Integrated Community Case Management (ICCM) Delivered by Village Health Teams in Bushenyi District in Uganda

Not Applicable

Completed

• Conditions: Maternal and Child Health
• Interventions: Other: ICCM delivered by VHT; Other: No intervention; Other: ICCM delivered by VHT with Cell Phone

• Registration Number: NCT02046018
• Lead Sponsor: Healthy Child Uganda

Brief Summary

In Sub-Saharan Africa (SSA), many children die from diarrhoea, acute respiratory illness (ARI) and malaria, despite well- recognized, inexpensive and highly effective treatments, since health access and human resources are limited. Healthy Child Uganda (HCU) is a Ugandan-Canadian partnership that since 2003, has developed, implemented and evaluated a Village Health Volunteer (VHV) program in 175 rural villages. Volunteers, selected by peers, provide health education and refer sick children. Volunteer retention (94%) and significant decreases in child deaths are remarkable. Now, HCU wonders whether VHV scope can extend to provide treatment for sick children using Oral Rehydration Salts (ORS)/Zinc, antibiotics, and antimalarials. Use of lay providers in this capacity, called integrated community case management (iCCM), has been proposed as a potential inexpensive solution to SSA's human health resource crisis.

PRIMARY QUESTION: In rural southwest Uganda, can iCCM provided by lay volunteers, improve the proportion of children with diarrhoea receiving ORS/Zn, ARI receiving antibiotics, and fever/malaria receiving antimalarials? Secondary study questions consider VHV capacity to prescribe appropriate drug, dose, duration; iCCM acceptance by family, and VHV; VHV retention/motivation; program cost. Selected VHV will be iCCM trained then receive treatments for distribution. Qualitative and quantitative methods including household surveys, and focus groups will consider pre/post intervention differences and differences in control and intervention populations. A research short course and micro research grants (\~ $3000 to multidisciplinary groups pursuing relevant questions) will promote health system evaluation capacity. Lessons learned are critical as SSA countries move forward in planning for increased iCCM programming.

Detailed Description

Not available

Study Timeline

• Study Start: 2009-10
• Primary Completion: 2012-11
• Study Completion: 2013-05
• Study First Submitted: 2014-01-21
• Study First Submitted QC: 2014-01-23
• Study First Posted: 2014-01-27
• Status Verified: 2014-07
• Last Update Submitted: 2014-07-09
• Last Update Posted: 2014-07-11

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 5000

Inclusion Criteria

• Children under five (< or =59 months)

Exclusion Criteria

• Children over five years (> 59 Months)

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
ICCM delivered by VHT	ICCM delivered by VHT	Health Outcomes in Communities where VHT's were trained in ICCM and given drugs.
ICCM delivered by VHT with cell phone	ICCM delivered by VHT	Health Outcomes in communities with VHT's who were trained in ICCM and given cell phones
ICCM delivered by VHT with cell phone	ICCM delivered by VHT with Cell Phone	Health Outcomes in communities with VHT's who were trained in ICCM and given cell phones
Health outcomes in communities with no ICCM	No intervention	Health outcomes in communities with VHT's who were not trained in ICCM

Primary Outcome Measures

Name	Time	Method
Percentage of change in number of children under five in intervention area who receive appropriate Integrated Community Case Management Treatment from a Community Health Worker for presumed pneumonia.	March 2013 - November 2014 (8 months)	Children diagnosed by a Community Health Worker with presumed pneumonia (fast breathing and cough) treated with Amoxicillin.
Percentage of change in number of children under five in intervention area who receive appropriate Integrated Community Case Management Treatment from a Community Health Worker for diarrhea	March 2013 - November 2014 (8 months)	Children diagnosed with diarrhea will be treated with ORS and zinc.
Percentage of change in number of children under five in intervention area who receive Integrated Community Case Management Treatment from a Community Health Worker for fever.	March 2013 - November 2014 (8 months)	Children diagnosed with fever are presumed to have malaria, as per government treatment guidelines, and are treated with Coartem.