This study will provide important evidence to the Ministry of Community Development, Mother and Child Health (MCDMCH) and the Ministry of Health (MOH) on how to effectively implement iCCM with a focus on improving both the flow of supplies to CHWs as well as the quality of their supervision and mentorship. The overall aim will be to determine whether improvements in supplies for community health workers (CHWs) and strengthened supervision result in improved early and appropriate treatment for children with malaria, pneumonia, and diarrhea in rural Zambia when compared to CHWs offering iCCM without this logistics and supervision support.
The main objective of this study is to strengthen the delivery of integrated community case management (iCCM) of malaria, diarrhea, and pneumonia in Chadiza and Chipata Districts of Eastern Province, through mHealth supported improved supply chain management of iCCM commodities and enhanced supportive supervision of iCCM-trained CHWs.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
3,840
Improved stock management of iCCM commodities using the DHIS2 mHealth platform
Strengthening of supportive supervision using DHIS2
ICCM implementation as per current practice without mHealth interventions
Chadiza and Chipata Districts
Chipata, Eastern Province, Zambia
RECRUITINGComposite percentage of children appropriately treated for malaria, diarrhea, and pneumonia.
Defined as percentage of sick children under five years of age presenting with an i-CCM condition to an i-CCM trained health worker (CHW or a CHA) who received appropriate treatment for an iCCM condition (composite indicator): Appropriate treatment for malaria: received artemisinin-based combination therapy (ACT) for malaria for at least three days or Appropriate treatment for pneumonia: received amoxicillin for pneumonia for at least five days or Appropriate treatment for diarrhea: received zinc in addition to fluid from ORS packet or oral rehydration solution (ORS) liquid or homemade fluid for diarrhea
Time frame: Through study completion, up to six months
a) Medicine availability (artemether-lumefantrine)
Defined as percentage of iCCM sites with artemether-lumefantrine in stock during the monthly assessments
Time frame: Through study completion, up to six months
b) Clinical supervision coverage
Defined as proportion of CHWs who received at least one supervisory contact (in person) every 3 months during which a sick child visit or scenario was assessed and coaching provided.
Time frame: Through study completion, up to six months
c) Virtual supervision coverage (via mobile technology)
Defined as proportion of CHWs who received at least SMS per month from their supervisor reinforcing the appropriate use of the iCCM algorithm for classification and treatment.
Time frame: Through study completion, up to six months
d) Average cost per iCCM contact
Defined as average expenditure per iCCM contact by type of condition
Time frame: Through study completion, up to six months
e) Diagnostic availability
Defined as percentage of iCCM sites with all iCCM diagnostics (malaria rapid diagnostic tests) in stock during the monthly assessments
Time frame: Through study completion, up to six months
f) Medicine availability (amoxicillin)
Defined as percentage of iCCM sites with amoxicillin in stock during the monthly assessments
Time frame: Through study completion, up to six months
g) Medicine availability (ORS)
Defined as percentage of iCCM sites with ORS in stock during the monthly assessments
Time frame: Through study completion, up to six months
h) Medicine availability (Zinc)
Defined as percentage of iCCM sites with Zinc in stock during the monthly assessments
Time frame: Through study completion, up to six months
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