Evaluating the impact of community health volunteer home visits on child diarrhea and fever in the Volta Region, Ghana: A cluster-randomized controlled trial
| Autor: | Joseph Kwami Degley, John Koku Awoonor-Williams, Yinseo Cho, Yeunji Ma, Christopher R. Sudfeld, Seungman Cha, Heunghee Kim, Jaeeun Lee |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Fevers 030204 cardiovascular system & hematology Pathology and Laboratory Medicine Ghana Pediatrics law.invention Geographical Locations Families 0302 clinical medicine Randomized controlled trial Hygiene law Medicine and Health Sciences Cluster Analysis Public and Occupational Health Community Health Services 030212 general & internal medicine Child Children media_common Community Health Workers Child Health General Medicine House Calls Diarrhea Health Education and Awareness Child Preschool Community health Medicine Female Health education medicine.symptom Behavioral and Social Aspects of Health Research Article Adult medicine.medical_specialty Fever media_common.quotation_subject Gastroenterology and Hepatology Disease cluster 03 medical and health sciences Signs and Symptoms Diagnostic Medicine Internal medicine Parasitic Diseases medicine Humans business.industry Tropical Diseases medicine.disease Malaria Health Care Age Groups Relative risk People and Places Africa Population Groupings business Follow-Up Studies |
| Zdroj: | PLoS Medicine PLoS Medicine, Vol 16, Iss 6, p e1002830 (2019) |
| ISSN: | 1549-1676 |
| DOI: | 10.1371/journal.pmed.1002830 |
| Popis: | Background Although there is mounting evidence demonstrating beneficial effects of community health workers (CHWs), few studies have examined the impact of CHW programs focused on preventing infectious diseases in children through behavior changes. We assessed the preventive effects of community health volunteers (CHVs), who receive no financial incentive, on child diarrhea and fever prevalence in Ghana. Methods and findings We conducted a cluster-randomized controlled trial in 40 communities in the Volta Region, Ghana. Twenty communities were randomly allocated to the intervention arm, and 20 to the control arm, using a computer-generated block randomization list. In the intervention arm, CHVs were deployed in their own community with the key task of conducting home visits for health education and community mobilization. The primary outcomes of the trial were diarrhea and fever prevalence at 6 and 12 months among under-5 children based on caregivers’ recall. Secondary outcomes included oral rehydration treatment and rapid diagnostic testing for malaria among under-5 children, and family planning practices of caregivers. Generalized estimating equations (GEEs) with a log link and exchangeable correlation matrix were used to determine the relative risk (RR) and 95% confidence intervals (CIs) for diarrhea, fever, and secondary outcomes adjusted for clustering and stratification. Between April 18 and May 4, 2015, 1,956 children were recruited and followed up until September 20, 2016. At 6 and 12 months post-randomization, 1,660 (85%) and 1,609 (82%) participants, respectively, had outcomes assessed. CHVs’ home visits had no statistically significant effect on diarrhea or fever prevalence at either time point. After a follow-up of 12 months, the prevalence of diarrhea and fever was 7.0% (55/784) and 18.4% (144/784), respectively, in the control communities and 4.5% (37/825) and 14.7% (121/825), respectively, in the intervention communities (12-month RR adjusted for clustering and stratification: diarrhea, RR 0.73, 95% CI 0.37–1.45, p = 0.37; fever, RR 0.76, 95% CI 0.51–1.14, p = 0.20). However, the following were observed: improved hand hygiene practices, increased utilization of insecticide-treated bed nets, and greater participation in community outreach programs (p-values < 0.05) in the intervention group. In a post hoc subgroup analysis, the prevalence of diarrhea and fever at 6 months was 3.2% (2/62) and 17.7% (11/62), respectively, in the intervention communities with ≥70% coverage and a ≥30-minute visit duration, and 14.4% (116/806) and 30.2% (243/806) in the control communities (RR adjusted for clustering, stratification, baseline prevalence, and covariates: diarrhea, RR 0.23, 95% CI 0.09–0.60, p = 0.003; fever, RR 0.69, 95% CI 0.52–0.92, p = 0.01). The main limitations were the following: We were unable to investigate the longer-term effects of CHVs; the trial may have been underpowered to detect small to moderate effects due to the large decline in diarrheal and fever prevalence in both the intervention and control group; and caregivers’ practices were based on self-report, and the possibility of caregivers providing socially desirable responses cannot be excluded. Conclusions We found no effect of CHVs’ home visits on the prevalence of child diarrhea or fever. However, CHV programs with high community coverage and regular household contacts of effective duration may reduce childhood infectious disease prevalence. Trial registration International Standard Randomised Controlled Trial Registry, ISRCTN49236178. Author summary Why was this study done? A wide range of health interventions could be delivered by community health workers (CHWs) including interventions for nutrition, maternal health, birth and newborn care preparedness, neonatal health, and promotion of breastfeeding. Many of the previous studies of CHW interventions have focused on case management, immunization, or child mortality. Only a few randomized controlled trials have explored the promotive effect of CHWs on infectious disease in children through health education, particularly when CHWs were assigned comprehensive tasks on a voluntary basis, including community mobilization, home visits, minor illness treatment, support of the professional health workforce, surveillance, and referral of patients to health facilities, and the results were mixed. What did the researchers do and find? We conducted a cluster-randomized controlled trial in 40 communities in Ghana to assess the effect of a community health volunteer (CHV) intervention on reducing diarrhea and fever prevalence in children under 5 years of age, and the participants were followed up at 6 and 12 months after the intervention started. Associations of CHVs’ home visit coverage and intensity with the primary outcomes, 14-day diarrhea and fever prevalence, were also examined. No statistically significant effect of CHVs on the primary outcomes was found; however, we found significant differences in some health behaviors to prevent diarrhea and malaria between the intervention and control groups. We found that the communities in which the CHV intervention was fully implemented had lower risks of both diarrhea and fever compared to control communities. What do these findings mean? We found that CHVs’ home visits had no overall effect on prevention and treatment of child diarrhea and fever, or on family planning practices. However, a subgroup analysis identified potential beneficial effects among villages where the CHV intervention reached ≥70% coverage of home visits, with an average visit duration of ≥30 minutes. This study has policy implications for CHW home visit programs, particularly regarding the frequency and duration of home visits and the optimal number of educational messages to be delivered. |
| Databáze: | OpenAIRE |
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