Access to Health Care clinical trials at UCSF
1 in progress, 0 open to new patients
Sorry, accepting new patients by invitation only
The purpose of this study is to evaluate whether the addition of Proactive Case Detection to Community Case Management will provide an increase in early access to health care and a reduction in deaths among children aged 0-59 months. Integrated Community Case Management is the package of community-based services for children delivered by Community Health Workers (CHW), including diagnosis and treatment of malaria, pneumonia, diarrheal disease and malnutrition. In many i-CCM interventions, CHWs are stationed in their villages and available in a passive, reactive manner to provide care to patients who seek them out. This study seeks to determine whether the addition of proactive case detection by CHWs, in which the conduct daily door-to-door home visits to find and care for patients, improve early access to care and reduce child mortality. Villages will be randomised to receive Integrated Community Case Management (i-CCM) from a passive CHW or Proactive Community Case Management (Pro-CCM) from a CHW that conducts daily active case finding home visits. All villages in both study arms will receive additional interventions that could significantly reduce under-five mortality, including removal of point-of-care fees, clinical staff training at primary health centres, and improvement in health centre infrastructure. All women of reproductive age eligible for inclusion in the study will be surveyed at baseline, and again at 12, 24 and 36 months. The study hypothesis is a significant reduction in child mortality in both study arms, with a significantly larger reduction where there is proactive case detection, or Pro-CCM, by CHWs. An exhaustive survey of 22 847 women of reproductive age followed for three years will give a study which has 90% power to detect an absolute difference of 0.75% (and a relative difference of 25%) in under-five child mortality reduction between the two study arms.