The added value of a mobile application of Community Case Management on under-5 referral, re-consultation and hospitalization rates in two districts in Northern Malawi: the Supporting LIFE study protocol for a pragmatic cluster-randomized controlled trial
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Type
Journal Article
Abstract
Background: There is evidence to suggest frontline community health workers in Malawi are under-referring children with acute illness to higher-level facilities. Integrating a digitized version of paper-based methods of delivering Community Case Management (CCM) could strengthen delivery, increasing urgent referral rates and preventing unnecessary
re-consultations and hospital admissions. This trial aims to evaluate the added value of the Supporting LIFE electronic Community Case Management Application (SL eCCM App) compared to paper-based CCM on urgent referral, re-consultation and hospital admission rates, in two districts in Northern Malawi.
Methods: This is a pragmatic stepped-wedge cluster randomized trial assessing the
added value of the SL eCCM App on urgent referral, re-consultation, and
hospitalization rates of children aged ≥2 months to <5 years, within 7-days of the index visit. 102 HSAs were stratified into six clusters based on geographical location, and clusters randomized to the timing of crossover to the intervention using simple computer-generated randomization. Training workshops were conducted prior to the control (paper-CCM) and intervention (paper-CCM + SL eCCM App) in assigned clusters. Neither participants nor study personnel were blinded to allocation. Outcome
measures were determined by abstraction of clinical data from patient records 2 weeks after recruitment. A nested qualitative study explored perceptions of adherence to urgent referral recommendations, and a cost evaluation determined the financial and time-related costs to caregivers of subsequent healthcare utilization. The trial was conducted between July 2016 and February 2017.
Discussion: This is the first large-scale trial evaluating the value of adding a mobile application of CCM to the assessment of acutely ill children under-5. The trial will generate evidence on the potential use of mobile health for CCM in Malawi, and more widely in other developing countries.
re-consultations and hospital admissions. This trial aims to evaluate the added value of the Supporting LIFE electronic Community Case Management Application (SL eCCM App) compared to paper-based CCM on urgent referral, re-consultation and hospital admission rates, in two districts in Northern Malawi.
Methods: This is a pragmatic stepped-wedge cluster randomized trial assessing the
added value of the SL eCCM App on urgent referral, re-consultation, and
hospitalization rates of children aged ≥2 months to <5 years, within 7-days of the index visit. 102 HSAs were stratified into six clusters based on geographical location, and clusters randomized to the timing of crossover to the intervention using simple computer-generated randomization. Training workshops were conducted prior to the control (paper-CCM) and intervention (paper-CCM + SL eCCM App) in assigned clusters. Neither participants nor study personnel were blinded to allocation. Outcome
measures were determined by abstraction of clinical data from patient records 2 weeks after recruitment. A nested qualitative study explored perceptions of adherence to urgent referral recommendations, and a cost evaluation determined the financial and time-related costs to caregivers of subsequent healthcare utilization. The trial was conducted between July 2016 and February 2017.
Discussion: This is the first large-scale trial evaluating the value of adding a mobile application of CCM to the assessment of acutely ill children under-5. The trial will generate evidence on the potential use of mobile health for CCM in Malawi, and more widely in other developing countries.
Date Issued
2017-10-11
Date Acceptance
2017-09-25
Citation
Trials, 2017, 18
ISSN
1745-6215
Publisher
BioMed Central
Journal / Book Title
Trials
Volume
18
Copyright Statement
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
License URL
Sponsor
Commission of the European Communities
Grant Number
305292
Subjects
1102 Cardiovascular Medicine And Haematology
1103 Clinical Sciences
Cardiovascular System & Hematology
General & Internal Medicine
Publication Status
Published
Article Number
475
Date Publish Online
2017-10-11