Evaluating the impact of a community health worker programme on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi: protocol for a stepped-wedge, cluster randomised controlled trial

Elizabeth L Dunbar; Emily B Wroe; Basimenye Nhlema; Chiyembekezo Kachimanga; Ravi Gupta; Celia Taylor; Annie Michaelis; Katie Cundale; Luckson Dullie; Arnold Jumbe; Lawrence Nazimera; Ryan McBain; Richard J Lilford; Samuel Ian Watson

doi:10.1136/bmjopen-2017-019473

Evaluating the impact of a community health worker programme on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi: protocol for a stepped-wedge, cluster randomised controlled trial

Elizabeth L Dunbar, Emily B Wroe, Basimenye Nhlema, Chiyembekezo Kachimanga, Ravi Gupta, Celia Taylor, Annie Michaelis, Katie Cundale, Luckson Dullie, Arnold Jumbe, Lawrence Nazimera, Ryan McBain, Richard J Lilford, Samuel Ian Watson

Applied Health Research

Research output: Contribution to journal › Article › peer-review

7 Citations (Scopus)

Abstract

INTRODUCTION: This protocol concerns the implementation and evaluation of an intervention designed to realign the existing cadre of community health workers (CHWs) in Neno district, Malawi to better support the care needs of the clients they serve. The proposed intervention is a 'Household Model' where CHWs will be reassigned to households, rather than to specific patients with HIV and/or tuberculosis (TB).

METHODS AND ANALYSIS: Using a stepped-wedge, cluster-randomised design, this study investigates whether high HIV retention rates can be replicated for non-communicable diseases (NCDs), and the model's impact on TB and paediatric malnutrition case finding, as well as the uptake of family planning and antenatal care. Eleven sites (health centres and hospitals) were arranged into six clusters (average cluster population 21 800). Primary outcomes include retention in care for HIV and chronic NCDs, TB case finding, paediatric malnutrition case finding, and utilisation of early and complete antenatal care. Clinical outcomes are based on routinely collected data from the Ministry of Health's District Health Information System 2 and an OpenMRS electronic medical record supported by Partners In Health. Additionally, semistructured qualitative interviews with various stakeholders will assess community perceptions and context of the Household Model.

ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Malawian National Health Science Research Committee (#16/11/1694) in Lilongwe, Malawi; Partners Healthcare Human Research Committee (#2017P000548/PHS) in Somerville, Massachusetts; and the Biomedical and Scientific Research Ethics Sub-Committee (REGO-2017-2060) at the University of Warwick in Coventry, UK. Dissemination will include manuscripts for peer-reviewed publication as well as a full report detailing the findings of the intervention for the Malawian Ministry of Health.

TRIAL REGISTRATION NUMBER: NCT03106727.

PRIMARY SPONSOR: Partners In Health | Abwenzi Pa Za Umoyo P.O. Box 56, Neno, Malawi. Protocol Version 4, March 2018.

Original language	English
Pages (from-to)	e019473
Journal	BMJ open
Volume	8
Issue number	7
DOIs	https://doi.org/10.1136/bmjopen-2017-019473
Publication status	Published - 13 Jul 2018

Bibliographical note

Keywords

Cluster Analysis
Community Health Workers/education
Family Planning Services/organization & administration
Female
HIV Infections/therapy
Home Care Services/organization & administration
Humans
Malawi
Malnutrition/therapy
Noncommunicable Diseases/therapy
Pregnancy
Prenatal Care/organization & administration
Randomized Controlled Trials as Topic
Tuberculosis/therapy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1136/bmjopen-2017-019473

Fingerprint

Dive into the research topics of 'Evaluating the impact of a community health worker programme on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi: protocol for a stepped-wedge, cluster randomised controlled trial'. Together they form a unique fingerprint.

Cite this

Dunbar, E. L., Wroe, E. B., Nhlema, B., Kachimanga, C., Gupta, R., Taylor, C., Michaelis, A., Cundale, K., Dullie, L., Jumbe, A., Nazimera, L., McBain, R., Lilford, R. J., & Watson, S. I. (2018). Evaluating the impact of a community health worker programme on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi: protocol for a stepped-wedge, cluster randomised controlled trial. BMJ open, 8(7), e019473. https://doi.org/10.1136/bmjopen-2017-019473

@article{d8d4aeb30d924db480fd5e796773da0c,

title = "Evaluating the impact of a community health worker programme on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi: protocol for a stepped-wedge, cluster randomised controlled trial",

abstract = "INTRODUCTION: This protocol concerns the implementation and evaluation of an intervention designed to realign the existing cadre of community health workers (CHWs) in Neno district, Malawi to better support the care needs of the clients they serve. The proposed intervention is a 'Household Model' where CHWs will be reassigned to households, rather than to specific patients with HIV and/or tuberculosis (TB).METHODS AND ANALYSIS: Using a stepped-wedge, cluster-randomised design, this study investigates whether high HIV retention rates can be replicated for non-communicable diseases (NCDs), and the model's impact on TB and paediatric malnutrition case finding, as well as the uptake of family planning and antenatal care. Eleven sites (health centres and hospitals) were arranged into six clusters (average cluster population 21 800). Primary outcomes include retention in care for HIV and chronic NCDs, TB case finding, paediatric malnutrition case finding, and utilisation of early and complete antenatal care. Clinical outcomes are based on routinely collected data from the Ministry of Health's District Health Information System 2 and an OpenMRS electronic medical record supported by Partners In Health. Additionally, semistructured qualitative interviews with various stakeholders will assess community perceptions and context of the Household Model.ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Malawian National Health Science Research Committee (#16/11/1694) in Lilongwe, Malawi; Partners Healthcare Human Research Committee (#2017P000548/PHS) in Somerville, Massachusetts; and the Biomedical and Scientific Research Ethics Sub-Committee (REGO-2017-2060) at the University of Warwick in Coventry, UK. Dissemination will include manuscripts for peer-reviewed publication as well as a full report detailing the findings of the intervention for the Malawian Ministry of Health.TRIAL REGISTRATION NUMBER: NCT03106727.PRIMARY SPONSOR: Partners In Health | Abwenzi Pa Za Umoyo P.O. Box 56, Neno, Malawi. Protocol Version 4, March 2018.",

keywords = "Cluster Analysis, Community Health Workers/education, Family Planning Services/organization & administration, Female, HIV Infections/therapy, Home Care Services/organization & administration, Humans, Malawi, Malnutrition/therapy, Noncommunicable Diseases/therapy, Pregnancy, Prenatal Care/organization & administration, Randomized Controlled Trials as Topic, Tuberculosis/therapy",

author = "Dunbar, {Elizabeth L} and Wroe, {Emily B} and Basimenye Nhlema and Chiyembekezo Kachimanga and Ravi Gupta and Celia Taylor and Annie Michaelis and Katie Cundale and Luckson Dullie and Arnold Jumbe and Lawrence Nazimera and Ryan McBain and Lilford, {Richard J} and Watson, {Samuel Ian}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2018",

month = jul,

day = "13",

doi = "10.1136/bmjopen-2017-019473",

language = "English",

volume = "8",

pages = "e019473",

journal = "BMJ open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "7",

}

Dunbar, EL, Wroe, EB, Nhlema, B, Kachimanga, C, Gupta, R, Taylor, C, Michaelis, A, Cundale, K, Dullie, L, Jumbe, A, Nazimera, L, McBain, R, Lilford, RJ & Watson, SI 2018, 'Evaluating the impact of a community health worker programme on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi: protocol for a stepped-wedge, cluster randomised controlled trial', BMJ open, vol. 8, no. 7, pp. e019473. https://doi.org/10.1136/bmjopen-2017-019473

Evaluating the impact of a community health worker programme on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi: protocol for a stepped-wedge, cluster randomised controlled trial. / Dunbar, Elizabeth L; Wroe, Emily B; Nhlema, Basimenye et al.
In: BMJ open, Vol. 8, No. 7, 13.07.2018, p. e019473.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Evaluating the impact of a community health worker programme on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi

T2 - protocol for a stepped-wedge, cluster randomised controlled trial

AU - Dunbar, Elizabeth L

AU - Wroe, Emily B

AU - Nhlema, Basimenye

AU - Kachimanga, Chiyembekezo

AU - Gupta, Ravi

AU - Taylor, Celia

AU - Michaelis, Annie

AU - Cundale, Katie

AU - Dullie, Luckson

AU - Jumbe, Arnold

AU - Nazimera, Lawrence

AU - McBain, Ryan

AU - Lilford, Richard J

AU - Watson, Samuel Ian

N1 - © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2018/7/13

Y1 - 2018/7/13

N2 - INTRODUCTION: This protocol concerns the implementation and evaluation of an intervention designed to realign the existing cadre of community health workers (CHWs) in Neno district, Malawi to better support the care needs of the clients they serve. The proposed intervention is a 'Household Model' where CHWs will be reassigned to households, rather than to specific patients with HIV and/or tuberculosis (TB).METHODS AND ANALYSIS: Using a stepped-wedge, cluster-randomised design, this study investigates whether high HIV retention rates can be replicated for non-communicable diseases (NCDs), and the model's impact on TB and paediatric malnutrition case finding, as well as the uptake of family planning and antenatal care. Eleven sites (health centres and hospitals) were arranged into six clusters (average cluster population 21 800). Primary outcomes include retention in care for HIV and chronic NCDs, TB case finding, paediatric malnutrition case finding, and utilisation of early and complete antenatal care. Clinical outcomes are based on routinely collected data from the Ministry of Health's District Health Information System 2 and an OpenMRS electronic medical record supported by Partners In Health. Additionally, semistructured qualitative interviews with various stakeholders will assess community perceptions and context of the Household Model.ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Malawian National Health Science Research Committee (#16/11/1694) in Lilongwe, Malawi; Partners Healthcare Human Research Committee (#2017P000548/PHS) in Somerville, Massachusetts; and the Biomedical and Scientific Research Ethics Sub-Committee (REGO-2017-2060) at the University of Warwick in Coventry, UK. Dissemination will include manuscripts for peer-reviewed publication as well as a full report detailing the findings of the intervention for the Malawian Ministry of Health.TRIAL REGISTRATION NUMBER: NCT03106727.PRIMARY SPONSOR: Partners In Health | Abwenzi Pa Za Umoyo P.O. Box 56, Neno, Malawi. Protocol Version 4, March 2018.

AB - INTRODUCTION: This protocol concerns the implementation and evaluation of an intervention designed to realign the existing cadre of community health workers (CHWs) in Neno district, Malawi to better support the care needs of the clients they serve. The proposed intervention is a 'Household Model' where CHWs will be reassigned to households, rather than to specific patients with HIV and/or tuberculosis (TB).METHODS AND ANALYSIS: Using a stepped-wedge, cluster-randomised design, this study investigates whether high HIV retention rates can be replicated for non-communicable diseases (NCDs), and the model's impact on TB and paediatric malnutrition case finding, as well as the uptake of family planning and antenatal care. Eleven sites (health centres and hospitals) were arranged into six clusters (average cluster population 21 800). Primary outcomes include retention in care for HIV and chronic NCDs, TB case finding, paediatric malnutrition case finding, and utilisation of early and complete antenatal care. Clinical outcomes are based on routinely collected data from the Ministry of Health's District Health Information System 2 and an OpenMRS electronic medical record supported by Partners In Health. Additionally, semistructured qualitative interviews with various stakeholders will assess community perceptions and context of the Household Model.ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Malawian National Health Science Research Committee (#16/11/1694) in Lilongwe, Malawi; Partners Healthcare Human Research Committee (#2017P000548/PHS) in Somerville, Massachusetts; and the Biomedical and Scientific Research Ethics Sub-Committee (REGO-2017-2060) at the University of Warwick in Coventry, UK. Dissemination will include manuscripts for peer-reviewed publication as well as a full report detailing the findings of the intervention for the Malawian Ministry of Health.TRIAL REGISTRATION NUMBER: NCT03106727.PRIMARY SPONSOR: Partners In Health | Abwenzi Pa Za Umoyo P.O. Box 56, Neno, Malawi. Protocol Version 4, March 2018.

KW - Cluster Analysis

KW - Community Health Workers/education

KW - Family Planning Services/organization & administration

KW - Female

KW - HIV Infections/therapy

KW - Home Care Services/organization & administration

KW - Humans

KW - Malawi

KW - Malnutrition/therapy

KW - Noncommunicable Diseases/therapy

KW - Pregnancy

KW - Prenatal Care/organization & administration

KW - Randomized Controlled Trials as Topic

KW - Tuberculosis/therapy

U2 - 10.1136/bmjopen-2017-019473

DO - 10.1136/bmjopen-2017-019473

M3 - Article

C2 - 30007924

SN - 2044-6055

VL - 8

SP - e019473

JO - BMJ open

JF - BMJ open

IS - 7

ER -

Dunbar EL, Wroe EB, Nhlema B, Kachimanga C, Gupta R, Taylor C et al. Evaluating the impact of a community health worker programme on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi: protocol for a stepped-wedge, cluster randomised controlled trial. BMJ open. 2018 Jul 13;8(7):e019473. doi: 10.1136/bmjopen-2017-019473