NCT01972321

Brief Summary

The aim of the inSCALE project is to test the effect of innovative approaches to increase coverage of integrated community case management, which provides community based-care for diarrhoea, pneumonia and malaria, resulting in more children receiving timely and appropriate care for these three most common childhood illnesses

Trial Health

90
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
2,289

participants targeted

Target at P75+ for not_applicable

Timeline
Completed

Started Apr 2013

Typical duration for not_applicable

Geographic Reach
2 countries

2 active sites

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Start

First participant enrolled

April 1, 2013

Completed
21 days until next milestone

First Submitted

Initial submission to the registry

April 22, 2013

Completed
6 months until next milestone

First Posted

Study publicly available on registry

October 30, 2013

Completed
1.6 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

June 1, 2015

Completed
6 months until next milestone

Study Completion

Last participant's last visit for all outcomes

December 1, 2015

Completed
Last Updated

January 8, 2016

Status Verified

January 1, 2016

Enrollment Period

2.2 years

First QC Date

April 22, 2013

Last Update Submit

January 7, 2016

Conditions

MalariaPneumoniaDiarrhoea

Keywords

Community health workerMotivationPerformanceQuality of careAfrica

Outcome Measures

Primary Outcomes (1)

  • Appropriate treatment of malaria, pneumonia and diarrhoea in children under five years of age

    Proportion of children under five years of age with symptoms of malaria, pneumonia and diarrhoea who received appropriate treatment

    1 year

Secondary Outcomes (1)

  • Community health workers with medicine stock-out <1 week each quarter

    1 year

Other Outcomes (1)

  • Community health worker retention

    1 year

Study Arms (3)

Technology supported supervision

EXPERIMENTAL

The technology supported supervision intervention will support the CHWs in providing quality case management for the under-fives who suffer from diarrhea, pneumonia and malaria through unlimited communication with their health facility supervisors and colleagues through closed-user-groups. It will enhance timely reporting of patient data and targeted support supervision on the CHWs who need support from their supervisors. With the CHWs receiving the above support and feedback messages, this will potentially increase CHW motivation, performance and retention. Data reported by CHWs can be used by the district planners to forecasting of medicine procurements and react to drug stock-outs or unusual data trends (e.g. disease outbreaks).

Other: Technology supported supervisionOther: Integrated community case management

Community supported supervision

EXPERIMENTAL

The community supported supervision intervention will set up village health clubs with the aim to improve child health through a community led forum with the CHW as the main focus point. Village health club meetings will provide a forum where CHWs and community members who are part of the club can work together to identify child health and CHW challenges. They will use village networks, knowledge, creativity and other assets.

Behavioral: Community supported supervisionOther: Integrated community case management

Control arm

ACTIVE COMPARATOR

The CHWs in the control arm will be receiving the standard Ministry of Health designed package to integrated community case management support and supervision.

Other: Integrated community case management

Interventions

Technology supported supervisionOTHER

CHWs will be provided with mobile phones and solar chargers to carry out the following: 1. Establish closed user groups (CUGs) to enable two-way communication between CHWs and their supervisors free of charge to the users. 2. Data submission through mobile phones 2.1. receive motivational performance related feedback provided in response. 2.2. Automated messages to supervisors which 2.2.1. Flags problems and strengths/successes identified in CHWs data 2.2.2. Alerting supervisors as to which CHWs require targeted supervision. 2.3. CHWs data summarised in a user friendly format and made accessible to district statisticians 3. Monthly motivational short message service (SMS) messages provided to CHWs that are locally relevant to CHW work and that are designed to impact positively on CHW performance.

Technology supported supervision
Community supported supervisionBEHAVIORAL

CHWs will facilitate the clubs using a learning, planning and action cycle. Club members will rank child health challenges faced by their community using picture cards and decide which one to focus on for each cycle. They will discuss solutions, which include supporting CHWs services, and take actions to meet challenges. They will also promote group decision-making and ownership and through this process gain tangible results. Solutions to health challenges developed by club members are a key focus of the village health club approach. Village Health Clubs are based on 5 guiding principles: clubs are open to all, village owned, intended to support CHW work, strength based, and fun and focused.

Community supported supervision
Integrated community case managementOTHER

Implementation of integrated community case management, with provision of training and equipment to CHWs for diagnosis and treatment of malaria, pneumonia and diarrhoea in children less than 5 years of age. Supportive supervision of CHWs will be provided by assigned health facility supervisors.

Community supported supervisionControl armTechnology supported supervision

Eligibility Criteria

Sexall
Healthy VolunteersYes
Age GroupsChild (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

  • CHWs in districts with ICCM implementation

You may not qualify if:

  • CHWs in districts without ICCM implementation

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (2)

6 Districts

Inhambane, 0, Mozambique

Location

26 Sub-Counties

Hoima, Please Select, Uganda

Location

Related Publications (13)

  • Thondoo M, Strachan DL, Nakirunda M, Ndima S, Muiambo A, Kallander K, Hill Z; InSCALE Study Group. Potential Roles of Mhealth for Community Health Workers: Formative Research With End Users in Uganda and Mozambique. JMIR Mhealth Uhealth. 2015 Jul 23;3(3):e76. doi: 10.2196/mhealth.4208.

    PMID: 26206419BACKGROUND

  • Kasteng F, Settumba S, Kallander K, Vassall A; inSCALE Study Group. Valuing the work of unpaid community health workers and exploring the incentives to volunteering in rural Africa. Health Policy Plan. 2016 Mar;31(2):205-16. doi: 10.1093/heapol/czv042. Epub 2015 May 22.

    PMID: 26001813BACKGROUND

  • Strachan DL, Kallander K, Nakirunda M, Ndima S, Muiambo A, Hill Z; inSCALE study group. Using theory and formative research to design interventions to improve community health worker motivation, retention and performance in Mozambique and Uganda. Hum Resour Health. 2015 Apr 30;13:25. doi: 10.1186/s12960-015-0020-8.

    PMID: 25925007BACKGROUND

  • Kallander K, Strachan D, Soremekun S, Hill Z, Lingam R, Tibenderana J, Kasteng F, Vassall A, Meek S, Kirkwood B. Evaluating the effect of innovative motivation and supervision approaches on community health worker performance and retention in Uganda and Mozambique: study protocol for a randomised controlled trial. Trials. 2015 Apr 12;16:157. doi: 10.1186/s13063-015-0657-6.

    PMID: 25873093BACKGROUND

  • Hill Z, Dumbaugh M, Benton L, Kallander K, Strachan D, ten Asbroek A, Tibenderana J, Kirkwood B, Meek S. Supervising community health workers in low-income countries--a review of impact and implementation issues. Glob Health Action. 2014 May 8;7:24085. doi: 10.3402/gha.v7.24085. eCollection 2014.

    PMID: 24815075BACKGROUND

  • Nanyonjo A, Makumbi F, Etou P, Tomson G, Kallander K; inSCALE Study Group. Perceived quality of care for common childhood illnesses: facility versus community based providers in Uganda. PLoS One. 2013 Nov 7;8(11):e79943. doi: 10.1371/journal.pone.0079943. eCollection 2013.

    PMID: 24244581BACKGROUND

  • Kallander K, Tibenderana JK, Akpogheneta OJ, Strachan DL, Hill Z, ten Asbroek AH, Conteh L, Kirkwood BR, Meek SR. Mobile health (mHealth) approaches and lessons for increased performance and retention of community health workers in low- and middle-income countries: a review. J Med Internet Res. 2013 Jan 25;15(1):e17. doi: 10.2196/jmir.2130.

    PMID: 23353680BACKGROUND

  • Nanyonjo A, Nakirunda M, Makumbi F, Tomson G, Kallander K, The inSCALE Study Group. Community acceptability and adoption of integrated community case management in Uganda. Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):97-104. doi: 10.4269/ajtmh.2012.11-0763.

    PMID: 23136284BACKGROUND

  • Strachan DL, Kallander K, Ten Asbroek AHA, Kirkwood B, Meek SR, Benton L, Conteh L, Tibenderana J, Hill Z. Interventions to improve motivation and retention of community health workers delivering integrated community case management (iCCM): stakeholder perceptions and priorities. Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):111-119. doi: 10.4269/ajtmh.2012.12-0030.

    PMID: 23136286BACKGROUND

  • Nanyonjo A, Ssekitooleko J, Counihan H, Makumbi F, Tomson G, Kallander K. Impact of an integrated community case management programme on uptake of appropriate diarrhoea and pneumonia treatments in Uganda: A propensity score matching and equity analysis study. Int J Equity Health. 2015 Sep 4;14:74. doi: 10.1186/s12939-015-0202-y.

    PMID: 26337975BACKGROUND

  • Nanyonjo A, Bagorogoza B, Kasteng F, Ayebale G, Makumbi F, Tomson G, Kallander K; inSCALE study group. Estimating the cost of referral and willingness to pay for referral to higher-level health facilities: a case series study from an integrated community case management programme in Uganda. BMC Health Serv Res. 2015 Aug 28;15:347. doi: 10.1186/s12913-015-1019-5.

    PMID: 26315661RESULT

  • Kallander K, Soremekun S, Strachan DL, Hill Z, Kasteng F, Kertho E, Nanyonjo A, Ten Asbroek G, Nakirunda M, Lumumba P, Ayebale G, Bagorogoza B, Vassall A, Meek S, Tibenderana J, Lingam R, Kirkwood B. Improving community health worker treatment for malaria, diarrhoea, and pneumonia in Uganda through inSCALE community and mHealth innovations: A cluster randomised controlled trial. PLOS Digit Health. 2023 Jun 12;2(6):e0000217. doi: 10.1371/journal.pdig.0000217. eCollection 2023 Jun.

    PMID: 37307519DERIVED

  • Batura N, Kasteng F, Condoane J, Bagorogosa B, Castel-Branco AC, Kertho E, Kallander K, Soremekun S, Lingam R, Vassall A; inSCALE study group. Costs of treating childhood malaria, diarrhoea and pneumonia in rural Mozambique and Uganda. Malar J. 2022 Aug 20;21(1):239. doi: 10.1186/s12936-022-04254-y.

    PMID: 35987625DERIVED

Related Links

MeSH Terms

Conditions

MalariaPneumoniaDiarrhea

Condition Hierarchy (Ancestors)

Protozoan InfectionsParasitic DiseasesInfectionsMosquito-Borne DiseasesVector Borne DiseasesRespiratory Tract InfectionsLung DiseasesRespiratory Tract DiseasesSigns and Symptoms, DigestiveSigns and SymptomsPathological Conditions, Signs and Symptoms

Study Officials

  • Sylvia Meek, PhD

    Malaria Consortium

    STUDY DIRECTOR

Study Design

Study Type
interventional
Phase
not applicable
Allocation
RANDOMIZED
Masking
NONE
Purpose
HEALTH SERVICES RESEARCH
Intervention Model
PARALLEL
Sponsor Type
OTHER
Responsible Party
PRINCIPAL INVESTIGATOR
PI Title
Senior Research Advisor

Study Record Dates

First Submitted

April 22, 2013

First Posted

October 30, 2013

Study Start

April 1, 2013

Primary Completion

June 1, 2015

Study Completion

December 1, 2015

Last Updated

January 8, 2016

Record last verified: 2016-01

Locations

UG(1)MO(1)