Community interventions to reduce child mortality in Dhanusha, Nepal: study protocol for a cluster randomized controlled trial

Abstract

BackgroundNeonatal mortality remains high in rural Nepal. Previous work suggests that local women's groups can effect significant improvement through community mobilisation. The possibility of identification and management of newborn infections by community-based workers has also arisen.Methods/DesignThe objective of this trial is to evaluate the effects on newborn health of two community-based interventions involving Female Community Health Volunteers.MIRA Dhanusha community groups: a participatory intervention with women's groups. MIRA Dhanusha sepsis management: training of community volunteers in the recognition and management of neonatal sepsis.The study design is a cluster randomized controlled trial involving 60 village development committee clusters allocated 1:1 to two interventions in a factorial design.MIRA Dhanusha community groups: Female Community Health Volunteers (FCHVs) are supported in convening monthly women's groups. Nine groups per cluster (270 in total) work through two action research cycles in which they (i) identify local issues around maternity, newborn health and nutrition, (ii) prioritise key problems, (iii) develop strategies to address them, (iv) implement the strategies, and (v) evaluate their success. Cycle 1 focuses on maternal and newborn health and cycle 2 on nutrition in pregnancy and infancy and associated postpartum care practices.MIRA Dhanusha sepsis management: FCHVs are trained to care for vulnerable newborn infants. They (i) identify local births, (ii) identify low birth weight infants, (iii) identify possible newborn infection, (iv) manage the process of treatment with oral antibiotics and referral to a health facility to receive parenteral gentamicin, and (v) follow up infants and support families.Primary outcome: neonatal mortality rates. Secondary outcomes: MIRA Dhanusha community group: stillbirth, infant and under-two mortality rates, care practices and health care seeking behaviour, maternal diet, breastfeeding and complementary feeding practices, maternal and under-2 anthropometric status. MIRA Dhanusha sepsis management: identification and treatment of neonatal sepsis by community health volunteers, infection-specific neonatal mortality.Trial Registration noISRCTN: ISRCTN87820538

Why service users do not complain or have ‘voice’: a mixed-methods study from Nepal’s rural primary health care system

“…Promotion of channels such as HFMC members and FCHVs for receiving community concerns is likely to be crucial for those who are not able to speak directly to service providers or who have problems with literacy. As mentioned elsewhere in this paper, HFMCs have representation from different village community groups and similarly FCHVs are health volunteers from local villages and are selected from mothers’ groups [28]. FCHVs are supposed to meet with service providers at monthly meetings at health facilities.…”

“…Community-based services are provided by female community health volunteers (FCHVs), immunization clinics, and outreach clinics [26]. FCHVs are local women, selected by mothers’ groups in villages; they conduct monthly meetings with their groups and provide community health services [27, 28]. All PHC facilities have a health facility operation and management committee (HFMC) to manage funds, human resources, and health programs locally [29, 30].…”

Effect of antenatal multiple micronutrient supplementation on anthropometry and blood pressure in mid-childhood in Nepal: follow-up of a double-blind randomised controlled trial

“…Modules covered socioeconomic status, food security, and parental recall of diarrhoeal and respiratory illnesses in the past week and year. We assessed food security with the Household Food Insecurity Access Scale (HFIAS) 24 and the Household Dietary Diversity Score (HDDS), 25 which have been used in other research in the specialty 26 . We used the HFIAS to work out the level of food insecurity experienced by a household during the past 30 days, in terms of anxiety about food access, quality, and quantity of food.…”

Generating Insights from Trends in Newborn Care Practices from Prospective Population-Based Studies: Examples from India, Bangladesh and Nepal

“…The Bangladesh trial included the districts of Bogra, Maulvibazaar and Faridpur [ 18 , 19 ]. The Nepal trials were based in the middle hills district of Makwanpur [ 16 ], and the plains district of Dhanusha [ 17 ]. The interventions in all of these trials involved four-phase participatory learning and action cycles with women’s groups, details of which are presented elsewhere [ 16 – 20 ].…”