Integrated Sustainable Childhood Pneumonia and Infectious Disease Reduction in Nigeria (INSPIRING) Through Whole System Strengthening in Jigawa, Nigeria: Study Protocol For a Cluster Randomised Controlled Trial

Abstract

BackgroundChild mortality remains unacceptably high, with Northern Nigeria reporting some of the highest rates globally (e.g. 192/1000 live births in Jigawa State). Coverage of key protect and prevent interventions, such as vaccination and clean cooking fuel use, are low. Additionally, knowledge, care-seeking and health system factors are poor. Therefore, a whole systems approach is needed for sustainable reductions in child mortality.MethodsThis is a cluster randomised controlled trial, with integrated process and economic evaluations, conducted from January 2021 – September 2022. The trial will be conducted in Kiyawa Local Government Area, Jigawa State, Nigeria, with an estimated population of 230,000. Clusters are defined as primary government health facility catchment areas (n=33). The 33 clusters will be randomly allocated (1:1) in a public ceremony, and 32 clusters included in the impact evaluation. The trial will evaluate a locally adapted ‘whole systems strengthening’ package of three evidence-based methods: community men’s and women’s groups; Partnership Defined Quality Scorecard; healthcare worker training, mentorship and provision of basic essential equipment and commodities. The primary outcome is mortality of children aged 7 days to 59 months. Mortality will be recorded prospectively using a cohort design, and secondary outcomes measured through baseline and endline cross-sectional surveys. Assuming the following, we will have a minimum detectable effect size of 30%: a) baseline mortality of 100 per 1000 livebirths; b) 4,480 compounds with 3 eligible children per compound; c) 80% power; d) 5% significance; e) intra-cluster correlation of 0.007; f) coefficient of variance of cluster size of 0.74. Analysis will be by intention-to-treat, comparing intervention and control clusters, adjusting for compound and trial clustering. DiscussionThis study will provide robust evidence of the effectiveness and cost-effectiveness of community-based participatory learning and action, with integrated health system strengthening and accountability mechanisms, to reduce child mortality. The ethnographic process evaluation will allow for a rich understanding of how the intervention works in this context. However, we encountered a key challenge in calculating the sample size, given the lack of timely and reliable mortality data, and the uncertain impacts of the COVID-19 pandemic. Trial registrationISRCTN 39213655, registered 11th December 2019

Linking communities and health facilities to improve child health in low-resource settings: a systematic review

“…The variables included in the selection criteria were chosen to find interventions with similarities to the ones being implemented in the INSPIRING Jigawa trial ( King et al ., 2021 ). As Jigawa is predominantly non-urban, and Nigeria is a lower-middle-income country ( WorldBank, 2021 ), two of the inclusion criteria imposed that the studies had to be set in rural areas (thereby excluding those set in urban environments) and in low- or lower-middle income (LMIC) countries.…”

“…To the best of our knowledge, there has been no comprehensive review specifically addressing various types of community–facility linkage interventions and their impact on child health. This review was conducted with the purpose of informing the theory and design of a whole systems intervention being trialled in Jigawa State, Nigeria, with the specific aim of supporting the design of the monitoring and evaluation plan for the community–facility linkage component of it [INSPIRING Project: ( ISRCTN39213655, 2019 ; King et al ., 2021 )]. This intervention aims to reduce childhood mortality due to pneumonia and other infectious diseases in a setting where the under-5 mortality rate is 192 deaths per 1000 live births ( National Population Commission—NPC and ICF, 2019 ), and there is low-quality healthcare system, poor community health education and lack of protective and preventive factors ( Iuliano et al ., 2020 ; King et al ., 2020 ; Shittu et al ., 2020 ).…”

Maternal mental well-being and recent child illnesses–A cross-sectional survey analysis from Jigawa State, Nigeria

“…We conducted a secondary analysis of cross-sectional data from women with children under the age of five, residing in Kiyawa Local Government Area (LGA), Jigawa State, Nigeria. Data were collected as part of the wider baseline survey for the INSPIRING Project (trial registration: ISRCTN39213655) [30] from January 7 th 2020 to March 17 th 2020. On this date, all field activities were paused as a precaution due to the COVID-19 pandemic, however no cases had been recorded in Jigawa State at that time.…”

“…Kiyawa LGA consists of 3 districts: Kiyawa district, Shuwarin district and Abalago district, with a total of 11 wards, which are the administrative units used for electoral purposes. Kiyawa LGA had a population of 172,952 in the last census conducted in 2006 and is currently estimated to be 230,000 [30,31]. The socio-cultural situation in the state is homogeneous and mostly populated by the Hausa-Fulani; over 99% of the people in Kiyawa practice Islam and it is predominantly rural with agriculture as the main occupation [30,32,33].…”

“…Kiyawa LGA had a population of 172,952 in the last census conducted in 2006 and is currently estimated to be 230,000 [30,31]. The socio-cultural situation in the state is homogeneous and mostly populated by the Hausa-Fulani; over 99% of the people in Kiyawa practice Islam and it is predominantly rural with agriculture as the main occupation [30,32,33].…”