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

BMJ Open
Elizabeth L DunbarSamuel Ian Watson

Abstract

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). 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 st...Continue Reading

References

Feb 17, 2001·Statistics in Medicine·D J Spiegelhalter
Jun 2, 2001·Medical Decision Making : an International Journal of the Society for Medical Decision Making·A O'Hagan, J W Stevens
Dec 14, 2011·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Michael L RichAgnes Binagwaho
Feb 11, 2015·BMJ : British Medical Journal·K HemmingR J Lilford
Jun 4, 2015·The New England Journal of Medicine·James Macinko, Matthew J Harris

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Citations

Sep 5, 2019·Journal of Medical Ethics·Samuel I WatsonRichard J Lilford
Feb 28, 2021·International Journal of Medical Informatics·Neha VermaTheresa Cullen
Mar 18, 2021·Global Health, Science and Practice·Daniel PalazuelosEmily Wroe
Jun 3, 2021·International Journal of Environmental Research and Public Health·Veronica ShiroyaAndreas Deckert

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Software Mentioned

Neno
MOH District Health Information Software II ( DHIS2 )

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