Study of Post-Training Supports for Health Workers in Benin

Study Overview
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Brief Summary
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The objective of this study was to determine the effectiveness and cost-effectiveness of a package of interventions to support health workers in Benin (in West Africa) who had been trained to use Integrated Management of Childhood Illness guidelines (i.e., guidelines intended to improve the treatment of childhood illnesses).

Detailed Description
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Integrated Management of Childhood Illness (IMCI) is a child health strategy in developing countries with a goal of improving the treatment of illnesses at first-level health facilities through the use of clinical practice guidelines. The World Health Organization (WHO) recommends implementing the guidelines with an 11-day training course. There is a concern that health workers might not master all aspects of the guidelines and that health worker performance may deteriorate over time. In 1999, Benin (in West Africa) was planning to implement IMCI. In response to concerns about how well health workers would follow IMCI guidelines, interventions were designed to support health workers after IMCI training: 1) regular supervision of health workers; 2) supervision of supervisors; 3) job aids; and 4) non-financial incentives for health workers. These interventions were intended to be used together. The objective of this study was to determine the effectiveness and cost-effectiveness of the package of interventions to support IMCI-trained health workers in Benin.

Official Title
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A Randomized Controlled Trial of Post-Training Supports for Health Workers Trained in the Use of Integrated Management of Childhood Illness Guidelines in Ouémé Department, Benin

Conditions
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Malaria, Pneumonia, Diarrhea, Measles, Malnutrition

Intervention / Treatment
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* Behavioral: Health worker supports (supervision, job aids, incentives)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Inclusion criteria for health facilities were: 1) public and licensed private health facilities providing outpatient services, and 2) the level of care was appropriate for use of Integrated Management of Childhood Illness (IMCI) guidelines. Inclusion criteria for consultations were children 1 week - 59 months old seen for any illness during regular working hours (typically 8am-6pm) on weekdays. Exclusion Criteria: Health facilities in which the level of care was not appropriate for use of Integrated Management of Childhood Illness (IMCI) guidelines(i.e., one referral hospital and one sub-specialty hospital).

Ages Eligible for Study
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Minimum Age: 1 Week
Maximum Age: 59 Months

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Behavioral: Health worker supports (supervision, job aids, incentives)|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of children with potentially life-threatening illnesses who received recommended treatment, according to Integrated Management of Childhood Illness guidelines. |  | 3 years | 
| Proportion of children with potentially life-threatening illnesses who received recommended treatment, according to Integrated Management of Childhood Illness guidelines, or adequate treatment. |  | 3 years | 
| Mean proportion of needed case management tasks that were performed during consultations. |  | 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of children with pneumonia who received recommended treatment, according to Integrated Management of Childhood Illness guidelines. |  | 3 years | 
| Proportion of children with malaria who received recommended treatment, according to Integrated Management of Childhood Illness guidelines. |  | 3 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Benin, child health, developing country, health services research, health worker performance, Integrated Management of Childhood Illness