SummaryBackgroundCommunity 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.MethodsWe 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 caregiver-reported 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.FindingsAt 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).InterpretationCommunity 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.FundingBill & Melinda Gates Foundation.
Abstractobjective To explore associations of environmental and demographic factors with diarrhoea and nutritional status among children in Rusizi district, Rwanda.methods We obtained cross-sectional data from 8847 households in May-August 2013 from a baseline survey conducted for an evaluation of an integrated health intervention. We collected data on diarrhoea, water quality, and environmental and demographic factors from households with children <5, and anthropometry from children <2. We conducted log-binomial regression using diarrhoea, stunting and wasting as dependent variables.results Among children <5, 8.7% reported diarrhoea in the previous 7 days. Among children <2, stunting prevalence was 34.9% and wasting prevalence was 2.1%. Drinking water treatment (any method) was inversely associated with caregiver-reported diarrhoea in the previous 7 days (PR = 0.79, 95% CI: 0.68-0.91). Improved source of drinking water (PR = 0.80, 95% CI: 0.73-0.87), appropriate treatment of drinking water (PR = 0.88, 95% CI: 0.80-0.96), improved sanitation facility (PR = 0.90, 95% CI: 0.82-0.97), and complete structure (having walls, floor and roof) of the sanitation facility (PR = 0.65, 95% CI: 0.50-0.84) were inversely associated with stunting. None of the exposure variables were associated with wasting. A microbiological indicator of water quality was not associated with diarrhoea or stunting.conclusions Our findings suggest that in Rusizi district, appropriate treatment of drinking water may be an important factor in diarrhoea in children <5, while improved source and appropriate treatment of drinking water as well as improved type and structure of sanitation facility may be important for linear growth in children <2. We did not detect an association with water quality.
ObjectiveCommunity health clubs (CHCs)—multi‐session village‐level gatherings led by trained facilitators, designed to promote healthful behaviors—have been implemented in several African and Asian countries but have never been rigorously evaluated. We aimed to evaluate the impact of CHCs on child health and nutrition outcomes.MethodsWe conducted a cluster‐randomized controlled trial to evaluate the health impact of two versions of the CHC model in Rusizi district, western Rwanda. We enrolled 8734 households with children under five years of age in a baseline survey in 2013. A total of 150 villages were randomized to three groups: no intervention (control, n=50), eight sessions (Lite, n=50), or 20 sessions (Classic, n=50). We re‐enrolled 7934 (91%) of the households in an endline survey in 2015. The primary outcomes were caregiver‐reported diarrhea in children <5 years within the previous seven days and nutritional status of children <2 years, measured through length‐for‐age (LAZ) and weight‐for‐length (WLZ) z‐scores. We measured intermediate outcomes related to water, sanitation, hygiene, infant and young child feeding, and food security. To analyze impact on dichotomous variables at the individual level, we used log‐binomial regression with a log link function and generalized estimating equations (GEE) to account for community level clustering, then exponentiated the coefficients to obtain prevalence ratios (PRs). For dichotomous outcomes at the household level, we used binomial regression with an identity link function and GEE, to obtain risk differences (RDs). For continuous variables, we used linear regression with GEE. All analyses accounted for clustering at the village level. Analysis was by intention to treat and per‐protocol.ResultsWe observed no impact on caregiver‐reported diarrhea in the Lite (PR=0.97, 95% CI: 0.81–1.16) or the Classic group (PR=0.99, CI: 0·85–1·15). We observed no impact on LAZ in the Lite (β=−0·04, 95% CI: −0·18–0·11) or the Classic (β=−0·08, 95% CI: −0·23–0·08) group, nor on WLZ in the Lite (β=−0·01, 95% CI: −0·12–0·10) or the Classic (β=−0·07, 95% CI: −0·18–0·05) group. The Classic intervention had a positive impact on reported household water treatment (RD=0·086, 95% CI: 0·029–0·14), use of improved sanitation facilities (RD=0·085, 95% CI: 0·015–0·16), and presence of structurally complete sanitation facility (RD=0·065, 95% CI: 0·0013–0·13). There was no impact on the remaining intermediate outcomes, including improved microbiological water quality; drinking water source; presence of a hand washing station with soap; exclusive breastfeeding for children <6 months; dietary diversity for children 6–23 months; or household food security. In the Lite intervention, there was no impact on any intermediate outcomes. Per‐protocol analysis of households in the Classic arm who reported attending all 20 sessions suggested positive impacts on reported household water treatment (RD=0·20, 95% CI: 0·12–0·28), use of improved sanitation facility (RD=0·14, 95% CI: 0·053–0·22), and presence of structurally complete sanitation facility (RD=0·075, 95% CI: 0·0014–0·15). No other differences were noted.ConclusionsThe CHC approach, as implemented in this setting in western Rwanda, had no impact on any main outcomes, but it had a positive impact on household water treatment and type and structure of sanitation facility. Our results raise questions about the value of implementing this intervention at scale.Support or Funding InformationBill & Melinda Gates Foundation
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.