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Table 4 Summary of key study measures organized by aim and domain using modified RE-AIM evaluation framework

From: Assessing the Integrated Community-Based Health Systems Strengthening initiative in northern Togo: a pragmatic effectiveness-implementation study protocol

Study aim RE-AIM framework domain Outcome(s)/indicator(s) Data source Indicator definition/clarification
Study aim I: implementation strategy Reach Health service coverage
CHW home visits Community-based household survey Proportion of participants in the last year reporting a home visit by an IH CHW.
CHW home treatment Community-based household survey Proportion of participants in the last year reporting treatment at home by an IH CHW
Health facility treatment Community-based household survey Proportion of participants in the last year reporting care at a health facility.
Early service access for child health
Malaria coverage Community-based household survey Proportion of children under five reported febrile receiving guideline-based treatment within 24 h of symptom onset.
Pneumonia coverage Community-based household survey Proportion of children under five with a cough and proportion of those receiving guideline-based treatment within 24 h of symptom onset.
Gastrointestinal illness coverage Community-based household survey Proportion of children under five with diarrhea receiving guideline-based treatment within 24 h of symptom onset.
Malnutrition coverage Community-based household survey Proportion of children under five with malnutrition receiving effective treatment.
Coverage estimate of prenatal care Community-based household survey Proportion of pregnant women in the last two years who completed four ANC visits.
Percentage of births at healthcare facility Community-based household survey Proportion of pregnant women in the last two years who delivered in a health facility
Percentage of births at home Community-based household survey Proportion of pregnant women who delivered at home in last 2 years.
Coverage estimate of post-natal care Community-based household survey Proportion of post-partum women who received post-natal care in last 2 years.
Study aim 2: effectiveness Effectiveness Primary outcome
Children under five mortality rate Community-based household survey Using a standard birth/death history table, calculate under-five mortality rates, and compare risk of death before age five across surveys with the Cox proportional hazards regression using survey year as the explanatory variable. Children still alive and under age five at the time of survey will be right censored.
Secondary outcomes
Neonatal mortality rate Community-based household survey The neonatal mortality rates from all births reported by respondents in the 5 years prior to the survey using the same methods described for under-five mortality, adjusted for 28 days.
Children under one mortality rate Community-based household survey The under-one mortality rates from all births reported by respondents in the 5 years prior to the survey using the same methods described for under-five, adjusted for 1 year.
Children under two mortality rate Community-based household survey The under-two mortality rates from all births reported by respondents in the 5 years prior to the survey using the same methods described for under-five, adjusted for 2 years.
Maternal mortality rate Community-based household survey Exploratory maternal mortality analysis based on the sisterhood reports [57, 58].
Quality of care parameters
Timeliness/promptitude of child care for malaria Routine programmatic data Proportion of children under five reported febrile and the proportion who received effective antimalarial treatment within 24 h of symptom onset.
Timeliness/promptitude of child care for pneumonia Routine programmatic data Proportion of children under five reported with cough and the proportion of those children who received an effective pneumonia treatment within 24 h of symptom onset.
Timeliness/promptitude of child care for diarrhea Routine programmatic data Proportion of children under five reported with diarrhea and the proportion of those children who received an effective treatment for diarrheal disease within 24 h of symptom onset.
CHW technical competence Routine programmatic data Proportion of IH CHWs who adhere to evidence-based protocols for iCCM and maternal health.
Facility clinical staff technical competence Routine programmatic data Proportion of facility clinical staff who adhere to evidence-based protocols for iCCM and maternal health.
Equitable Community-based household survey Access differences in child mortality between maternal wealth quintiles, distance to facility, and education level.
Healthcare readiness score Health facility assessments Examine facility changes in procurement, physical infrastructure, and management through annual readiness score [41].
Study aim I : implementation strategy Adoption Community-level engagement
Community engagement sessions Routine programmatic data Number of community forums and community members in attendance.
Participant-level behavior change
Child care cascades for fever, pneumonia, and diarrhea Community-based household survey Changes in childcare-seeking behavior over time for fever, pneumonia, and diarrhea in patients presenting to health clinic, CHW, or non-clinical site.
Test if these proportions increased using the same approach to mixed-effects generalized linear models as described in the primary effectiveness outcome measure.
Women of reproductive age cascade for antenatal care, facility-based delivery, and post-natal care Community-based household survey Changes in pregnant women care-seeking behavior over time, services delivered by IH CHWs, facility-based delivery, as well as antenatal care and post-natal care attendance. Test if these proportions increased using the same approach to mixed effects generalized linear models as described in the primary effectiveness outcome measure.
Study aim I : implementation strategy Implementation Qualitative interviews
Fidelity Key informant interviews Degree that intervention(s) were implemented as planned in original protocol.
Feasibility Key informant interviews Extent that an intervention can be carried out in a particular setting.
Outer context [59] Key informant interviews Macro-level external factors including social, funding, and leadership.
Inner context [59] Key informant interviews Micro-level internal factors including IH/MoH partnership, distinct issues about IH and MoH roles, feedback, facility, community, household, and individual level.
Study aim I : implementation strategy Maintenance Costing and return-on-investment assessment
Annual price per capita Costing surveys Price per capita compared to current MoH funding using the Community Health Planning and Costing Tool [48] at the cluster level.
Return on investment Costing surveys Return on investment using the Community Health Planning and Costing Tool [48] and the Lives Saved Tool [49] with primary outcome at the cluster level.