{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T17:59:24Z","timestamp":1773770364019,"version":"3.50.1"},"reference-count":40,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Cast-A-Pebble","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,2,26]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The \u2018Health-2-Go\u2019 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\u2019s 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Exposure to Health-2-Go was significantly associated with a 67.7% reduction in the hazard of death (<jats:italic>HR=0.323; p=0.015; 95%\u2009CI 0.130, 0.803<\/jats:italic>). The programme\u2019s impact on healthcare utilisation showed a significant 83% reduction in unnecessary clinic visits for uncomplicated malaria among children 5 and under (<jats:italic>IRR=0.17; p=0.027; 95%\u2009CI 0.04, 0.82<\/jats:italic>). No significant association was found between programme exposure and the expected number of clinic visits for severe malaria among children 5 and under.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The Health-2-Go programme demonstrates substantial potential in reducing child mortality and improving healthcare access in low-resource and \u2018hard-to-reach\u2019 settings in rural Ghana. Further prospective research is recommended to confirm these findings and explore the long-term sustainability of the programme.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-017786","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T23:15:16Z","timestamp":1741907716000},"page":"e017786","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["The \u2018Health-2-Go\u2019 programme\u2019s impact on all-cause mortality and clinic utilisation for children 5 and under: a retrospective cohort analysis of an iCCM intervention in Ghana\u2019s Barekese Subdistrict"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7595-0579","authenticated-orcid":false,"given":"Isabella","family":"Guynn","sequence":"first","affiliation":[{"name":"Department of Community Health, Ensign Global University, Kpong, Eastern Region, Ghana"},{"name":"Department of Health Policy and Management, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen","family":"Hassmiller Lich","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5783-6595","authenticated-orcid":false,"given":"Stephen","family":"Manortey","sequence":"additional","affiliation":[{"name":"Department of Community Health, Ensign Global University, Kpong, Eastern Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leah","family":"Frerichs","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyssa J","family":"Mansfield","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Shaibu","sequence":"additional","affiliation":[{"name":"Ghana Health Service Barekese Sub-District Health Center, Barekese, Atwima Nwabiagya North District, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moselle-Margaret","family":"Anum-Brown","sequence":"additional","affiliation":[{"name":"Department of Community Health, Ensign Global University, Kpong, Eastern Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip Owusu","family":"Antwi","sequence":"additional","affiliation":[{"name":"Department of Community Health, Ensign Global University, Kpong, Eastern Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen C","family":"Alder","sequence":"additional","affiliation":[{"name":"Department of Community Health, Ensign Global University, Kpong, Eastern Region, Ghana"},{"name":"Center for Business, Health, and Prosperity, University of Utah, Salt Lake City, Utah, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"2025072914215857000_10.3.e017786.1","doi-asserted-by":"crossref","unstructured":"Azevedo MJ . The state of health system(s) in Africa: challenges and opportunities. In: Historical perspectives on the state of health and health systems in Africa. 2017: 1\u201373.","DOI":"10.1007\/978-3-319-32564-4_1"},{"key":"2025072914215857000_10.3.e017786.2","doi-asserted-by":"crossref","first-page":"395","DOI":"10.2147\/IJGM.S223882","article-title":"Identifying Key Challenges Facing Healthcare Systems In Africa And Potential Solutions","volume":"12","author":"Oleribe","year":"2019","journal-title":"Int J Gen Med"},{"key":"2025072914215857000_10.3.e017786.3","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s10389-018-0946-0","article-title":"Facilitators of and barriers to the use of healthcare services from a user and provider perspective in Ejisu-Juaben municipality, Ghana","volume":"27","author":"Agyemang-Duah","year":"2019","journal-title":"J Public Health (Berl)"},{"key":"2025072914215857000_10.3.e017786.4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10389-019-01019-x","article-title":"Why does inaccessibility widely exist in healthcare in Ghana? Understanding the reasons from past to present","volume":"28","author":"Peprah","year":"2020","journal-title":"J Public Health (Berl)"},{"key":"2025072914215857000_10.3.e017786.5","unstructured":"Barnabas K , Yeboah B , Letsa T , et al . Progress of community-based health planning and services in Ghana. 2020."},{"key":"2025072914215857000_10.3.e017786.6","unstructured":"Service GH . Holistic assessment of the health sector. Ghana Health Service; 2021."},{"key":"2025072914215857000_10.3.e017786.7","unstructured":"Organization WH . Global health workforce statistics. 2021. Available: https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/medical-doctors-(per-10-000-population)"},{"key":"2025072914215857000_10.3.e017786.8","unstructured":"Bank W . Physicians (per 1,000 people) - Ghana. 2021. Available: https:\/\/data.worldbank.org\/indicator\/SH.MED.PHYS.ZS?locations=GH"},{"key":"2025072914215857000_10.3.e017786.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12961-021-00794-y","article-title":"Is value-based payment for healthcare feasible under Ghana\u2019s National Health Insurance Scheme?","volume":"19","author":"Issahaku","year":"2021","journal-title":"Health Res Policy Syst"},{"key":"2025072914215857000_10.3.e017786.10","first-page":"122","article-title":"Access to Healthcare in Rural Communities in Ghana: A Study of Some Selected Communities in the Pru District","volume":"2","author":"Sulemana","year":"2014","journal-title":"Eur J Res in Soc Sci"},{"key":"2025072914215857000_10.3.e017786.11","unstructured":"UNICEF . Ghana - statistics. 2023. Available: https:\/\/data.unicef.org\/country\/gha"},{"key":"2025072914215857000_10.3.e017786.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31593-8"},{"key":"2025072914215857000_10.3.e017786.13","doi-asserted-by":"crossref","unstructured":"Tekin M . Under-five mortality causes and prevention. In: Mortality rates in middle and low-income countries. IntechOpen, 2021.","DOI":"10.5772\/intechopen.100526"},{"key":"2025072914215857000_10.3.e017786.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-021-02934-3","article-title":"Are maternal and child health initiatives helping to reduce under-five mortality in Ghana? Results of a quasi-experimental study using coarsened exact matching","volume":"21","author":"Kolekang","year":"2021","journal-title":"BMC Pediatr"},{"key":"2025072914215857000_10.3.e017786.15","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/S2352-4642(22)00039-6","article-title":"Measuring and monitoring child health and wellbeing: recommendations for tracking progress with a core set of indicators in the Sustainable Development Goals era","volume":"6","author":"Requejo","year":"2022","journal-title":"Lancet Child Adolesc Health"},{"key":"2025072914215857000_10.3.e017786.16","unstructured":"Black RE , Walker N , Laxminarayan R , et al . Reproductive, maternal, newborn, and child health: disease control priorities. 3rd edn. 2. Washington (DC): The International Bank for Reconstruction and Development \/ The World Bank, 2016."},{"key":"2025072914215857000_10.3.e017786.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-004760","article-title":"Patterns and trends in causes of child and adolescent mortality 2000-2016: setting the scene for child health redesign","volume":"6","author":"Strong","year":"2021","journal-title":"BMJ Glob Health"},{"key":"2025072914215857000_10.3.e017786.18","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.1016\/S2214-109X(15)00272-7","article-title":"Early identification and treatment of pneumonia: a call to action","volume":"4","author":"Kallander","year":"2016","journal-title":"Lancet Glob Health"},{"key":"2025072914215857000_10.3.e017786.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pdig.0000235","article-title":"Improving outcomes for children with malaria, diarrhoea and pneumonia in Mozambique: A cluster randomised controlled trial of the inSCALE technology innovation","volume":"2","author":"Soremekun","year":"2023","journal-title":"PLOS Digit Health"},{"key":"2025072914215857000_10.3.e017786.20","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.11.13008","article-title":"Prevalence of diarrhoea, acute respiratory infections, and malaria over time (1995-2017): A regional analysis of 23 countries in West and Central Africa","volume":"11","author":"Simen-Kapeu","year":"2021","journal-title":"J Glob Health"},{"key":"2025072914215857000_10.3.e017786.21","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2023.1270510","article-title":"Strengthening primary health care in low- and middle-income countries: furthering structural changes in the post-pandemic era","volume":"11","author":"Alegre","year":"2023","journal-title":"Front Public Health"},{"key":"2025072914215857000_10.3.e017786.22","unstructured":"United States Agency for International Development (USAID) . Preventing child and maternal deaths: 2024 annual report to congress. Washington, D.C USAID; 2024. Available: https:\/\/www.usaid.gov\/document\/jul-22-2024-preventing-child-and-maternal-deaths-2024-annual-report-congress"},{"key":"2025072914215857000_10.3.e017786.23","unstructured":"Organization WH, UNICEF . Integrated community case management (iCCM): an equity-focused strategy to improve access to essential treatment services for children. World Health Organization and UNICEF; 2012."},{"key":"2025072914215857000_10.3.e017786.24","doi-asserted-by":"crossref","first-page":"66","DOI":"10.33545\/26641658.2023.v5.i2b.150","article-title":"Examining the outcomes of the \u2018Health 2 go\u2019 project: A community health worker intervention program, 2016-2020","volume":"5","author":"Manortey","year":"2023","journal-title":"Int J Adv Res Community Health Nurs"},{"key":"2025072914215857000_10.3.e017786.25","unstructured":"University of Utah, Center for Business, Health, and Prosperity . H2Go quarterly report: q3. Salt Lake City (UT) University of Utah; 2024. Available: https:\/\/eccles-wpmedia.s3.us-west-2.amazonaws.com\/center-for-business-health-and-prosperity\/wp-content\/uploads\/2024\/12\/H2Go-Quarterly-Report-09-30-24.pdf"},{"key":"2025072914215857000_10.3.e017786.26","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1093\/oxfordjournals.aje.a113261","article-title":"Randomization by cluster. Sample size requirements and analysis","volume":"114","author":"Donner","year":"1981","journal-title":"Am J Epidemiol"},{"key":"2025072914215857000_10.3.e017786.27","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60095-1"},{"key":"2025072914215857000_10.3.e017786.28","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv113"},{"key":"2025072914215857000_10.3.e017786.29","unstructured":"The DHS Program . Demographic and health survey model questionnaire \u2013 phase 8. Rockville (MD) ICF; 2020. Available: https:\/\/dhsprogram.com\/publications\/publication-dhsq8-dhs-questionnaires-and-manuals.cfm"},{"key":"2025072914215857000_10.3.e017786.30","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyu105"},{"key":"2025072914215857000_10.3.e017786.31","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.04.020411","article-title":"Assessing the impact of integrated community case management (iCCM) programs on child mortality: Review of early results and lessons learned in sub-Saharan Africa","volume":"4","author":"Amouzou","year":"2014","journal-title":"J Glob Health"},{"key":"2025072914215857000_10.3.e017786.32","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2012.11-0571"},{"key":"2025072914215857000_10.3.e017786.33","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.09.010801","article-title":"Evidence of Impact: iCCM as a strategy to save lives of children under five","volume":"9","author":"Prosnitz","year":"2019","journal-title":"J Glob Health"},{"key":"2025072914215857000_10.3.e017786.34","doi-asserted-by":"crossref","DOI":"10.29392\/joghr.3.e2019030","article-title":"Improving access to appropriate case management for common childhood illnesses in hard-to-reach areas of Abia State, Nigeria","volume":"3","author":"Isiguzo","year":"2019","journal-title":"Journal of Global Health Reports"},{"key":"2025072914215857000_10.3.e017786.35","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.09.010807","article-title":"Achievements and challenges of implementation in a mature iCCM programme: Malawi case study","volume":"9","author":"Zalisk","year":"2019","journal-title":"J Glob Health"},{"key":"2025072914215857000_10.3.e017786.36","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1111\/tmi.12383","article-title":"Influence of community health volunteers on care seeking and treatment coverage for common childhood illnesses in the context of free health care in rural s ierra l eone","volume":"19","author":"Yansaneh","year":"2014","journal-title":"Tropical Med Int Health"},{"key":"2025072914215857000_10.3.e017786.37","doi-asserted-by":"crossref","unstructured":"Kassa EA , Handiso TB , Admassu B , et al . Utilization of integrated community case management service of childhood illness (ICCM) and associated factors among under-five children in Shashogo district, Hadiya zone, south Ethiopia. SAGE Open Med 2022;10. doi:10.1177\/20503121221097643","DOI":"10.1177\/20503121221097643"},{"key":"2025072914215857000_10.3.e017786.38","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60171-4"},{"key":"2025072914215857000_10.3.e017786.39","doi-asserted-by":"crossref","DOI":"10.4081\/jphia.2011.e18","article-title":"Verbal autopsy: an analysis of the common causes of childhood death in the Barekese sub-district of Ghana","volume":"2","author":"Manortey","year":"2011","journal-title":"J Public Health Afr"},{"key":"2025072914215857000_10.3.e017786.40","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0211482","article-title":"Community health workers trained to conduct verbal autopsies provide better mortality measures than existing surveillance: Results from a cross-sectional study in rural western Uganda","volume":"14","author":"Nabukalu","year":"2019","journal-title":"PLoS One"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2024-017786","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T21:22:09Z","timestamp":1753824129000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2024-017786"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":40,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,13]]},"published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1136\/bmjgh-2024-017786"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2024-017786","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]}}}