2 research outputs found
Effect of community health clubs on child diarrhoea in western Rwanda: cluster-randomised controlled trial
Background Community health clubs are multi-session village-level gatherings led by trained facilitators and designed
to promote healthy behaviours mainly related to water, sanitation, and hygiene. They have been implemented in
several African and Asian countries but have never been evaluated rigorously. We aimed to evaluate the effect of
two versions of the community health club model on child health and nutrition outcomes.
Methods We did a cluster-randomised trial in Rusizi district, western Rwanda. We defined villages as clusters.
We assessed villages for eligibility then randomly selected 150 for the study using a simple random sampling routine
in Stata. We stratified villages by wealth index and by the proportion of children younger than 2 years with caregiverreported
diarrhoea within the past 7 days. We randomly allocated these villages to three study groups: no intervention
(control; n=50), eight community health club sessions (Lite intervention; n=50), or 20 community health club sessions
(Classic intervention; n=50). Households in these villages were enrolled in 2013 for a baseline survey, then re-enrolled
in 2015 for an endline survey. The primary outcome was caregiver-reported diarrhoea within the previous 7 days in
children younger than 5 years. Analysis was by intention to treat and per protocol. This trial is registered with
ClinicalTrials.gov, number NCT01836731.
Findings At the baseline survey undertaken between May, 2013, and August, 2013, 8734 households with children
younger than 5 years of age were enrolled. At the endline survey undertaken between Sept 21, 2015, and
Dec 22, 2015, 7934 (91%) of the households were re-enrolled. Among children younger than 5 years, the prevalence
of caregiver-reported diarrhoea in the previous 7 days was 514 (14%) of 3616 assigned the control, 453 (14%)
of 3196 allocated the Lite intervention (prevalence ratio compared with control 0·97, 95% CI 0·81–1·16; p=0·74),
and 495 (14%) of 3464 assigned the Classic intervention (prevalence ratio compared with control 0·99, 0·85–1·15;
p=0·87).
Interpretation Community health clubs, in this setting in western Rwanda, had no effect on caregiver-reported
diarrhoea among children younger than 5 years. Our results question the value of implementing this intervention at
scale for the aim of achieving health gains
Recommended from our members
Before and after implementation of group antenatal care in Rwanda: a qualitative study of women’s experiences
BackgroundThe Preterm Birth Initiative-Rwanda is conducting a 36-cluster randomized controlled trial of group antenatal and postnatal care. In the context of this trial, we collected qualitative data before and after implementation. The purpose was two-fold. First, to inform the design of the group care program before implementation and second, to document women's experiences of group care at the mid-point of the trial to make ongoing programmatic adjustments and improvements.MethodsWe completed 8 focus group discussions among women of reproductive age before group care implementation and 6 focus group discussions among women who participated in group antenatal care and/or postnatal care at 18 health centers that introduced the model, approximately 9 months after implementation.ResultsBefore implementation, focus group participants reported both enthusiasm for the potential for support and insight from a group of peers and concern about the risk of sharing private information with peers who may judge, mock, or gossip. After implementation, group care participants reported benefits including increased knowledge, peer support, and more satisfying relationships with providers. When asked about barriers to group care participation, none of them cited concern about privacy but instead cited lack of financial resources, lack of cooperation from a male partner, and long distances to the health center. Finally, women stated that the group care experience would be improved if all participants and providers arrived on time and remained focused on the group care visit throughout.DiscussionThese results are consistent with other published reports of women's perceptions of group antenatal care, especially increased pregnancy- and parenting-related knowledge, peer support, and improved relationships with health care providers. Some results were unexpected, especially the consequences of staff allocation patterns that resulted in providers arriving late for group visits or having to leave during group visits to attend to other facility services, which diminished women's experiences of care.ConclusionGroup antenatal and postnatal care provide compelling benefits to women and families. If the model requires the addition of human resources at the health center, intensive reminder communications, and large-scale community outreach to benefit the largest number of pregnant and postnatal mothers, those additional resources required must be factored into any future decision to scale a group care model.Trial registrationThis trial is registered at clinicaltrials.gov as NCT03154177