scholarly journals The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial

The Lancet ◽  
2011 ◽  
Vol 378 (9793) ◽  
pp. 795-803 ◽  
Author(s):  
Dejan Zurovac ◽  
Raymond K Sudoi ◽  
Willis S Akhwale ◽  
Moses Ndiritu ◽  
Davidson H Hamer ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Treatment Guidelines ◽  
Health Workers ◽  
Randomised Trial ◽  
Text Message ◽  
Malaria Treatment ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

scholarly journals Basic or enhanced clinician training to improve adherence to malaria treatment guidelines: a cluster-randomised trial in two areas of Cameroon

2014 ◽  
Vol 2 (6) ◽  
pp. e346-e358 ◽  
Author(s):  
Wilfred F Mbacham ◽  
Lindsay Mangham-Jefferies ◽  
Bonnie Cundill ◽  
Olivia A Achonduh ◽  
Clare I R Chandler ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Randomised Trial ◽  
Malaria Treatment ◽  
Cluster Randomised Trial ◽  
Clinician Training ◽  
Cluster Randomised

scholarly journals Saving babies’ lives (SBL) – a programme to reduce neonatal mortality in rural Cambodia: study protocol for a stepped-wedge cluster-randomised trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kaajal Patel ◽  
Sopheakneary Say ◽  
Daly Leng ◽  
Manila Prak ◽  
Koung Lo ◽  
...  
Keyword(s):  
Data Collection ◽  
Neonatal Mortality ◽  
Rural Areas ◽  
Health Workers ◽  
Randomised Trial ◽  
Scale Up ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Cluster Randomised ◽  
The Continuum

Abstract Background Neonatal mortality remains unacceptably high. Many studies successful at reducing neonatal mortality have failed to realise similar gains at scale. Effective implementation and scale-up of interventions designed to tackle neonatal mortality is a global health priority. Multifaceted programmes targeting the continuum of neonatal care, with sustainability and scalability built into the design, can provide practical insights to solve this challenge. Cambodia has amongst the highest neonatal mortality rates in South-East Asia, with rural areas particularly affected. The primary objective of this study is the design, implementation, and assessment of the Saving Babies’ Lives programme, a package of interventions designed to reduce neonatal mortality in rural Cambodia. Methods This study is a five-year stepped-wedge cluster-randomised trial conducted in a rural Cambodian province with an estimated annual delivery rate of 6615. The study is designed to implement and evaluate the Saving Babies’ Lives programme, which is the intervention. The Saving Babies’ Lives programme is an iterative package of neonatal interventions spanning the continuum of care and integrating into the existing health system. The Saving Babies’ Lives programme comprises two major components: participatory learning and action with community health workers, and capacity building of primary care facilities involving facility-based mentorship. Standard government service continues in control arms. Data collection covering the whole study area includes surveillance of all pregnancies, verbal and social autopsies, and quality of care surveys. Mixed methods data collection supports iteration of the complex intervention, and facilitates impact, outcome, process and economic evaluation. Discussion Our study uses a robust study design to evaluate and develop a holistic, innovative, contextually relevant and sustainable programme that can be scaled-up to reduce neonatal mortality. Trial registration ClinicalTrials.gov: NCT04663620. Registered on 11th December 2020, retrospectively registered.

scholarly journals Action leveraging evidence to reduce perinatal mortality and morbidity (ALERT): study protocol for a stepped-wedge cluster-randomised trial in Benin, Malawi, Tanzania and Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joseph Akuze ◽  
Kristi Sidney Annerstedt ◽  
Lenka Benova ◽  
Effie Chipeta ◽  
Jean-Paul Dossou ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Process Evaluation ◽  
Study Protocol ◽  
Health Workers ◽  
Randomised Trial ◽  
User Participation ◽  
Cluster Randomised Trial ◽  
Evidence Based ◽  
Stepped Wedge ◽  
Cluster Randomised

Abstract Background Insufficient reductions in maternal and neonatal deaths and stillbirths in the past decade are a deterrence to achieving the Sustainable Development Goal 3. The majority of deaths occur during the intrapartum and immediate postnatal period. Overcoming the knowledge-do-gap to ensure implementation of known evidence-based interventions during this period has the potential to avert at least 2.5 million deaths in mothers and their offspring annually. This paper describes a study protocol for implementing and evaluating a multi-faceted health care system intervention to strengthen the implementation of evidence-based interventions and responsive care during this crucial period. Methods This is a cluster randomised stepped-wedge trial with a nested realist process evaluation across 16 hospitals in Benin, Malawi, Tanzania and Uganda. The ALERT intervention will include four main components: i) end-user participation through narratives of women, families and midwifery providers to ensure co-design of the intervention; ii) competency-based training; iii) quality improvement supported by data from a clinical perinatal e-registry and iv) empowerment and leadership mentoring of maternity unit leaders complemented by district based bi-annual coordination and accountability meetings. The trial’s primary outcome is in-facility perinatal (stillbirths and early neonatal) mortality, in which we expect a 25% reduction. A perinatal e-registry will be implemented to monitor the trial. Our nested realist process evaluation will help to understand what works, for whom, and under which conditions. We will apply a gender lens to explore constraints to the provision of evidence-based care by health workers providing maternity services. An economic evaluation will assess the scalability and cost-effectiveness of ALERT intervention. Discussion There is evidence that each of the ALERT intervention components improves health providers’ practices and has modest to moderate effects. We aim to test if the innovative packaging, including addressing specific health systems constraints in these settings, will have a synergistic effect and produce more considerable perinatal mortality reductions. Trial registration Pan African Clinical Trial Registry (www.pactr.org): PACTR202006793783148. Registered on 17th June 2020.

scholarly journals Innovative, enhanced community management of non-hypoxaemic chest-indrawing pneumonia in 2–59-month-old children: a cluster-randomised trial in Africa and Asia

2022 ◽  
Vol 7 (1) ◽  
pp. e006405
Author(s):  
Keyword(s):  
Pulse Oximetry ◽  
Health Facility ◽  
Health Workers ◽  
Randomised Trial ◽  
Community Level ◽  
Community Treatment ◽  
Cluster Randomised Trial ◽  
Adjusted Risk ◽  
Oral Amoxicillin ◽  
Cluster Randomised

IntroductionThe WHO recommends oral amoxicillin for 2–59-month-old children with chest-indrawing pneumonia presenting at the health facility. Community-level health workers (CLHWs) are not allowed to treat these children when presented at the community level. This study aimed to evaluate whether CLHWs can safely and effectively treat children 2–59 months-old with chest indrawing with a 5-day course of oral amoxicillin in a few selected countries in Africa and Asia, especially when a referral is not feasible.MethodsWe conducted a prospective multicountry cluster-randomised, open-label, non-inferiority trial in rural areas of four countries (Bangladesh, Ethiopia, India and Malawi) from September 2016 to December 2018. Children aged 2–59 months having parents/caregivers reported cough and/or difficult breathing presenting to a CLHW were screened for enrolment. CLHWs in the intervention clusters assessed children for hypoxaemia and treated non-hypoxaemic chest-indrawing pneumonia with two times per day oral amoxicillin (50 mg/kg body weight per dose) for 5 days at the community level. CLHWs in the control clusters identified chest indrawing and referred them to a referral-level health facility for treatment. Study supervisors performed pulse oximetry in the control clusters except in Bangladesh. Children were assessed for the primary outcome (clinical treatment failure) up to day 14 after enrolment. The accuracy and impact of pulse oximetry by CLHWs in the intervention clusters were also assessed.ResultsIn 208 clusters, 1688 CLHWs assessed 62 363 children with cough and/or difficulty breathing. Of these, 4013 non-hypoxaemic 2–59-month-old children with chest-indrawing pneumonia were enrolled. We excluded 116 children from analysis, leaving 3897 for intention-to-treat analysis. In the intervention clusters, 4.3% (90/2081) failed treatment, including five deaths, while in the control clusters, 4.4% (79/1816) failed treatment, including five deaths. The adjusted risk difference was -0.01 (95% CI −1.5% to 1.5%), which satisfied the prespecified non-inferiority criterion. CLHWs correctly performed pulse oximetry in 91.1% (2001/2196) of cases in the intervention clusters.ConclusionsThe community treatment of non-hypoxaemic children with chest-indrawing pneumonia with 5-day oral amoxicillin by trained, equipped and supervised CLHWs is non-inferior to currently recommended facility-based treatment. These findings encourage a review of the existing strategy of community-based management of pneumonia.Trial registrationACTRN12617000857303; The Australian New Zealand Clinical Trials Registry.

scholarly journals Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa

2018 ◽  
Vol 3 (1) ◽  
pp. e000577 ◽  
Author(s):  
Jane Goudge ◽  
Tobias Chirwa ◽  
Sandra Eldridge ◽  
Francesc Xavier F Gómez-Olivé ◽  
Chodziwadziwa Kabudula ◽  
...  
Keyword(s):  
Chronic Care ◽  
Health Workers ◽  
Clinical Care ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Lay Health Workers ◽  
Cross Sectional ◽  
Middle Income ◽  
Cluster Randomised ◽  
Low Middle Income Countries

IntroductionIn low/middle-income countries with substantial HIV and tuberculosis epidemics, health services often neglect other highly prevalent chronic conditions, such as hypertension, which as a result are poorly managed. This paper reports on a study to assess the effect on hypertension management of lay health workers (LHW) working in South African rural primary healthcare clinics to support the provision of integrated chronic care.MethodsA pragmatic cluster randomised trial with a process evaluation in eight rural clinics assessed the effect of adding two LHWs supporting nurses in providing chronic disease care in each intervention clinic over 18 months. Control clinics continued with usual care. The main outcome measure was the change in the difference of percentage of clinic users who had elevated cardiovascular risk associated with high blood pressure (BP) before and after the intervention, as measured by two cross-sectional population surveys.ResultsThere was no improvement in BP control among users of intervention clinics as compared with control clinics. However, the LHWs improved clinic functioning, including overall attendance, and attendance on the correct day. All clinics faced numerous challenges, including rapidly increasing number of users of chronic care, unreliable BP machines and cuffs, intermittent drug shortages and insufficient space.ConclusionLHWs improved the process of providing care but improved BP control required improved clinical care by nurses which was compromised by large and increasing numbers of patients, the dominance of the vertically funded HIV programme and the poor standards of equipment in clinics.Trial registration numberISRCTN12128227.

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