Impact Evaluation of Community-Based Health Programs in Rwanda

NCT01836731 | Completed

• 1 other identifier: CBEHPP
• Study Type: interventional
• Target: 8,718
• Locations: 1 country
• Sites: 2

Brief Summary

Community Health Clubs to improve local sanitation, hygiene and health conditions have been implemented in several countries in Africa and Asia with some success. The Ministry of Health in Rwanda has committed to rolling out a program designed along similar lines, the Community Based Environmental Health Promotion Program (CBEHPP), in all 15000 villages across Rwanda. The main objective of the program is to achieve 'zero open defecation' in all villages of Rwanda, at least 80% hygienic latrine coverage and improvements in a range of health behaviors such as the use of mosquito nets, hand-washing with soap and the use of household water treatment. To evaluate the impact of the program on health, other socio-economic outcomes and community functioning, a single district has been chosen where 150 communities will be randomized to receive the intervention immediately or 18 months later. The evaluation is led by US based Innovation for Poverty Action (IPA) through researchers based at the National University of Rwanda, Georgetown University, London School of Hygiene and Tropical Medicine and New York University. The research team will work in close collaboration with the implementing team, which consists of the Ministry of Health, Rwanda and Africa AHEAD. The study will span three years, beginning in May 2013, and ending in late 2015.

Conditions

Diarrhea; Malaria

Keywords

weight-for age; height-for-age; water sanitation facilities; hygiene behavior

Outcome Measures

Primary Outcomes (1)

• Incidence of Diarrhea

  The main outcome of the health impact evaluation trial will be 14 day recall self-reported diarrhoea in children under 5 years.

  2 weeks

Secondary Outcomes (7)

• Impact of CBEHPP on height-for-age in children under-5 years

  2.5 years

• Impact of CBEHPP on weight-for-age in children under-5 years

  2.5 years

• Impact of CBEHPP on drinking water quality

  2.5 years

• Impact of CBEHPP on incidence of malaria

  2.5 years

• Impact of CBEHPP on individual contribution to public goods game

  2.5 years

Study Arms (3)

Classic Intervention

EXPERIMENTAL

The standard "classic" approach will implement a total of 20 community health club sessions delivered through weekly education programs in the target communities as per the training manual. Community health workers (CHW) will receive careful training in the delivery of the CBEHPP instruction. High quality instructional materials (in color) will be used. Club members will each receive a membership card to be used to track attendance and compliance. Finally model home competitions and a graduation ceremony will be held. Monitoring of the clubs will be conducted by community health workers using mobile phones.

Behavioral: Classic Intervention

Minimum Intervention

EXPERIMENTAL

The "lite" trial arm will only implement 8 sessions covering all the WASH topics. It will be facilitated by CHWs receiving minimal training and using black/white photocopies of instructional materials. Members will not be issued with membership cards and will not have a graduation ceremony or home garden competitions. Minimal monitoring of this arm will be carried out by environmental health officers.

Behavioral: Minimum Intervention

Control

NO INTERVENTION

The control group is not enrolled in the CBEHPP. Because of the government's commitment for the national roll out to the CBEHPP, the control population will receive the intervention as soon as possible following the conclusion of the trial phase. Nevertheless, we will continue to evaluate the sustained impact of the intervention for two additional years by monitoring various behavioural outcomes and indicators and their impact on exposure outcomes (drinking water, hand hygiene, consumption, schooling and labour market participation etc.). We will use data from the RCT phase and clinical records to estimate the effect of any sustained impact on health. Long term impacts can be inferred by using data from the trial as well as data on long term behavioural outcomes.

Interventions

Classic Intervention BEHAVIORAL

The standard "classic" approach will implement a total of 20 community health club sessions delivered through weekly education programs in the target communities as per the training manual. Community health workers (CHW) will receive careful training in the delivery of the CBEHPP instruction. High quality instructional materials (in color) will be used. Club members will each receive a membership card to be used to track attendance and compliance. Finally model home competitions and a graduation ceremony will be held. Monitoring of the clubs will be conducted by community health workers using mobile phones.

Classic Intervention

Minimum Intervention BEHAVIORAL

The "lite" trial arm will only implement 8 sessions covering all the WASH topics. It will be facilitated by CHWs receiving minimal training and using black/white photocopies of instructional materials. Members will not be issued with membership cards and will not have a graduation ceremony or home garden competitions. Minimal monitoring of this arm will be carried out by environmental health officers.

Minimum Intervention

Eligibility Criteria

• Age: 1 Day - 5 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• All households with children under 5 years in the study communities are eligible for socio-economic and health outcome evaluation.

You may not qualify if:

• All households are eligible to participate in the intervention. However, for the purposes of the study, households with no children under the age of 5 will not be selected for data collection purposes.

Sponsors & Collaborators

• Georgetown University: lead
• National University, Rwanda: collaborator
• New York University: collaborator
• London School of Hygiene and Tropical Medicine: collaborator
• Innovations for Poverty Action: collaborator
• Bill and Melinda Gates Foundation: collaborator
• Emory University: collaborator

Study Sites (2)

IPA Rwanda District Office

Kamembe, Rusizi District, Rwanda

Location

Innovations for Poverty Action

Kigali, Rwanda

Location

Related Publications (1)

• Sinharoy SS, Schmidt WP, Wendt R, Mfura L, Crossett E, Grepin KA, Jack W, Rwabufigiri BN, Habyarimana J, Clasen T. Effect of community health clubs on child diarrhoea in western Rwanda: cluster-randomised controlled trial. Lancet Glob Health. 2017 Jul;5(7):e699-e709. doi: 10.1016/S2214-109X(17)30217-6.

  PMID: 28619228 DERIVED

MeSH Terms

Conditions

Diarrhea; Malaria

Condition Hierarchy (Ancestors)

Signs and Symptoms, Digestive; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Protozoan Infections; Parasitic Diseases; Infections; Mosquito-Borne Diseases; Vector Borne Diseases

Study Officials

• James P Habyarimana, PhD

  Georgetown University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor, Public Policy Institute

Study Record Dates

• First Submitted: April 16, 2013
• First Posted: April 22, 2013
• Study Start: April 1, 2013
• Primary Completion: December 1, 2016
• Study Completion: June 30, 2017
• Last Updated: July 14, 2017

Record last verified: 2017-07

Locations

RW (2)