Peek Community Eye Health - mHealth system to increase access and efficiency of eye health services in Trans Nzoia County, Kenya: study protocol for a cluster randomised controlled trial.

Abstract Background: Globally eye care provision is currently insufficient to meet the requirement for eye care services. Lack of access and awareness are key barriers to specialist services, in addition, specialist services are over utilised by people with conditions that could be managed in the community or primary care. In combination, these lead to a large unmet need for eye health provision. We have developed a validated smart phone-based screening algorithm (Peek Community Screening App). The application (app) is part of the Peek Community Eye Health system (Peek CEH) that enables Community Volunteer (CVs) to make referral decisions about patients with eye problems. It generates referrals, automated short messages service (SMS) notifications to patients and carers and has a program dashboard for visualizing service delivery. We hypothesize that a greater proportion of people with eye problems will be identified using the Peek CEH system and that there will be increased uptake of referrals, compared to those identified and referred using the current community screening approaches. Methods: A single masked, cluster-randomised controlled trial. The unit of randomisation will be the “community units”, defined as a dispensary or health centres with its catchment population. The community units will be allocated to receive either the intervention (Peek CEH system) or the current care (periodic health centre-based outreach clinics with onward referral for further treatment). In both arms, a triage clinic will be held at the link health facility four weeks from sensitization, where attendance will be ascertained. During triage participants will be assessed and treated, and if necessary referred onwards to Kitale eye unit. Discussion: We aim to evaluate a M-health system (Peek CEH) geared towards reducing avoidable blindness through early identification and improved adherence to referral for those with eye problems and reducing demand at secondary care for conditions that can be managed effectively at primary care level. Trial registration: The Pan African Clinical Trials Registry (PACTR), 201807329096632. Registered 8th june 2018, https://pactr.samrc.ac.za. Keywords: Eye problems, Visual Impairement, Access, Primary eye care , Community Eye Health system, Community volunteres, Peek community screening app., cluster randomised controlled trial.

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Peek Community Eye Health - mHealth system to increase access and efficiency of eye health services in Trans Nzoia County, Kenya: study protocol for a cluster randomised controlled trial.

10.21203/rs.2.327/v2 ◽

2019 ◽

Author(s):

Hillary Rono ◽

Andrew Bastawrous ◽

David Macleod ◽

Emmanuel Wanjala ◽

Stephene Gichuhi ◽

...

Keyword(s):

Primary Care ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Eye Care ◽

Community Screening ◽

Eye Health ◽

Cluster Randomised ◽

Specialist Services ◽

Eye Problems ◽

Randomised Controlled

Abstract Background: Globally eye care provision is currently insufficient to meet the requirement for eye care services. Lack of access and awareness are key barriers to specialist services, in addition, specialist services are over utilised by people with conditions that could be managed in the community or primary care. In combination, these lead to a large unmet need for eye health provision. We have developed a validated smart phone-based screening algorithm (Peek Community Screening App). The application (App) is part of the Peek Community Eye Health system (Peek CEH) that enables Community Volunteer (CVs) to make referral decisions about patients with eye problems. It generates referrals, automated short messages service (SMS) notifications to patients or guardians and has a program dashboard for visualizing service delivery. We hypothesize that a greater proportion of people with eye problems will be identified using the Peek CEH system and that there will be increased uptake of referrals, compared to those identified and referred using the current community screening approaches. Study design: A single masked, cluster-randomised controlled trial design will be used. The unit of randomisation will be the “community unit”, defined as a dispensary or health centres with its catchment population. The community units will be allocated to receive either the intervention (Peek CEH system) or the current care (periodic health centre-based outreach clinics with onward referral for further treatment). In both arms, a triage clinic will be held at the link health facility four weeks from sensitization, where attendance will be ascertained. During triage participants will be assessed and treated, and if necessary referred onwards to Kitale eye unit. Discussion: We aim to evaluate a M-health system (Peek CEH) geared towards reducing avoidable blindness through early identification and improved adherence to referral for those with eye problems and reducing demand at secondary care for conditions that can be managed effectively at primary care level. Trial registration The Pan African Clinical Trials Registry (PACTR), 201807329096632. Registered 8th June 2018, https://pactr.samrc.ac.za

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Integrated Sustainable Childhood Pneumonia and Infectious Disease Reduction in Nigeria (INSPIRING) Through Whole System Strengthening in Jigawa, Nigeria: Study Protocol For a Cluster Randomised Controlled Trial

10.21203/rs.3.rs-584049/v1 ◽

2021 ◽

Author(s):

Carina King ◽

Rochelle Burgess ◽

Ayobami Bakare ◽

Funmilayo Shittu ◽

Julius Salako ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Health System ◽

Child Mortality ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Health System Strengthening ◽

Economic Evaluations ◽

Cluster Randomised ◽

Randomised Controlled ◽

Whole Systems

Abstract BackgroundChild mortality remains unacceptably high, with Northern Nigeria reporting some of the highest rates globally (e.g. 192/1000 live births in Jigawa State). Coverage of key protect and prevent interventions, such as vaccination and clean cooking fuel use, are low. Additionally, knowledge, care-seeking and health system factors are poor. Therefore, a whole systems approach is needed for sustainable reductions in child mortality.MethodsThis is a cluster randomised controlled trial, with integrated process and economic evaluations, conducted from January 2021 – September 2022. The trial will be conducted in Kiyawa Local Government Area, Jigawa State, Nigeria, with an estimated population of 230,000. Clusters are defined as primary government health facility catchment areas (n=33). The 33 clusters will be randomly allocated (1:1) in a public ceremony, and 32 clusters included in the impact evaluation. The trial will evaluate a locally adapted ‘whole systems strengthening’ package of three evidence-based methods: community men’s and women’s groups; Partnership Defined Quality Scorecard; healthcare worker training, mentorship and provision of basic essential equipment and commodities. The primary outcome is mortality of children aged 7 days to 59 months. Mortality will be recorded prospectively using a cohort design, and secondary outcomes measured through baseline and endline cross-sectional surveys. Assuming the following, we will have a minimum detectable effect size of 30%: a) baseline mortality of 100 per 1000 livebirths; b) 4,480 compounds with 3 eligible children per compound; c) 80% power; d) 5% significance; e) intra-cluster correlation of 0.007; f) coefficient of variance of cluster size of 0.74. Analysis will be by intention-to-treat, comparing intervention and control clusters, adjusting for compound and trial clustering. DiscussionThis study will provide robust evidence of the effectiveness and cost-effectiveness of community-based participatory learning and action, with integrated health system strengthening and accountability mechanisms, to reduce child mortality. The ethnographic process evaluation will allow for a rich understanding of how the intervention works in this context. However, we encountered a key challenge in calculating the sample size, given the lack of timely and reliable mortality data, and the uncertain impacts of the COVID-19 pandemic. Trial registrationISRCTN 39213655, registered 11th December 2019

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