Community Health Research Round-Up, Issue 039

Hi Everyone -

Here’s Issue 039 of the Research Round-Up! This edition features nine articles and one protocol. Happy reading!

Community Health Research Round-Up, Issue 039
July 28 - August 10, 2020

1. A cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in Burkina Faso.

  • Comments: Important addition to the literature on whether community health workers (CHWs) can effectively deliver intermittent preventive treatment of malaria in pregnancy (IPTp) while at the same time promoting ANC attendance at health facilities. Spoiler: IPTp & ANC coverage went up w/ CHWs (but not significant in all categories)!
  • Methods: Cluster Randomized Control Trial w/ intervention (IPTp delivered by CHW) or control (standard practice: IPTp delivered at health facility)
  • Takeaway: Community-based delivery of IPTp by CHWs can potentially lead to a greater number of IPTp doses delivered, with no apparent decrease in ANC coverage (in fact, study found an increase in ANC coverage although this was not statistically significant!)

2. District health teams’ readiness to institutionalize integrated community case management in the Uganda local health systems: a repeated qualitative study.

  • Comments: Important lessons on how to transition integrated community case management (iCCM) programs from external partners to district health teams. Despite DHTs reporting readiness, they were unable to institutionalize most program components.
  • Methods: Qualitative (group interviews & key informant interviews)
  • Takeaway: Barriers to successful institutionalization of iCCM by district health teams included lack of stewardship / coordination by the Ministry of Health and external partners; lack of agreement on community-level drug distribution; failure to integrate key iCCM indicators into national information management systems; and insufficient central government funding. Overall, more collaboration is needed among implementing partners and all levels of the health system.

3. Proactive community case management in Senegal 2014-2016: a case study in maximizing the impact of community case management of malaria.

  • Comments: Additional evidence - this time from Senegal - that proactive case finding by CHWs works! And we love the “comprehensive approach to [CHW] training, supervision, supply chain, and communication” outlined in the program case study.
  • Methods: Narrative case study w/ programmatic results
  • Takeaway: CHWs conducting proactive case finding in Senegal (i.e., they visited all households in their village weekly to identify fever cases and offer case management) detected and treated more malaria cases compared to CHWs who were available for community members to seek care, but who did NOT actively visit households to find cases. The authors note this program which “requires increased time commitment from CHWs also requires timely monetary compensation for the CHWs and supervisors, as well as support for transportation and coordination.”

4. Ethical practice in my work: community health workers’ perspectives using photovoice in Wakiso district, Uganda.

  • Comments: Innovative study from friends at CHW TWG examining what CHWs perceive to to be the most pressing ethical concerns in their work, documented through photovoice.
  • Methods: Qualitative / photovoice
  • Takeaway: Solutions are long overdue for key challenges identified by CHWs including: low commitment to their work due to other obligations; availability of some reference materials and guidelines in English yet majority could only read in the local language; and minimal avenues for knowledge enhancement such as trainings.

5. Measuring motivation among close-to-community health workers: developing the CTC Provider Motivational Indicator Scale across six countries.

  • Comments: New tool to measure motivation levels of close-to-community health service providers, tested in six countries
  • Methods: Mixed: Focus group discussions and interviews; literature search; surveys
  • Takeaway: The new tool measures CTC provider satisfaction across four key factors: organizational commitment, job satisfaction, community commitment, and conscientiousness. Community commitment (“I am proud to be working for my community”) is a novel addition from previous studies of health worker motivation.

6 & 7. Impact of a community-based approach to patient engagement in rural, low-income adults with type 2 diabetes & A Telehealth-supported, Integrated care with CHWs, and MEdication-access (TIME) Program for Diabetes Improves HbA1c: a Randomized Clinical Trial.

  • Comments: Two studies from the USA on the role of CHWs in improving patient outcomes for diabetes management
  • Methods: Feasibility study (6) and randomized clinical trial (7)
  • Takeaway: Both studies demonstrated that CHWs can have a positive effect on diabetes management. The first study found a correlation between CHW engagement and higher patient activation scores, while the second study found that CHW-supported patients had significant HbA1c decreases (p = 0.002), systolic & diastolic blood pressure changes (p = 0.023 and p = 0.046, respectively), and ADA guideline adherence (p < 0.001). Larger-scale trials are needed.

8 & 9. Community health volunteers’ contribution to tuberculosis patients notified to National Tuberculosis program through contact investigation in Kenya & Using community health workers for facility and community based TB case finding: An evaluation in central Mozambique.

  • Comments: Two studies from Kenya and Mozambique, respectively, showing the contributions of CHWs to case finding and contact tracing in TB programs. Important lessons as countries continue to deploy CHWs in the efforts to test, trace, and isolate COVID-19 cases! (N.B. Pay CHWs!)
  • Methods: Retrospective data analysis (8) and pre/post with control (9)
  • Takeaway: Community health workers can play an important role in household contact tracing and referral management for TB.

10. PROTOCOL: Reflecting on principles of primary health care in the implementation of national community health worker programs in low- and middle-income countries: a scoping review protocol.

  • Comments: We can’t wait for this one!
  • Methods: Scoping review will include English-language articles published after September 1978 (Alma Ata) through 2019.
  • Takeaway: Forthcoming review will assess the implementation of national-level CHW programs in LMICs using primary health care principles.