Community Mobilization and Incentivization for Childhood Diarrhea and Pneumonia

NCT03594279 | Completed DMC

• 1 other identifier: 4676-WCH-ERC-17
• Study Type: interventional
• Target: 48
• Locations: 1 country
• Sites: 1

Brief Summary

Childhood diarrhea and pneumonia remains the leading cause of mortality among children under five years of age in Pakistan. The prevalence of diarrhea in Pakistan has increased from 15% in 1990 to 23% in 2013 while there has been no progress in the prevalence of pneumonia and it has been almost constant over the last two decades. The coverage of preventive and therapeutic interventions for childhood diarrhea and pneumonia also remains low. This study aims to improve the adherence to recommended preventive and curative practices for childhood diarrhea and pneumonia.

Conditions

Childhood Diarrhea; Childhood Pneumonia; Community Mobilisation; Sanitation and Hygiene; Community Incentives

Outcome Measures

Primary Outcomes (9)

• Age-appropriate immunization 12-23 months

  At six months of intervention

• ORS use for diarrhea

  At six months of intervention

• Mean Sanitation Index

  The scale is focused on 12 components. All the components are valued equally and can be scored '0' (for 'No') or '1' (for 'Yes'). These would be summed up for each household for a total possible score of 12 and a range of 0-12. Higher score represents a better outcome. It comprises of the following three subscales: 1. Drinking water - possible score of minimum 0 and maximum 3 * Interior water storage container is covered; * Exterior water storage container is cleaned; * Water present in water storage container 2. Food - possible score of minimum 0 and maximum 3 * Clean dishes are covered; * Clean dishes are kept high; * All food is covered 3. Domestic hygiene - possible score of minimum 0 and maximum 6 * No trash outside the house; * No trash inside the house; * No unrestrained animals in patio or house; * No accumulation of dirty clothes; * Insignificant number of flies in house; * No standing water in patio or around house

  At six months of intervention

• Age-appropriate immunization 12-23 months

  At 12 months of intervention

• ORS use for diarrhea

  At 12 months of intervention

• Mean Sanitation Index

  The scale is focused on 12 components. All the components are valued equally and can be scored '0' (for 'No') or '1' (for 'Yes'). These would be summed up for each household for a total possible score of 12 and a range of 0-12. Higher score represents a better outcome. It comprises of the following three subscales: 1. Drinking water - possible score of minimum 0 and maximum 3 * Interior water storage container is covered; * Exterior water storage container is cleaned; * Water present in water storage container 2. Food - possible score of minimum 0 and maximum 3 * Clean dishes are covered; * Clean dishes are kept high; * All food is covered 3. Domestic hygiene - possible score of minimum 0 and maximum 6 * No trash outside the house; * No trash inside the house; * No unrestrained animals in patio or house; * No accumulation of dirty clothes; * Insignificant number of flies in house; * No standing water in patio or around house

  At 12 months of intervention

• Age-appropriate immunization 12-23 months

  At 24 months of intervention

• ORS use for diarrhea

  At 24 months of intervention

• Mean Sanitation Index

  The scale is focused on 12 components. All the components are valued equally and can be scored '0' (for 'No') or '1' (for 'Yes'). These would be summed up for each household for a total possible score of 12 and a range of 0-12. Higher score represents a better outcome. It comprises of the following three subscales: 1. Drinking water - possible score of minimum 0 and maximum 3 * Interior water storage container is covered; * Exterior water storage container is cleaned; * Water present in water storage container 2. Food - possible score of minimum 0 and maximum 3 * Clean dishes are covered; * Clean dishes are kept high; * All food is covered 3. Domestic hygiene - possible score of minimum 0 and maximum 6 * No trash outside the house; * No trash inside the house; * No unrestrained animals in patio or house; * No accumulation of dirty clothes; * Insignificant number of flies in house; * No standing water in patio or around house

  At 24 months of intervention

Secondary Outcomes (6)

• Handwashing with soap at important time

  At 24 months of intervention

• Exclusive breastfeeding rates - children who are exclusively breastfed at 6 months of age

  At 24 months of intervention

• Care seeking for severe cases of childhood diarrhea and pneumonia - parents/caregivers who sought care for child with diarrhea/pneumonia

  At 24 months of intervention

• Prevalence of Diarrhea and pneumonia

  At 24 months of intervention

• Open defecation rates

  At 24 months of intervention

Study Arms (3)

Community Mobilization

EXPERIMENTAL

This arm will receive specific messages regarding the prevention and management of childhood diarrhea and pneumonia. The investigators will form village committees (VC) consisting of prominent members of the community (6-8 in a group) to carry out awareness and motivational activities for the uptake of the identified interventions.

Behavioral: Community Mobilization; Behavioral: Community Mobilization and Community Incentive

Community Mobilization and Community Incentive

EXPERIMENTAL

In this arm, along with the interventions in the community mobilization arm, community based incentives will also be provided. The clusters which improve the practices for preventive and curative strategies for diarrhea and pneumonia will receive community-based incentive including structural benefits linked to health including tube wells, water supply, toilets in community/schools, water storage facility or any other incentive as decided with the respective village committees.

Behavioral: Community Mobilization and Community Incentive

Control

NO INTERVENTION

This arm will receive the routine standard of care.

Interventions

Community Mobilization BEHAVIORAL

Community Mobilization

Community Mobilization

Community Mobilization and Community Incentive BEHAVIORAL

Community Mobilization and Community Incentive

Community Mobilization; Community Mobilization and Community Incentive

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• People residing in the villages in the selected study site and consent to participate.

Sponsors & Collaborators

• Aga Khan University: lead
• Bill and Melinda Gates Foundation: collaborator

Study Sites (1)

Aga Khan University

Karachi, Sindh, 74800, Pakistan

Location

Related Publications (2)

• Das JK, Salam RA, Padhani ZA, Rizvi A, Mirani M, Jamali MK, Chauhadry IA, Sheikh I, Khatoon S, Muhammad K, Bux R, Naqvi A, Shaheen F, Ali R, Muhammad S, Cousens S, Bhutta ZA. An innovative Community Mobilisation and Community Incentivisation for child health in rural Pakistan (CoMIC): a cluster-randomised, controlled trial. Lancet Glob Health. 2025 Jan;13(1):e121-e133. doi: 10.1016/S2214-109X(24)00428-5.

  PMID: 39706650 DERIVED

• Das JK, Siddiqui F, Padhani ZA, Khan MH, Jabeen S, Mirani M, Mughal S, Baloch S, Sheikh I, Khatoon S, Muhammad K, Gangwani M, Nathani K, Salam RA, Bhutta ZA. Health behaviors and care seeking practices for childhood diarrhea and pneumonia in a rural district of Pakistan: A qualitative study. PLoS One. 2023 May 16;18(5):e0285868. doi: 10.1371/journal.pone.0285868. eCollection 2023.

  PMID: 37192190 DERIVED

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: Assistant Professor

Model Details: The intervention is based on the Behavior Change Theory.

Study Record Dates

• First Submitted: June 28, 2018
• First Posted: July 20, 2018
• Study Start: July 1, 2017
• Primary Completion: December 31, 2020
• Study Completion: December 31, 2020
• Last Updated: August 31, 2021

Record last verified: 2021-08

Locations

PA (1)