Integrated Community Case Management Study in Eastern Province, Zambia
Study Details
Study Description
Brief Summary
This study will provide important evidence to the Ministry of Community Development, Mother and Child Health (MCDMCH) and the Ministry of Health (MOH) on how to effectively implement iCCM with a focus on improving both the flow of supplies to CHWs as well as the quality of their supervision and mentorship. The overall aim will be to determine whether improvements in supplies for community health workers (CHWs) and strengthened supervision result in improved early and appropriate treatment for children with malaria, pneumonia, and diarrhea in rural Zambia when compared to CHWs offering iCCM without this logistics and supervision support.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
The main objective of this study is to strengthen the delivery of integrated community case management (iCCM) of malaria, diarrhea, and pneumonia in Chadiza and Chipata Districts of Eastern Province, through mHealth supported improved supply chain management of iCCM commodities and enhanced supportive supervision of iCCM-trained CHWs.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Intervention mHealth inventory management and referrals via text messaging plus supportive supervision of CHWs via an mHealth strategy |
Other: mHealth inventory management
Improved stock management of iCCM commodities using the DHIS2 mHealth platform
Other Names:
Other: Supportive supervision
Strengthening of supportive supervision using DHIS2
Other Names:
|
| Placebo Comparator: Control ICCM current standard of care with CHWs operating under standard conditions without enhanced inventory management or supportive supervision by mHealth |
Other: ICCM current standard of care
ICCM implementation as per current practice without mHealth interventions
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Composite percentage of children appropriately treated for malaria, diarrhea, and pneumonia. [Through study completion, up to six months]
Defined as percentage of sick children under five years of age presenting with an i-CCM condition to an i-CCM trained health worker (CHW or a CHA) who received appropriate treatment for an iCCM condition (composite indicator): Appropriate treatment for malaria: received artemisinin-based combination therapy (ACT) for malaria for at least three days or Appropriate treatment for pneumonia: received amoxicillin for pneumonia for at least five days or Appropriate treatment for diarrhea: received zinc in addition to fluid from ORS packet or oral rehydration solution (ORS) liquid or homemade fluid for diarrhea
Secondary Outcome Measures
- a) Medicine availability (artemether-lumefantrine) [Through study completion, up to six months]
Defined as percentage of iCCM sites with artemether-lumefantrine in stock during the monthly assessments
- b) Clinical supervision coverage [Through study completion, up to six months]
Defined as proportion of CHWs who received at least one supervisory contact (in person) every 3 months during which a sick child visit or scenario was assessed and coaching provided.
- c) Virtual supervision coverage (via mobile technology) [Through study completion, up to six months]
Defined as proportion of CHWs who received at least SMS per month from their supervisor reinforcing the appropriate use of the iCCM algorithm for classification and treatment.
- d) Average cost per iCCM contact [Through study completion, up to six months]
Defined as average expenditure per iCCM contact by type of condition
- e) Diagnostic availability [Through study completion, up to six months]
Defined as percentage of iCCM sites with all iCCM diagnostics (malaria rapid diagnostic tests) in stock during the monthly assessments
- f) Medicine availability (amoxicillin) [Through study completion, up to six months]
Defined as percentage of iCCM sites with amoxicillin in stock during the monthly assessments
- g) Medicine availability (ORS) [Through study completion, up to six months]
Defined as percentage of iCCM sites with ORS in stock during the monthly assessments
- h) Medicine availability (Zinc) [Through study completion, up to six months]
Defined as percentage of iCCM sites with Zinc in stock during the monthly assessments
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Age <5 years
-
Treatment for an iCCM condition (malaria, pneumonia, or diarrhea) by a CHW
-
Willingness of the child's caregiver to provide informed consent
Exclusion Criteria:
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Chadiza and Chipata Districts | Chipata | Eastern Province | Zambia |
Sponsors and Collaborators
- Zambia Center for Applied Health Research and Development
- UNICEF
- Bill and Melinda Gates Foundation
- Boston University
- Ministry of Health, Zambia
- Ministry of Community Development, Mother and Child Health
Investigators
- Principal Investigator: Godfrey Biemba, MBChB, M.Sc, ZCAHRD and Boston University
- Principal Investigator: David Hamer, MD, Boston University
- Study Director: Boniface M Chiluba, B.Sc, M.Sc, Zambia Center for Applied Health Research and Development
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 4980/A0/04/001/010