Improving community case management of diarrhoea and pneumonia in district Badin, Pakistan through a cluster randomised study—the NIGRAAN trial protocolReport as inadecuate

Improving community case management of diarrhoea and pneumonia in district Badin, Pakistan through a cluster randomised study—the NIGRAAN trial protocol - Download this document for free, or read online. Document in PDF available to download.

Implementation Science

, 9:186

First Online: 10 December 2014Received: 27 October 2014Accepted: 28 November 2014DOI: 10.1186-s13012-014-0186-9

Cite this article as: Rabbani, F., Mukhi, A.A.A., Perveen, S. et al. Implementation Sci 2014 9: 186. doi:10.1186-s13012-014-0186-9


BackgroundDiarrhoea and pneumonia contribute 30% of deaths in children under 5 in Pakistan. Pakistan’s Lady Health Workers Programme LHW-P covers about 60% of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers. An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors LHSs is a key determinant of this problem. Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs. Ultimately, community case management CCM of childhood pneumonia and diarrhoea will improve.

Methods-DesignNIGRAAN is a cluster-randomised trial in District Badin, Pakistan. There are approximately 1100 LHWs supervised by 36 LHSs in Badin. For this study, each LHS serves as a cluster. All LHSs working permanently in Badin who regularly conduct and report field visits are eligible. Thirty-four LHSs have been allocated to either intervention or control arms in a ratio of 1:1 through computer-generated simple randomisation technique. Five LHWs from each LHSs are also randomly picked. All 34 LHSs and 170 LHWs will be actively monitored. The intervention consists of training to build LHS knowledge and skills, clinical mentorship and written feedback to LHWs. Pre- and post-intervention assessments of LHSs, LHWs and community caregivers will be conducted via focus group discussions, in-depth interviews, knowledge assessment questionnaires, skill assessment scorecards and household surveys.

Primary outcome is improvement in CCM practices of childhood diarrhoea and pneumonia and will be assessed at the cluster level.

DiscussionNIGRAAN takes a novel approach to implementation research and explores whether training of LHSs in supervisory skills results in improving the CCM practices of childhood diarrhoea and pneumonia. No significant harm to participants is anticipated. The enablers and barriers towards improved CCM would provide recommendations to policymakers for scale up of this intervention nationally and regionally.

Trial registrationNIGRAAN is registered with the ‘Australian New Zealand Clinical Trials Registry’. Registration Number: ACTRN12613001261707

KeywordsCommunity case management Pneumonia and diarrhoea LHW programme Supervision Implementation research Pakistan AbbreviationsMDGMillennium Development Goal

LHWlady health worker

LHSlady health supervisor

FENPFourth External Evaluation of National Programme

CCMcommunity case management

FGDfocus group discussion

IDIin-depth interview

FLCFfirst-level care facility

LHVlady health visitor

WHOWorld Health Organization

QoCquality of case

Electronic supplementary materialThe online version of this article doi:10.1186-s13012-014-0186-9 contains supplementary material, which is available to authorized users.

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Author: Fauziah Rabbani - Aftab Akbar Ali Mukhi - Shagufta Perveen - Xaher Gul - Saleem Perwaiz Iqbal - Shamim Ahmed Qazi - Iqba


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