TY - JOUR
T1 - Improving community case management of diarrhoea and pneumonia in district Badin, Pakistan through a cluster randomised study--the NIGRAAN trial protocol
AU - Rabbani, Fauziah
AU - Mukhi, Aftab A.kbar Ali
AU - Perveen, Shagufta
AU - Gul, Xaher
AU - Iqbal, Saleem P.erwaiz
AU - Qazi, Shamim A.hmed
AU - Syed, Iqbal A.zam
AU - Shaikh, Khalid H.ussain
AU - Aftab, Wafa
N1 - Funding Information:
The authors would like to thank the Department of Maternal, Adolescent and Child Health of World Health Organization (WHO-MCA) for funding this study. The authors appreciate the hard work and convey their thanks to the project field staff in year I (Selwyn Victor, Kashif Sangrasi, Zahid Abbasi and the entire team of data collectors) and to the year II team members (Beenish Mahboob, Aysha Zahidie, Saleem Vadsaria). The authors would also like to thank the Department of Health (DOH), the Government of Sindh and the Provincial and District LHW programme officials for demonstrating their support to the study and allowing to work with the lady health supervisors and the workers.
Funding Information:
NIGRAAN is funded by the World Health Organization, Geneva, Department of Maternal, Newborn, Child and Adolescent Health. The trial is registered with the ‘Australian New Zealand Clinical Trials Registry’. Registration Number: ACTRN12613001261707
PY - 2014
Y1 - 2014
N2 - BACKGROUND: Diarrhoea and pneumonia contribute 30% of deaths in children under 5 in Pakistan. Pakistan's Lady Health Workers Programme (LHW-P) covers about 60% of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers. An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors (LHSs) is a key determinant of this problem. Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs. Ultimately, community case management (CCM) of childhood pneumonia and diarrhoea will improve.METHODS/DESIGN: NIGRAAN is a cluster-randomised trial in District Badin, Pakistan. There are approximately 1100 LHWs supervised by 36 LHSs in Badin. For this study, each LHS serves as a cluster. All LHSs working permanently in Badin who regularly conduct and report field visits are eligible. Thirty-four LHSs have been allocated to either intervention or control arms in a ratio of 1:1 through computer-generated simple randomisation technique. Five LHWs from each LHSs are also randomly picked. All 34 LHSs and 170 LHWs will be actively monitored. The intervention consists of training to build LHS knowledge and skills, clinical mentorship and written feedback to LHWs. Pre- and post-intervention assessments of LHSs, LHWs and community caregivers will be conducted via focus group discussions, in-depth interviews, knowledge assessment questionnaires, skill assessment scorecards and household surveys. Primary outcome is improvement in CCM practices of childhood diarrhoea and pneumonia and will be assessed at the cluster level.DISCUSSION: NIGRAAN takes a novel approach to implementation research and explores whether training of LHSs in supervisory skills results in improving the CCM practices of childhood diarrhoea and pneumonia. No significant harm to participants is anticipated. The enablers and barriers towards improved CCM would provide recommendations to policymakers for scale up of this intervention nationally and regionally.TRIAL REGISTRATION: NIGRAAN is registered with the 'Australian New Zealand Clinical Trials Registry'.REGISTRATION NUMBER: ACTRN12613001261707.
AB - BACKGROUND: Diarrhoea and pneumonia contribute 30% of deaths in children under 5 in Pakistan. Pakistan's Lady Health Workers Programme (LHW-P) covers about 60% of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers. An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors (LHSs) is a key determinant of this problem. Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs. Ultimately, community case management (CCM) of childhood pneumonia and diarrhoea will improve.METHODS/DESIGN: NIGRAAN is a cluster-randomised trial in District Badin, Pakistan. There are approximately 1100 LHWs supervised by 36 LHSs in Badin. For this study, each LHS serves as a cluster. All LHSs working permanently in Badin who regularly conduct and report field visits are eligible. Thirty-four LHSs have been allocated to either intervention or control arms in a ratio of 1:1 through computer-generated simple randomisation technique. Five LHWs from each LHSs are also randomly picked. All 34 LHSs and 170 LHWs will be actively monitored. The intervention consists of training to build LHS knowledge and skills, clinical mentorship and written feedback to LHWs. Pre- and post-intervention assessments of LHSs, LHWs and community caregivers will be conducted via focus group discussions, in-depth interviews, knowledge assessment questionnaires, skill assessment scorecards and household surveys. Primary outcome is improvement in CCM practices of childhood diarrhoea and pneumonia and will be assessed at the cluster level.DISCUSSION: NIGRAAN takes a novel approach to implementation research and explores whether training of LHSs in supervisory skills results in improving the CCM practices of childhood diarrhoea and pneumonia. No significant harm to participants is anticipated. The enablers and barriers towards improved CCM would provide recommendations to policymakers for scale up of this intervention nationally and regionally.TRIAL REGISTRATION: NIGRAAN is registered with the 'Australian New Zealand Clinical Trials Registry'.REGISTRATION NUMBER: ACTRN12613001261707.
UR - http://www.scopus.com/inward/record.url?scp=84964697029&partnerID=8YFLogxK
U2 - 10.1186/s13012-014-0186-9
DO - 10.1186/s13012-014-0186-9
M3 - Article
C2 - 25490971
AN - SCOPUS:84964697029
SN - 1748-5908
VL - 9
SP - 186
JO - Implementation Science
JF - Implementation Science
ER -
