Rabbani Fauziah, Mukhi Aftab Akbar Ali, Perveen Shagufta, Gul Xaher, Iqbal Saleem Perwaiz, Qazi Shamim Ahmed, Syed Iqbal Azam, Shaikh Khalid Hussain, Aftab Wafa
Department of Community Health Sciences, The Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan.
Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
Implement Sci. 2014 Dec 10;9:186. doi: 10.1186/s13012-014-0186-9.
Diarrhoea and pneumonia contribute 30% of deaths in children under 5 in Pakistan. Pakistan's Lady Health Workers Programme (LHW-P) covers about 60% of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers. An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors (LHSs) is a key determinant of this problem. Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs. Ultimately, community case management (CCM) of childhood pneumonia and diarrhoea will improve.
METHODS/DESIGN: NIGRAAN is a cluster-randomised trial in District Badin, Pakistan. There are approximately 1100 LHWs supervised by 36 LHSs in Badin. For this study, each LHS serves as a cluster. All LHSs working permanently in Badin who regularly conduct and report field visits are eligible. Thirty-four LHSs have been allocated to either intervention or control arms in a ratio of 1:1 through computer-generated simple randomisation technique. Five LHWs from each LHSs are also randomly picked. All 34 LHSs and 170 LHWs will be actively monitored. The intervention consists of training to build LHS knowledge and skills, clinical mentorship and written feedback to LHWs. Pre- and post-intervention assessments of LHSs, LHWs and community caregivers will be conducted via focus group discussions, in-depth interviews, knowledge assessment questionnaires, skill assessment scorecards and household surveys. Primary outcome is improvement in CCM practices of childhood diarrhoea and pneumonia and will be assessed at the cluster level.
NIGRAAN takes a novel approach to implementation research and explores whether training of LHSs in supervisory skills results in improving the CCM practices of childhood diarrhoea and pneumonia. No significant harm to participants is anticipated. The enablers and barriers towards improved CCM would provide recommendations to policymakers for scale up of this intervention nationally and regionally.
NIGRAAN is registered with the 'Australian New Zealand Clinical Trials Registry'.
ACTRN12613001261707.
腹泻和肺炎导致巴基斯坦5岁以下儿童死亡人数的30%。巴基斯坦的妇幼保健员项目（LHW-P）覆盖了约60%的人口，但在降低与这些主要儿童杀手相关的发病率和死亡率方面几乎没有起到作用。对LHW-P的一项外部评估表明，妇幼保健督导员（LHSs）对妇幼保健员缺乏支持性监督是这一问题的关键决定因素。NIGRAAN项目旨在通过妇幼保健督导员采用的监督策略来提高妇幼保健员和社区护理人员的知识和技能。最终，儿童肺炎和腹泻的社区病例管理（CCM）将会得到改善。
方法/设计：NIGRAAN是在巴基斯坦巴丁县进行的一项整群随机试验。巴丁县约有1100名妇幼保健员由36名妇幼保健督导员监督。在本研究中，每个妇幼保健督导员作为一个群组。所有长期在巴丁工作且定期进行并报告实地访问的妇幼保健督导员均符合条件。通过计算机生成的简单随机化技术，34名妇幼保健督导员以1:1的比例被分配到干预组或对照组。每个妇幼保健督导员还随机挑选5名妇幼保健员。所有34名妇幼保健督导员和170名妇幼保健员都将受到积极监测。干预措施包括培训以增强妇幼保健督导员的知识和技能、临床指导以及给妇幼保健员的书面反馈。将通过焦点小组讨论、深入访谈、知识评估问卷、技能评估记分卡和家庭调查对妇幼保健督导员、妇幼保健员和社区护理人员进行干预前和干预后的评估。主要结局是儿童腹泻和肺炎的社区病例管理实践得到改善，并将在群组层面进行评估。
NIGRAAN采用了一种新颖的实施研究方法，探讨对妇幼保健督导员进行监督技能培训是否能改善儿童腹泻和肺炎的社区病例管理实践。预计不会对参与者造成重大伤害。改善社区病例管理的促进因素和障碍将为政策制定者提供建议，以便在国家和地区层面扩大这项干预措施。
NIGRAAN已在“澳大利亚新西兰临床试验注册中心”注册。
ACTRN12613001261707。
