Testing the Effectiveness of a Modified Community Model in Improving Child Health Outcomes in Mashonaland East, Zimbabwe
Condition: Pneumonia; Diarrhea; Malnutrition; Fever
MeSH terms: Malnutrition; Diarrhea
Study type: Interventional

Summary: 
      This study modified and contextualized a community mobilization approach in a bid to find a
      solution to reduce the high incidence and prevalence of child morbidity and mortality in
      Zimbabwe.The developed model will be tested for its effectiveness in reducing child morbidity
      and mortality at community level by comparing the effect of the intervention to that of the
      conventional community interventions.
    

Detailed description: 
      In Zimbabwe the Neonatal and infant mortality rate are 31/1000 and 57/1000 respectively
      (ZDHS, 2011). Seventy -four percent of these death occur at community level due to the delay
      in deciding to seek care . The government of Zimbabwe has intensified facility based health
      systems though very little has been done in community health system strengthening yet there
      is glaring evidence from recent studies that the burden of infant and child morbidity and
      mortality is largely at community level. The effect of social mobilization approaches in
      reducing socio-cultural causes of morbidity and mortality is not known. Evidence base for
      participatory models and their effectiveness remains scanty and in-country, there is no
      approved , integrated community mobilization model that achieves saturation coverage in
      addressing all facets of community maternal newborn and child health along the continuum of
      care. Community immersion with health services is in line with the Alma Ata Declaration of
      the Primary Health Care approach that seeks to decentralize health services to the
      marginalized people. The study will test the effectiveness of the contextualized model in
      improving child health outcomes.

      A cluster randomized controlled design will be used in 2 randomly selected districts of
      Mashonaland East , Zimbabwe. Women 18- 49 years with children 0-48 months in the selected
      districts will be recruited and followed up for 9-12 months . Stratified randomization will
      be used to select 11 pairs of participating villages . Central randomization will be employed
      for allocation concealment . The sample size was calculated in STATA 13. assuming a morbidity
      prevalence of 50% with a margin error of 5%. The assumed intra-cluster correlation
      coefficient (ICC) of 0.05 with a level of significance of 5% , design effect of 2.45 and
      power of 0.9. The sample size per arm will be 330 mother-child pairs and each arm will have
      11 clusters.

      Data will be collected monthly using monthly data collection tools. The study will require
      participants to commit at most 2 hours once in every two weeks. The main intervention is
      provision of critical health education and targeted promotion services to the participants in
      their locality. Participatory approaches will be employed in the intervention arm for
      learning and sharing of good community IMNCI practices for the prevention and management of
      childhood illnesses. Participants will be motivated through learning exchange visits and
      provision of promotional materials as incentives for successful completion and practice of
      recommended behaviors and child care practices.
    

Intervention name(s): prevention and management of childhood illnesses at community level; conventional community interventions
Intervention type(s): Behavioral; Behavioral
Intervention description(s): provision of critical health education and targeted promotion services to the participants in their locality; community health programs as the sole source of health education
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The study will have an intervention arm under which the study intervention will be implemented and this will be compared with the outcomes in the conventional intervention arm. Each arm will have 11 clusters of an average size of 50.
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Community mobilisation