通过“加强社区疟疾、腹泻和肺炎防治能力提升项目”（inSCALE）社区及移动健康创新改善乌干达社区卫生工作者对疟疾、腹泻和肺炎的治疗：一项整群随机对照试验
Improving community health worker treatment for malaria, diarrhoea, and pneumonia in Uganda through inSCALE community and mHealth innovations: A cluster randomised controlled trial.
作者信息
Källander Karin, Soremekun Seyi, Strachan Daniel Ll, Hill Zelee, Kasteng Frida, Kertho Edmound, Nanyonjo Agnes, Ten Asbroek Guus, Nakirunda Maureen, Lumumba Patrick, Ayebale Godfrey, Bagorogoza Benson, Vassall Anna, Meek Sylvia, Tibenderana James, Lingam Raghu, Kirkwood Betty
机构信息
Malaria Consortium, London, United Kingdom.
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
出版信息
PLOS Digit Health. 2023 Jun 12;2(6):e0000217. doi: 10.1371/journal.pdig.0000217. eCollection 2023 Jun.
The inSCALE cluster randomised controlled trial in Uganda evaluated two interventions, mHealth and Village Health Clubs (VHCs) which aimed to improve Community Health Worker (CHW) treatment for malaria, diarrhoea, and pneumonia within the national Integrated Community Case Management (iCCM) programme. The interventions were compared with standard care in a control arm. In a cluster randomised trial, 39 sub-counties in Midwest Uganda, covering 3167 CHWs, were randomly allocated to mHealth; VHC or usual care (control) arms. Household surveys captured parent-reported child illness, care seeking and treatment practices. Intention-to-treat analysis estimated the proportion of appropriately treated children with malaria, diarrhoea, and pneumonia according to WHO informed national guidelines. The trial was registered at ClinicalTrials.gov (NCT01972321). Between April-June 2014, 7679 households were surveyed; 2806 children were found with malaria, diarrhoea, or pneumonia symptoms in the last one month. Appropriate treatment was 11% higher in the mHealth compared to the control arm (risk ratio [RR] 1.11, 95% CI 1.02, 1.21; p = 0.018). The largest effect was on appropriate treatment for diarrhoea (RR 1.39; 95% CI 0.90, 2.15; p = 0.134). The VHC intervention increased appropriate treatment by 9% (RR 1.09; 95% CI 1.01, 1.18; p = 0.059), again with largest effect on treatment of diarrhoea (RR 1.56, 95% CI 1.04, 2.34, p = 0.030). CHWs provided the highest levels of appropriate treatment compared to other providers. However, improvements in appropriate treatment were observed at health facilities and pharmacies, with CHW appropriate treatment the same across the arms. The rate of CHW attrition in both intervention arms was less than half that of the control arm; adjusted risk difference mHealth arm -4.42% (95% CI -8.54, -0.29, p = 0.037) and VHC arm -4.75% (95% CI -8.74, -0.76, p = 0.021). Appropriate treatment by CHWs was encouragingly high across arms. The inSCALE mHealth and VHC interventions have the potential to reduce CHW attrition and improve the care quality for sick children, but not through improved CHW management as we had hypothesised. Trial Registration:ClinicalTrials.gov (NCT01972321).
乌干达的inSCALE整群随机对照试验评估了两种干预措施，即移动健康（mHealth）和乡村健康俱乐部（VHCs），其目的是在国家综合社区病例管理（iCCM）项目中改善社区卫生工作者（CHW）对疟疾、腹泻和肺炎的治疗。将这些干预措施与对照组的标准护理进行比较。在一项整群随机试验中，乌干达中西部的39个次县，覆盖3167名社区卫生工作者，被随机分配到移动健康组、乡村健康俱乐部组或常规护理（对照）组。家庭调查收集了家长报告的儿童疾病、就医和治疗情况。意向性分析根据世界卫生组织提供的国家指南估计了患疟疾、腹泻和肺炎的儿童得到适当治疗的比例。该试验已在ClinicalTrials.gov（NCT01972321）注册。2014年4月至6月期间，对7679户家庭进行了调查；在过去一个月中发现2806名儿童有疟疾、腹泻或肺炎症状。与对照组相比，移动健康组的适当治疗率高11%（风险比[RR]1.11，95%置信区间1.02，1.21；p = 0.018）。最大的效果体现在腹泻的适当治疗上（RR 1.39；95%置信区间0.90，2.15；p = 0.134）。乡村健康俱乐部干预使适当治疗率提高了9%（RR 1.09；95%置信区间1.01，1.18；p = 0.059），同样在腹泻治疗上效果最大（RR 1.56，95%置信区间1.04，2.34，p = 0.030）。与其他提供者相比，社区卫生工作者提供的适当治疗水平最高。然而，在医疗机构和药店也观察到了适当治疗的改善，各分组中社区卫生工作者的适当治疗情况相同。两个干预组的社区卫生工作者流失率均不到对照组的一半；调整后的风险差异，移动健康组为-4.42%（95%置信区间-8.54，-0.29，p = 0.037），乡村健康俱乐部组为-4.75%（95%置信区间-8.74，-0.76，p = 0.021）。各分组中社区卫生工作者的适当治疗率都高得令人鼓舞。inSCALE移动健康和乡村健康俱乐部干预措施有可能减少社区卫生工作者的流失，并提高患病儿童的护理质量，但并非如我们所假设的那样通过改善对社区卫生工作者的管理来实现。试验注册：ClinicalTrials.gov（NCT01972321）。
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