Abstract
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.
Highlights
The importance of good health and nutrition for children younger than 5 years is widely recognised
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, and 495 (14%) of 3464 assigned the Classic intervention
The 2014–15 Demographic and Health Survey documents a steady decline in the proportion of children who are chronically undernourished, from 51% in 2005 to 38% in 2014–15.4 in these data, the prevalence of caregiver-reported diarrhoea has declined only slightly, from 14% in 2005 to 12% in 2014–15, possibly attributable in part to deficiencies in water quality, sanitation, and hygiene (WASH) practices.[4]
Summary
The importance of good health and nutrition for children younger than 5 years is widely recognised. The recently adopted Sustainable Development Goals include goals such as zero hunger (Goal 2), good health and wellbeing (Goal 3), and clean water and sanitation (Goal 6), which reflect the global community’s prioritisation of the need to improve food and nutrition security as well as coverage of improved water and sanitation.[1]. Similar groupbased approaches at the community level in sub-Saharan Africa have been shown to have positive effects on infant mortality and other health and nutrition outcomes, but few studies have shown an effect on behaviours relating to WASH.[6,7] The objective of our study was to evaluate the effect of the CBEHPP model on child diarrhoea, child anthropometry, and household water quality
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
