Evaluation of a community intervention to increase recognition of alarm signs in children under 5 in low-income and indigenous communities in the state of Yucatan, Mexico.

Abstract

Improving child health and reducing child mortality is a universal objective, and access and quality of care are two critical elements in the reduction of child deaths. A collaborative study by the Institute of Health Metrics and Evaluation and the University of Yucatan developed a community intervention in low-income and indigenous communities in the State of Yucatan, Mexico, to increase awareness and knowledge surrounding recognizing alarm signs in children under five hence leading to a timelier seeking of care. Initial analysis showed the intervention effect to be positive but not significant in the whole study population. This thesis project investigates whether there was a differential impact of the intervention on alarm sign recognition when stratified by education and household size. The intervention team recruited fifty women each from eight communities (N= 307 participants in total) to participate in the study. Participants filled out questionnaires evaluating alarm sign knowledge for the following health conditions: general medical attention, sepsis, respiratory infections (pneumonia), and congenital heart defects. The intervention was evaluated using an experimental design with pre-and post-intervention data in both the intervention and comparison groups. As the intervention was randomized, the data collected was analyzed as a pretest-posttest study design. Additionally, it was analyzed using a difference-in-difference approach with the data collected pre-and post-intervention. Results from this analysis show an improvement in knowledge among caregivers of children under five between baseline and follow-up measurements. Though the intervention did not have an effect overall, it did increase recognition of heart defect alarm signs and general alarm signs among caregivers with low education and large household sizes. This intervention program showed a community intervention is able to increase recognition of alarm signs for children under five, especially among caregivers with less education and living in large households.