Evaluating the impact of a community health worker programme on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi: protocol for a stepped-wedge, cluster randomised controlled trial

Elizabeth L. Dunbar, Emily B. Wroe, Basimenye Nhlema, Chiyembekezo Kachimanga, Ravi Gupta, Celia Taylor, Annie Michaelis, Katie Cundale, Luckson Dullie, Arnold Jumbe, Lawrence Nazimera, Ryan McBain, Richard J. Lilford, Samuel Ian Watson

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

Introduction This protocol concerns the implementation and evaluation of an intervention designed to realign the existing cadre of community health workers (CHWs) in Neno district, Malawi to better support the care needs of the clients they serve. The proposed intervention is a 'Household Model' where CHWs will be reassigned to households, rather than to specific patients with HIV and/or tuberculosis (TB). Methods and analysis Using a stepped-wedge, cluster-randomised design, this study investigates whether high HIV retention rates can be replicated for non-communicable diseases (NCDs), and the model's impact on TB and paediatric malnutrition case finding, as well as the uptake of family planning and antenatal care. Eleven sites (health centres and hospitals) were arranged into six clusters (average cluster population 21 800). Primary outcomes include retention in care for HIV and chronic NCDs, TB case finding, paediatric malnutrition case finding, and utilisation of early and complete antenatal care. Clinical outcomes are based on routinely collected data from the Ministry of Health's District Health Information System 2 and an OpenMRS electronic medical record supported by Partners In Health. Additionally, semistructured qualitative interviews with various stakeholders will assess community perceptions and context of the Household Model. 

Original languageEnglish
Article numbere019473
Number of pages9
JournalBMJ Open
Volume8
Issue number7
DOIs
Publication statusPublished - Jul 2018
Externally publishedYes

Keywords

  • community child health
  • community health
  • community health workers
  • integrated care
  • primary care

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