Liberia National Community Health Assistant (NCHA) Program and Under-five Mortality

NCT05123378 | Unknown

• 1 other identifier: Pro00048901
• Study Type: interventional
• Target: 23,702
• Locations: 1 country
• Sites: 1

Brief Summary

Last Mile Health (LMH) has partnered with the Liberian Ministry of Health (MOH) to support the design and implementation of the National Community Health Assistant Program (NCHAP). In collaboration with MOH, LMH is planning to conduct an impact evaluation in Grand Bassa to assess the effect of the National Community Health Assistant Program (NCHAP) on health outcomes, as well as to learn lessons around program operations and implementation. Our central hypothesis is that Community Health Assistants (CHAs) within the NCHAP will reduce under 5 mortality, as a result of expanding access to and uptake of health care utilization in remote communities. We will use a mixed effects discrete survival model, taking advantage of the staggered program implementation in Grand Bassa districts over a period of 4 years to compare the incidence of under-5 child mortality between the pre- and post-CHW program implementation periods.

Conditions

Malaria; Diarrhea; Acute Respiratory Infection; Malnutrition, Child

Keywords

Community Health; Mortality; Health Care Utilization; Child Illness Prevalence; Experiential Quality

Outcome Measures

Primary Outcomes (1)

• Mortality in children under 5

  Assess the impact of the NCHA program on under-5 mortality

  Cross-sectional household surveys administered at endline in 2022

Secondary Outcomes (3)

• Health care utilization

  Cross-sectional household surveys administered at baseline in 2018, midline 2019 and 2021, and endline in 2022

• Child illness prevalence

  Cross-sectional household surveys administered at baseline in 2018, midline 2019 and 2021, and endline in 2022

• Experiential quality and trust in the health care system

  Cross-sectional household surveys administered at baseline in 2018, midline 2019 and 2021, and endline in 2022

Study Arms (5)

Phase 1 Implementation

EXPERIMENTAL

Campwood District and District 3C begin NCHAP implementation in May 2018.

Behavioral: Liberia National Community Health Assistant Program

Phase 2 Implementation

EXPERIMENTAL

District 3AB and District 2 begin NCHAP implementation in November 2018.

Behavioral: Liberia National Community Health Assistant Program

Phase 3 Implementation

EXPERIMENTAL

District 4 begins NCHAP implementation in September 2020.

Behavioral: Liberia National Community Health Assistant Program

Phase 4 Implementation

EXPERIMENTAL

Owensgrove District and Commonwealth District begin NCHAP implementation in April 2021.

Behavioral: Liberia National Community Health Assistant Program

Phase 5 Implementation

EXPERIMENTAL

District 1 begins NCHAP implementation in January 2022.

Behavioral: Liberia National Community Health Assistant Program

Interventions

Liberia National Community Health Assistant Program BEHAVIORAL

Through the National Community Health Assistant Program (NCHAP), members of remote communities select Community Health Assistants (CHAs). Once selected, CHAs are trained to deliver direct services which include; treatment of diarrhea, ARI, and malaria following Integrated Community Case Management (iCCM) protocols, referrals for patients with clinical danger signs, family planning for women of childbearing age and birth preparedness and education for pregnant women. CHAs are also trained to deliver indirect services which include; health education, active surveillance, referral for mental health and other special conditions for all age groups. Since 2020 COVID-education has also been included in the CHAs work.

Phase 1 Implementation; Phase 2 Implementation; Phase 3 Implementation; Phase 4 Implementation; Phase 5 Implementation

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Communities \>5 km from a health facility
• Within a household all women 18-49 were interviewed (if possible).

Sponsors & Collaborators

• Last Mile Health: lead
• Heidelberg University: collaborator
• Northwestern University: collaborator
• Georgetown University: collaborator
• Massachusetts General Hospital: collaborator

Study Sites (1)

Last Mile Health

Monrovia, Montserrado County, Liberia

Location

MeSH Terms

Conditions

Malaria; Diarrhea; Child Nutrition Disorders; Patient Acceptance of Health Care

Condition Hierarchy (Ancestors)

Protozoan Infections; Parasitic Diseases; Infections; Mosquito-Borne Diseases; Vector Borne Diseases; Signs and Symptoms, Digestive; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Nutrition Disorders; Nutritional and Metabolic Diseases; Treatment Adherence and Compliance; Health Behavior; Behavior

Study Officials

• Marion Subah

  marionsubah@lastmilehealth.org

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Masking Details: All participants, care providers, investigators, and outcome assessors are aware of where and when the intervention is being delivered in each community in Grand Bassa.
• Purpose: PREVENTION
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: The NCHAP is being implemented in Grand Bassa county on a staggered schedule across eight study districts between 2018 and 2022. In order to serve most indigent districts first, the order is not randomized. Districts with more need for health interventions have been prioritized in the implementation roll out. All program implementations are preceded by community engagement activities, especially in getting the involvement of political and traditional leaders in the community and a training period for CHWs of a few months. Within this time CHWs are recruited and trained in a modular approach with in class training followed by practice in the community for mastery before the next module. The implementation process is still ongoing and the NCHA program will continue after the end of the study in 2022.

Study Record Dates

• First Submitted: November 5, 2021
• First Posted: November 17, 2021
• Study Start: May 1, 2018
• Primary Completion: August 1, 2022
• Study Completion: August 1, 2022
• Last Updated: November 17, 2021

Record last verified: 2021-11

Data Sharing

• IPD Sharing: Will not share

Locations

LI (1)