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A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
ID
4646025
Author(s)
Wroe, E. B.; Nhlema, B.; Dunbar, E. L.; Kulinkina, A. V.; Kachimanga, C.; Aron, M.; Dullie, L.; Makungwa, H.; Chabwera, B.; Phiri, B.; Nazimera, L.; Ndarama, E. P. L.; Michaelis, A.; McBain, R.; Brown, C.; Palazuelos, D.; Lilford, R.; Watson, S. I.
A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi
Journal
BMJ Glob Health
Volume
6
Number
9
Pages / Article-Number
e006535
Keywords
Child; Community Health Workers; Female; *HIV Infections/diagnosis/epidemiology/therapy; Humans; Malawi/epidemiology; *Malnutrition/diagnosis/epidemiology/prevention & control; Maternal Health; *Noncommunicable Diseases/epidemiology/therapy; Pregnancy; *Tuberculosis/epidemiology/therapy; *hiv; *child health; *diabetes; *health services research; *maternal health
Mesh terms
Child; Community Health Workers; Female; HIV Infections, therapy; Humans; Malawi, epidemiology; Malnutrition, prevention & control; Maternal Health; Noncommunicable Diseases, therapy; Pregnancy; Tuberculosis, therapy
Abstract
BACKGROUND: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC). METHODS: We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20-40 households for monthly (or more frequent) visits. FINDINGS: The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (-0.8 percentage points (pp) (95% credible interval: -2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: -0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (-0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (-0.6 per 1000 (95% CI -2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges. INTERPRETATION: CHW programmes can be successfully expanded to more comprehensively address health needs in a population, although programmes should be carefully tailored to CHW and health system capacity.
