UTILIZING COMMUNITY HEALTH WORKERS TO INCREASE ORS AND ZINC USE IN - - PowerPoint PPT Presentation

2 0 1 6 E A S T A F R I C A E V I D E N C E S U M M I T

J U LY 1 3 , 2 0 1 5 | D A R E S S A L A A M , TA N Z A N I A

UTILIZING COMMUNITY HEALTH WORKERS TO INCREASE ORS AND ZINC USE IN UGANDA: A CLUSTERED RANDOMIZED CONTROLLED TRIAL

JOHN BOSCO ASIIMWE | MAKERERE UNIVERSITY

MOTIVATION & POTENTIAL REASONS FOR UNDER- USE OF ORS

Motivation

• Diarrheal diseases are globally the second leading cause of child

mortality under-5 (Liu et al. 2012)

• In Uganda, under 5 child mortality is 90 per 1000. Diarrhea

accounts for 13% total children’s deaths

• Diarrhea is preventable.

It is also cheaply treatable through the use of ORS

• In Eastern and Central Uganda, the location of the proposed study,

under 40% of diarrheal cases are treated with ORS (UDHS 2011). Potential reasons for under-use

• Price (addressed by our study)
• Distance/Convenience (addressed by our study)
• Cultural/Belief/Preference barriers (not addressed by our study)

OVERVIEW OF THE INTERVENTION

Group 1 – Control: Maintain Status Quo Group 2– Household Visit/info + Free Distribution + Pre- Emptive Delivery/Home Storage: Addresses Price and Distance Group 3 – Household Visit/Info + Cost Sharing/Selling + Pre- Emptive Delivery/Home Storage: Addresses Distance alone Group 4 – Household Visit/Info + Free Distribution Upon Retrieval From the CHP’s household: Addresses Price alone Group 2-Group 3= Impact of free distribution vs. cost sharing Group 2-Group 4= Impact of increased convenience Group 2-Group 1= impact of free distribution and convenience

• )

CHP/CHW APPROACH & DESIGN

• Administered by BRAC, a large Bangladesh-based NGO. In

about 3,000 villages in over 70 districts in Uganda

• Provide health care services referrals, and health education

during household visits

• Not trained medical health workers
• Goal of program is to increase access to essential health

products DESIGN

• Clustered randomized controlled trial (Village Level = CHP

Level)

• 120 Villages (30 per arm) with sample of 2,400 Cases of

Diarrhea

• 20 cases per village (20-25% with a case in last 4-weeks)
• Detectable effect of 40% to 51% (power of .8)

MAIN OUTCOMES AND DISCUSSION OF HOW THEY ARE COLLECTED

Self Report

• 1. ORS Use (primary outcome)
• 2. Zinc Use
• 3. Antibiotic Use
• 4. Time to ORS use
• 5. Time to Zinc use

Observation Empty packets will be observed and used to identify use. Incentives will provided to keep empty packets (Group 2 only)

PRELIMINARY RESULTS: FORMATIVE WORK & PILOT

POLICY IMPLICATIONS: EVIDENCE ON PROGRAM ELECTIVENESS Implications For BRAC

• If successful BRAC will scale-up across Uganda
• Simple and cheap intervention
• CHPs already make household visits

Implications For Uganda Government

• Government funds Village Health Team (VHT)

program

• VHTs are very similar to CHPs
• Volunteer community members
• Door-to-door visits