Utilizing Community Health Workers to Increase Use of ORS and Zinc to Treat Child Diarrhea in Uganda

Last registered on April 30, 2018

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Pre-Trial

Trial Information

General Information

Title

Utilizing Community Health Workers to Increase Use of ORS and Zinc to Treat Child Diarrhea in Uganda

RCT ID

AEARCTR-0001288

Initial registration date

August 08, 2016

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published

August 08, 2016, 11:12 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated

April 30, 2018, 7:47 PM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Country

Uganda

Region

Sub-Saharan Africa

Primary Investigator

Name

Zachary Wagner

Affiliation

RAND

Contact Primary Investigator

Other Primary Investigator(s)

PI Name

John Asiimwe

PI Affiliation

Makerere University

Contact Investigator

PI Name

William Dow

PI Affiliation

UC Berkeley

Contact Investigator

PI Name

David Levine

PI Affiliation

UC Berkeley

Contact Investigator

Additional Trial Information

Status

Completed

Start date

2016-06-01

End date

2017-06-30

Keywords

Health

Additional Keywords

Community Health Workers, ORS, Diarrhea, Uganda, BRAC

JEL code(s)

Secondary IDs

Abstract

Oral rehydration salts (ORS) and zinc are highly effective at preventing child mortality from diarrhea yet they are widely underused throughout sub-Saharan Africa. This research aims to test the impact of a novel preemptive home-delivery intervention aimed at increasing the use of ORS and zinc for child diarrhea in Uganda. The intervention aims to increase availability of ORS and zinc and reduce barriers to access by having BRAC's community health promoters (CHPs) deliver the products directly to households for free prior to a diarrhea episode. Under this set-up, the products will be readily available for free immediately after a child comes down with diarrhea. Moreover, we will disentangle the mechanisms through which the intervention could change product use by using a multi-armed approach that tests for the impact of free distribution and premptive home-delivery separately (i.e. preemptive delivery but not free and free but not preemptive delivery). In additional to informing how best to implement such a program, these interventions will allow us to quantify the extent to which price and distance/convenience are barriers to ORS and zinc use. Under certain assumptions, we will also be able to isolate for the effect of information. We will use a four-arm cluster randomized controlled trial designed to measure the impact of each of the three interventions on ORS and zinc use for treating child diarrhea relative to a control group. We will also test for differences between intervention groups. The results of the study will be used to inform program scale-up and to provide insight into the remaining barriers to ORS and zinc use.

External Link(s)

Registration Citation

Citation

Asiimwe, John et al. 2018. "Utilizing Community Health Workers to Increase Use of ORS and Zinc to Treat Child Diarrhea in Uganda." AEA RCT Registry. April 30. https://doi.org/10.1257/rct.1288-8.0

Former Citation

Asiimwe, John et al. 2018. "Utilizing Community Health Workers to Increase Use of ORS and Zinc to Treat Child Diarrhea in Uganda." AEA RCT Registry. April 30. https://www.socialscienceregistry.org/trials/1288/history/28970

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Experimental Details

Interventions

Intervention(s)

Group 1 — Control: No intervention will take place. Caretakers will have standard access to ORS and zinc at local health facilities and pharmacies. Some CHPs in control villages could make household visits, however offers to sell diarrhea treatment pre-emptively are rare and CHPs are generally not the source of diarrhea treatment.

Group 2 — Household Visit + Free Distribution + Preemptive Delivery: CHPs will be provided a small incentive to visit all of the households in their catchment area that contain a child under 5-years-old (roughly 100 households) at the beginning of the study. CHPs will train caretakers on the dangers of diarrhea and the importance of ORS and zinc use. CHPs will then offer to give ORS and zinc to caretakers for free to store in their homes.

Group 3 — Household Visit + Cost Sharing + Preemptive Delivery: CHPs will be provided a small incentive to visit all of the households in their catchment area that contain a child under 5-years-old at the beginning of the study. CHPs will train caretakers on the dangers of diarrhea and the importance of ORS and zinc use. CHPs will then offer to sell ORS and zinc to caretakers at their standard subsidized price (roughly USD$0.40 in total per treatment course) to store in their homes.

Group 4 – Household Visit + Free Distribution Upon Retrieval: CHPs will be provided a small incentive to visit all of the households in their catchment area that contain a child under 5-years-old at the beginning of the study. CHPs will train caretakers on the dangers of diarrhea and the importance of ORS and zinc use. CHPs will then inform caretakers that they have ORS and zinc available for free that caretakers can retrieved from the CHPs home if needed. The average distance to the CHPs household is about 15 minutes.

Intervention (Hidden)

Intervention Start Date

2016-09-15

Intervention End Date

2017-02-01

Primary Outcomes

Primary Outcomes (end points)

1. Self reported ORS use for diarrhea episode in last 4 weeks (primary outcome)
2. Self reported zinc use for diarrhea episode in last 4 weeks
3. Self reported antibiotic use for diarrhea episode in last 4 weeks
4. Time (days) between diarrhea initiation and ORS use for diarrhea episode in last 4 weeks
5. Time (days) between diarrhea initiation and zinc use for diarrhea episode in last 4 weeks

Robustness Checks
1. Self reported ORS use for diarrhea episode in last 7 days and for current episode
2. Self reported zinc use for diarrhea episode in last 7 days and for current episode
3. Self reported antibiotic use for diarrhea episode in last 7 days and for current episode
4. Time (days) between diarrhea initiation and ORS use for diarrhea episode in last 7 days and for current episode
5. Time (days) between diarrhea initiation and zinc use for diarrhea episode in last 7 days and for current episode

Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)

Secondary Outcomes (explanation)

Experimental Design

We will use a cluster randomized controlled trial design in 120 villages to measure the impact of the three interventions.

Phase 1 – Listing and enrollment of households: In the first phase of the research CHPs will create a list of all the households with a child under 5-years-old in their catchment area. CHPs will record names of household heads for all households with a child under-5. The 80 households listed that are closest to the CHP's home will be included in the study.

Phase 2 – Baseline Survey: Enumerators will use the list provided by the CHPs and travel to the 40 listed households closest to the CHP's home to conduct a baseline survey. Questionnaires will be completed by primary caretakers and will be recorded in tablet devices. Caretakers that reported a child to have had diarrhea in the past 4-weeks will be asked detailed questions about the diarrhea episode and caretaker treatment decisions. Enumerators will move on quickly from households with no recent diarrhea episode only recording very basic information.

Phase 3 – Randomization and Intervention: Villages will be randomized to 1 of the 4 groups stratified by Brac brach where the CHP reports to (20 CHPs per branch), baseline ORS use, and access to free ORS. After randomization and CHP training, each CHP will carry out the assigned intervention.

Phase 4 – Endline Survey: Four weeks after the interventions are implemented, the 80 closest households to the CHP's home will be re-visited and asked to complete a follow-up survey that will follow the same protocol as the baseline survey. Four weeks will be sufficient time for roughly 25% of children to have a diarrhea episode (Uganda DHS).

Experimental Design Details

Randomization Method

Stratified randomization will be conducted using the randtreat package in StataSE 14

Randomization Unit

Village/CHP

Was the treatment clustered?

Yes

Experiment Characteristics

Sample size: planned number of clusters

120 Villages/CHPs

Sample size: planned number of observations

Total: 9,600 households/caretakers representing 17,280 children under-5 Diarrhea Cases: 2,880 caretakers with a child with a diarrhea episode and 3300 diarrhea episodes

Sample size (or number of clusters) by treatment arms

30 villages/CHPs per group

Minimum detectable effect size for main outcomes (accounting for sample design and clustering)

With 120 villages, 80 households enrolled in each village, and 30% of children having a case of diarrhea in the past month (UDHS 2011), we expect to have a final sample of 2880 cases of diarrhea (720 per group). Assuming an intra-class correlation (ICC) of .05, we will be able to detect a minimum of an 11-percentage point increase in ORS use between each group.

Supporting Documents and Materials

IRB