- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03371186
Implementing an Integrated RMNCH Intervention by Community Health Workers in Achham and Dolakha: National Pilot
September 6, 2019 updated by: Possible
The investigators will conduct a cluster-controlled, stepped wedge implementation science trial of a bundled reproductive, maternal, neonatal, and child healthcare (RMNCH) delivery intervention within an approximate population of 300,000 people in rural Nepal.
This intervention integrates five evidence-based approaches for reproductive, maternal, newborn, and child health focused on the "golden 1000 days" from conception through age two: 1) Community Health Worker model of home-based care to monitor and increase utilization of services, maternal and neonatal health knowledge, self-efficacy, social support, and emergency planning among mothers; 2) Continuous surveillance of all pregnancies and children via an integrated electronic medical record; 3) Delivering community-based integrated management of newborn and childhood illness (CB-IMNCI) via CHWs; 4) Group antenatal and postnatal care to improve care delivery and reduce mortality during the "golden 1000 days" from conception to age two; and 5) Balanced counseling to increase post-partum contraception.
Study Overview
Status
Unknown
Study Type
Interventional
Enrollment (Anticipated)
12000
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Duncan Maru, MD, PhD
- Email: duncan@possiblehealth.org
Study Contact Backup
- Name: Scott Halliday, MS
- Email: scott@possiblehealth.org
Study Locations
-
-
Achham
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Sanfebagar, Achham, Nepal
- Recruiting
- Bayalpata Hospital
-
Contact:
- Aradhana Thapa, MPH
- Email: aradhana@possiblehealth.org
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Principal Investigator:
- David Citrin, PhD, MPH
-
Contact:
- Santosh Dhungana, MD-GP
- Email: santosh@possiblehealth.org
-
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Dolakha
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Bhimeshwor, Dolakha, Nepal
- Recruiting
- Charikot Primary Health Center
-
Contact:
- Aradhana Thapa, MPH
- Email: aradhana@possiblehealth.org
-
Principal Investigator:
- David Citrin, PhD, MPH
-
Contact:
- Binod Dangal, MD-GP
- Email: binod@possiblehealth.org
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
13 years to 47 years (Child, Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
Female
Description
Inclusion Criteria:
- Reproductive aged women 15-49;
- Reproductive aged women 15-49; recently delivered in past two years;
- Reproductive aged women 15-49; active pregnancy during study period and identified by a CHW serving their village
- Children aged 0-2; children of recently-delivered mothers (population #2 or #3 above);
- Healthcare staff; CHWs serving village clusters, CHW Leaders serving one of the village clusters, Nyaya Health Nepal and Government of Nepal employees involved in study design, program implementation, data collection, or data analysis processes; and
- Must reside in either Achham or Dolakha District, Nepal.
Exclusion Criteria:
Patients meeting inclusion criteria and consenting to study enrollment, as stated above, will be included in the study unless 1) patients migrate from the study are before completion of any of the bundled interventions; 2) patients request exclusion from the study at any point during the bundled intervention.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Bundled RMNCH Intervention
Stepped wedge, cluster-controlled implementation science trial of 5 bundled intervention components (1.
Community Health Worker, 2, Continuous Surveillance, 3. CB-Integrated Management of Newborn and Childhood Illness, 4. Group Antenatal and Postnatal Care, and 5. Balanced Post-Partum Contraceptive Counseling) implemented across 40 village clusters in Achham District, Nepal and 40 village clusters in Dolakha District, Nepal (covering a total population of approximately 300,000) in coordination with district authorities and study staff.
The investigators anticipate the experimental arm will enroll approximately 12,000 women and their children over the 18mo enrollment period.
|
The intervention is designed to address these primary drivers of underutilization of reproductive, maternal, newborn, and child health services in rural Nepal, namely: poverty, lack of social support, and poor birth planning.
The investigators have worked with a cadre of Community Healthcare Workers who, in addition to the responsibilities of local community health volunteers, have added responsibilities, training, and managerial support.
These women support their community members in their homes to identify and overcome social barriers and plan for emergency healthcare needs.
The goals are to increase utilization of services, maternal and neonatal health knowledge, self-efficacy, social support, and emergency planning among mothers
Each patient identified by a Community Health Worker will undergo a complete diagnostic evaluation by the hospital-based clinicians and will be enrolled in the study only if they are identified as currently pregnant, have recently given birth, or have a child under the age of 24 months.
Continuous surveillance systems ensure that the entire population is surveyed every three months and has a three month touchpoint with a Community Health Worker.
Safe delivery care; effective neonatal resuscitation; management of childhood diarrhea, malnutrition, and pneumonia; and treatment of traumatic and congenital surgical conditions can reduce child mortality.
Community Based Integrated Management of Newborn and Child Illness (CB-IMNCI) has shown substantial reductions in neonatal and early child mortality.
Community Health Workers will use CB-IMNCI as the clinical protocol for ongoing care to the community.
The proposed model will change antenatal and pediatric care in three major ways: 1) conduct care in a group setting, 2) provide expert and facilitated peer counseling, and 3) incorporate emergency planning.
The group setting is designed to create a supportive social network among women facing similar challenges.
The opportunity for counseling beyond the current standard will promote detailed emergency planning and the sharing of context-specific advice from peers to overcome barriers to access care.
This intervention draws on the strength within communities of women to change health-seeking behaviors.
Research on interventions to improve postpartum contraception suggest strategies that bridge the continuum of reproductive health care-antenatal care, labor and delivery, postnatal care, and infant care-are more effective than short term, stand-alone counseling sessions.
The structured counseling module incorporated in the intervention will be partially adapted from the Balanced Counseling Strategy, an interactive contraceptive counseling method developed by the Population Council in accordance with the World Health Organization's tiered effectiveness guidelines.
Prior studies in clinical settings in Nepal have demonstrated increased uptake of modern contraceptive methods, especially of long-acting reversible contraceptives with use of balanced counseling.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Institutional Birth Rate
Time Frame: 3 years
|
The percentage of births in a healthcare facility with a healthcare professional present.
|
3 years
|
Under-Two Mortality Rate
Time Frame: 3 years
|
The under-2 mortality rate is the probability (expressed as a rate per 1,000 live births) of a child born in a specified year dying before reaching the age of two if subject to current age-specific mortality rates.
|
3 years
|
Post-Partum Contraceptive Prevalence Rate
Time Frame: 3 years
|
The post-partum contraceptive prevalence rate is number of married reproductive aged women (15-49) in the study population who delivered in the past two years who are using a modern contraceptive method out of the total number of married reproductive aged women (15-49) in the study population who delivered in the past two years.
|
3 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Home Visit Coverage
Time Frame: 3 months
|
The percentage of children under 2 receiving monthly home based care by a CHW out of total number of children under 2 (aggregated by the percentage of pregnant women and reproductive-aged women).
|
3 months
|
Group Care Content Fidelity
Time Frame: 3 months
|
The percentage of topics covered and completed out of total planned topics
|
3 months
|
Group Participation
Time Frame: 3 months
|
The percentage of participants completing group sessions out of total scheduled participants
|
3 months
|
Session Completion
Time Frame: 3 months
|
The percentage of group sessions completed out of total appropriate number of group sessions
|
3 months
|
First-Trimester Pregnancies Identified
Time Frame: 3 months
|
The percentage of pregnancies identified at less than 12 weeks
|
3 months
|
Antenatal Care Completion
Time Frame: 3 months
|
The percentage of women who have had 4 or more antenatal care visits and are eligible for the government financial incentive out of total number of women delivered
|
3 months
|
Pediatric Pneumonia Incidence
Time Frame: 1 month
|
The number of new cases of pneumonia in catchment area in children under age of two/month
|
1 month
|
Pediatric Diarrhea Incidence
Time Frame: 1 month
|
The number of new cases of diarrhea in catchment area in children under age of two/month
|
1 month
|
Pediatric Stunting Prevalence
Time Frame: 1 month
|
The number of cases children in catchment area under age of two whose length-for height or height-for-age is two SDs below WHO Child Growth Standards median/total number of children in catchment area under age of two
|
1 month
|
Exclusive Breastfeeding Prevalence
Time Frame: 1 month
|
The number of infants in catchment area age zero-five months who are exclusively breastfed/total infants in catchment area age zero-five months
|
1 month
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Percent of postpartum women with unmet need for contraception
Time Frame: 3 years
|
The number of reproductive age women within the first year following the birth of their most recent child who desire to either stop or postpone childbearing for the next 2 years who are not currently using a contraceptive method or have a repeat unintended pregnancy while not using contraception/Total number of women who are up to one year postpartum, excluding women who declare that they are infecund, have had a hysterectomy, or are in menopause
|
3 years
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Contraceptive Method Mix
Time Frame: 3 months
|
The percentage of women using each method of modern contraception out of total number of women using modern contraception
|
3 months
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Total Intervention Cost
Time Frame: 3 years
|
The total sum costs of each intervention component
|
3 years
|
Cost-Effectiveness of Bundled Intervention
Time Frame: 3 years
|
The total sum costs of each intervention component over under-2 deaths averted by intervention
|
3 years
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Sheela Maru, MD, MPH, Possible
- Principal Investigator: Pushpa Chaudhari, MD, Ministry of Health and Population, Nepal
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
February 1, 2016
Primary Completion (Anticipated)
February 1, 2020
Study Completion (Anticipated)
February 1, 2021
Study Registration Dates
First Submitted
December 4, 2017
First Submitted That Met QC Criteria
December 7, 2017
First Posted (Actual)
December 13, 2017
Study Record Updates
Last Update Posted (Actual)
September 10, 2019
Last Update Submitted That Met QC Criteria
September 6, 2019
Last Verified
September 1, 2019
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- RMNCHnyaya
- 1DP5OD019894-01 (U.S. NIH Grant/Contract)
- AID-OAA-A-11-0001 (Other Grant/Funding Number: United States Agency for International Development)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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