Changes in child mortality and population health following 10 years of health systems strengthening in rural Madagascar: A longitudinal cohort study
By measuring both indirect and direct impacts of HSS on population health in a context where health and economic indicators are not otherwise improving, these results provide converging evidence on how strengthening health systems, from community health to hospitals, in low-resource settings increases overall utilization of services, reduces inequities in access to those services, and corresponds with reductions in mortality.
Authors
- Felana Angella Ihantamalala (ORCID: https://orcid.org/0000-0001-5580-0863)
- Fiainamirindra Anjaratiana Ralaivavikoa
- Andrés Garchitorena (ORCID: https://orcid.org/0000-0001-6225-5226)
- Karen E. Finnegan (ORCID: https://orcid.org/0000-0001-9007-5417)
- Luc Rakotonirina
- Feno H. Rafenoarimalala
- Megan Murray (ORCID: https://orcid.org/0000-0003-0443-1986)
- Samuel Andrianambinina
- Michelle Evans (ORCID: https://orcid.org/0000-0002-5628-0502)
- Jacques Aubin Kotchofa
- Laura Cordier
- Estelle M. Raza-Fanomezanjanahary
- Vero Ramanandraitsiory
- Michael Rich (ORCID: https://orcid.org/0000-0003-4333-4695)
- Rado J. L. Rakotonanahary (ORCID: https://orcid.org/0000-0002-1819-1824)
- Zely Arivelo Randriamanantany (ORCID: https://orcid.org/0000-0001-6506-8282)
- Ann C. Miller (ORCID: https://orcid.org/0000-0001-6841-9439)
- Bénédicte Razafinjato
- Matthew H. Bonds (ORCID: https://orcid.org/0000-0002-3055-4237)
- Marius Randriamanambintsoa
- Hobisoa Léa Razanadranaivo
- Lethicia Lydia Yasmine
- Andoniaina Tojoharimanda Tolojananahary
- Andriatiana Tsitinomen’nyaina
- Sarah-Anne Barriault
Institutions
- Centre National de la Recherche Scientifique (FR)
- Harvard University (US)
- Université de Montpellier (FR)
- Maladies Infectieuses et Vecteurs: Écologie, Génétique, Évolution et Contrôle (FR)
- Catholic University of Madagascar (MG)
- Institut Pasteur de Madagascar (MG)
- Institut National de la Statistique (MG)
- Centre National de la Recherche Appliquée au Developpement Rural (MG)
- Harvard Global Health Institute (US)
- Institut de Recherche pour le Développement (FR)
Publication Details
- Journal
- PLoS Medicine
- Published
- 2025-10-07
- DOI
- https://doi.org/10.1371/journal.pmed.1004549
- Primary Topic
- Global Maternal and Child Health
- Type
- article
- Field-Weighted Citation Impact
- 0.00