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Reducing Child Mortality in Togo With an Integrated Primary Care Program: A Cluster Randomized Clinical Trial

Kevin P Fiori1,2,3, Samantha R Levano1,2,3, Jessica Haughton1,2,3

  • 1Department of Pediatrics, Division of Community & Population Health, Albert Einstein College of Medicine, Bronx, New York.

Pediatrics
|November 11, 2025
PubMed

Insights

The Integrated Primary Care Program (IPCP) significantly reduced under-five mortality (U5M) in Togo by 29%. This scalable, evidence-based intervention also improved care quality, demonstrating its effectiveness in real-world settings.

Area of Science:

  • Global Health
  • Public Health Interventions
  • Child Survival Strategies

Background:

  • High under-five mortality rates (U5M) remain a critical global health challenge, particularly in low-resource settings.
  • Integrated Primary Care Programs (IPCP) offer a promising approach to address multifaceted determinants of child health.
  • Evaluating the effectiveness and implementation of IPCP at scale is crucial for policy and practice.

Purpose of the Study:

  • To assess the effectiveness of the Integrated Primary Care Program (IPCP) in reducing under-five mortality (U5M) in Togo.
  • To evaluate the implementation strategies and scalability of the IPCP when deployed across multiple districts.
  • To analyze the impact of IPCP on the quality of care provided in primary health centers.

Main Methods:

  • A stepped-wedge cluster randomized trial design (NCT03694366) was employed for sequential implementation in four Togolese districts (2018-2021).
  • Data collection involved household surveys, health center assessments (Service Availability and Readiness Assessment), key informant interviews (Consolidated Framework for Implementation Research), and costing analysis.
  • Effectiveness was measured by U5M rates and quality of care; implementation was assessed via reach, adoption, implementation, and maintenance metrics.

Main Results:

  • A 29% reduction in the hazard of U5M was observed in intervention periods compared to control periods (45.5 vs. 64.5 deaths per 1000 live births).
  • Significant improvements in health center service readiness and availability were noted across all districts post-implementation.
  • Caregiver trust and engagement were identified as key factors for successful implementation, with an average annual program cost of $10.28 per person.

Conclusions:

  • The Integrated Primary Care Program (IPCP), incorporating evidence-based interventions and strategic implementation, effectively reduces under-five mortality (U5M).
  • Successful IPCP implementation leads to improved quality of care and demonstrates scalability in resource-limited settings.
  • The findings support the adoption of integrated primary care models for enhancing child survival globally.
Abstract

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