the information from the program reached tens of thousands more through social mobilization and outreach activities.

Prior to the launch of the Muso health system, the rate of under-five mortality in the area of the intervention was 155/1000, similar to Mali’s national under-five mortality rate. After three years, the rate of under-five mortality was 17/1000, a ten-fold decrease.  During the same period, home and clinic visits increased ten-fold and ultra-rapid access to malaria care (within 24 hours of the first symptom) nearly doubled.

To achieve such rapid access, the model fundamentally redefines how health systems work. Instead of a reactive model where providers wait for patients to come to them, Community Health Workers proactively search for sick patients door-to-door, provide care in the home, and when needed, bring them in for free and quality care at the government primary care center. Simultaneously, community members work on educating for prevention and organize to proactively identify sick children and pregnant women and get them to care early.

The study has important limitations and without a control group, it is not possible to conclude from this study design whether differences in the results were due to the intervention, demographic shifts, other unknown factors, or some combination of the above. Further research is needed. Replicating the results in a controlled setting could establish a model for saving millions of children’s lives annually.

These results come at a time when global leaders are pushing to rapidly reduce child deaths rates around the world. Through the fourth Millennium Development Goal (MDG4), global leaders have committed to reduce child deaths by two-thirds by 2015.  While progress has been made, only 13 of 61 countries with the highest under-five child mortality rates are on track to achieve MDG4, and 6.6 million children died globally in 2012, primarily from curable disease.

Photographs © Muso

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