- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05123378
Liberia National Community Health Assistant (NCHA) Program and Under-five Mortality
Assessing the Impact of the Liberia National Community Health Assistant (NCHA) Program on Under-five Mortality: A Study Protocol
Study Overview
Status
Intervention / Treatment
Detailed Description
Previous evaluations of the NCHAP in Rivercess and Grand Gedeh counties found significant increases in uptake of child and maternal health-care services from qualified providers. We will expand upon those studies to assess the impact of the CHA program after a phased implementation in an additional county.
The Liberian NCHAP is being rolled out staggered across the eight districts of Grand Bassa County by the government of Liberia. The practical program implementation is accompanied and supported by LMH. Starting with program implementation in March 2018, the last district will be covered by the NCHAP by January 2022. At baseline, midline, and endline LMH will conduct representative household surveys to assess the interventions uptake and effectiveness on population health. This programmatic strategy allows us to apply a effectiveness-implementation hybrid design, where we are using quasi experimental methods on the intervention's impact on relevant outcomes and program utilization and mixed methods to assess the implementation process.
The program implementation and data collection takes place in the Grand Bassa county of Liberia between 2018 and 2022. Measuring an area of 7,936 square kilometres and an overall population of 224,839 in 2008, the county is predominantly rural. For program roll out the five administrative districts were subdivided in eight study districts (see Figure 1). The target population of the NCHA are households in communities with a distance of more than 5 km from the nearest health facility. According to the 2018 LMH Grand Bassa household survey, 1,733 communities were identified as remote with 23,702 households.
The long-term objective of the NCHA program is to provide community-based health care that substantially improves population health and is desirable and respectful to the clients it serves. In pursuit of this objective, our specific research aims for the Grand Bassa causal impact evaluation is to assess the impact of the NCHA program on under-5 mortality.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Montserrado
-
Monrovia, Montserrado, Liberia
- Last Mile Health
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- ADULT
- OLDER_ADULT
- CHILD
Accepts Healthy Volunteers
Genders Eligible for Study
Description
The intervention will be accessable for everyone in the target communities without eligbilty criteria.
The impact assessment survey will be a full census. All remote target communities in Grand Bassa will be selected and all households within selected communities will be surveyed with the child mortality module and for other core indicators. Within each household the survey population will consist of all women of reproductive age who are at least 15 years old (15-49). We will select all 1,733 remote communities in the study area of Grand Bassa covering 23,702 households.
Inclusion Criteria:
- Communities >5 km from a health facility
- Within a household all women 18-49 were interviewed (if possible).
Exclusion Criteria:
-
Study Plan
How is the study designed?
Design Details
- Primary Purpose: PREVENTION
- Allocation: NON_RANDOMIZED
- Interventional Model: SEQUENTIAL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Phase 1 Implementation
Campwood District and District 3C begin NCHAP implementation in May 2018.
|
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.
|
EXPERIMENTAL: Phase 2 Implementation
District 3AB and District 2 begin NCHAP implementation in November 2018.
|
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.
|
EXPERIMENTAL: Phase 3 Implementation
District 4 begins NCHAP implementation in September 2020.
|
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.
|
EXPERIMENTAL: Phase 4 Implementation
Owensgrove District and Commonwealth District begin NCHAP implementation in April 2021.
|
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.
|
EXPERIMENTAL: Phase 5 Implementation
District 1 begins NCHAP implementation in January 2022.
|
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.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mortality in children under 5
Time Frame: Cross-sectional household surveys administered at endline in 2022
|
Assess the impact of the NCHA program on under-5 mortality
|
Cross-sectional household surveys administered at endline in 2022
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Health care utilization
Time Frame: Cross-sectional household surveys administered at baseline in 2018, midline 2019 and 2021, and endline in 2022
|
Determine effects of the NCHA program on health care utilization
|
Cross-sectional household surveys administered at baseline in 2018, midline 2019 and 2021, and endline in 2022
|
Child illness prevalence
Time Frame: Cross-sectional household surveys administered at baseline in 2018, midline 2019 and 2021, and endline in 2022
|
Determine effects of the NCHA program on 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
Time Frame: Cross-sectional household surveys administered at baseline in 2018, midline 2019 and 2021, and endline in 2022
|
Determine effects of the NCHA program on 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
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Marion Subah, marionsubah@lastmilehealth.org
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- Pro00048901
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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