Coverage of Immunization, Coverage of Vitamin A Supplementation, Feasibility and Fidelity of Implementation
Conditions
Keywords
VAS, immunization, coverage, hybrid effectiveness-implementation research study, essential child health and nutrition services
Brief summary
The primary objective of the study is to assess whether optimization of an essential package of health and nutrition services for children under five years of age using vitamin A supplementation touch points (i.e., the implementation model) in selected areas in Kenya and Senegal will increase the coverage of vitamin A supplementation and the coverage of other child health and nutrition services. In addition, the study will also assess the feasibility of the implementation model and the drivers of coverage outcomes.
Detailed description
Background: Countries have made significant progress over the last 20 years in improving child survival with under five mortality rates. Despite this progress, many countries still experience inequalities in the coverage of several essential child health and nutrition services, including vitamin A supplementation (VAS), growth monitoring and promotion (GMP), immunization, and regular nutrition screening for early detection of malnutrition. Optimizing the delivery of an Essential Child Health and Nutrition Package (essential package) may address this issue. Objective: The primary objective of the study is to assess the effect of optimizing the health system for the delivery of the essential package (the implementation model), on the coverage of VAS and on the coverage of immunization (as measured by vaccination for measles). In addition, the study will also assess the feasibility of the implementation model and the drivers of coverage outcomes. Methods: Target population will be children 12-59 months of age and their caregivers in Kisii County in Kenya and Fatick Region in Senegal. The study will use an effectiveness-research implementation hybrid design with two arms: 1) health system will be optimized to deliver VAS to all children 12-59 months of age using all the routine primary health care (PHC) contact points plus current standard of care (Intervention) and 2) current standard of care (Control). The study will be conducted for a period of 18 months. The optimization model will be implemented for 12 months. Baseline and endline surveys that will collect quantitative and qualitative data will be conducted to assess the coverage of essential child health and nutrition services in both arms from study participants per arm in both baseline and endline surveys and to assess implementation feasibility. Implementation fidelity will be assessed through monthly visits by the research team to health facilities.
Interventions
OTHEROptimized package of child essential health and nutrition services
Optimized package of child essential health and nutrition services
OTHERStandard package of essential child and nutrition services
Standard package of essential child and nutrition services
Sponsors
Kenya Ministry of Health
Cheikh Anta Diop University, Senegal
Senegal Ministry of Health
Henike Consultants
Nutrition International
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Intervention model description
Implementation model aims to optimize health workforce training and supervision, service delivery, health data and information, and leadership and governance as so to maximize VAS coverage and in doing so also improve coverage of other services
Eligibility
Sex/Gender
ALL
Age
15 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Caregivers of children 12-59 months of age * Health service providers
Exclusion criteria
\- None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Children who received their age-appropriate VAS | From enrollment to the end of intervention at 12 months | The proportion of children 12-59 months of age who received their age-appropriate VAS |
| Children who are immunized with measles vaccine | From enrollment to the end of intervention at 12 months | Proportion of children 12-23 months of age who are immunized with one dose of measles (MR1) in Kenya Proportion of children 24-35 months of age who are immunized with the second dose of measles (MR2) in Senegal |
| Implementation feasibility of new model perceived by health service providers, as assessed by key informant interviews and focus groups | From enrollment to the end of intervention at 12 months | Feasibility of implementation of the new model as perceived by health service providers will be assessed via key informant interviews and focus groups to enquire on: i. Implementation barriers and facilitators ii. Practicality of implementing the optimization model within context and resource availability iii. Program disruption due to the implementation of the model iv. Need for infrastructure to implement the model v. Sustainability of the optimized model. All qualitative information will be triangulated to assess feasibility of implementation of the new model |
| Fidelity of implementing the new model | From enrollment to the end of intervention at 12 months | Fidelity of implementation will be assessed by measuring: i. The proportion of health facilities preparing and using integrated microplans. ii. The proportion of supportive supervision visits carried out in an integrated way. iii. The proportion of service delivery points providing services in an integrated way Fidelity will be achieved if the three parameters score at least 80%. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Caregivers who report receiving more than one service | From enrollment to the end of intervention at 12 months | The proportion of caregivers of children 12-59 months of age who reported ever receiving more than one of the following services within the Essential Child Health and Nutrition Package during the same visit |
| Co-coverage of VAS and measles vaccine | From enrollment to the end of intervention at 12 months | Proportion of children 12-23 months of age who have received both their age-appropriate VAS and their age-appropriate vaccines (as measured by measles one) in Kenya Proportion of children 24-35 months of age who have received both their age-appropriate VAS and their age-appropriate vaccines (as measured by measles two) in Senegal |
| Caregivers who indicate are satisfied with the way the services are being delivered | From enrollment to the end of intervention at 12 months | The proportion of caregivers indicate are satisfied with the way the Essential Child Health and Nutrition Package services are being delivered to their children |
| Children screened for malnutrition in the last 6 months | From enrollment to the end of intervention at 12 months | The proportion of children 12-59 months of age who were screened for malnutrition in the last 6 months |
| Children who have received growth monitoring service | From enrollment to the end of intervention at 12 months | The proportion of children 12-59 months who have received growth monitoring service |
| Children who have received age-appropriate immunizations | From enrollment to the end of intervention at 12 months | The proportion of children 12-59 months who have received age-appropriate immunizations according to EPI schedule |
Countries
Kenya, Senegal
Contacts
Primary ContactDaniel Lopez de Romana, Ph.D.
Backup ContactBanda Ndiaye, B.S.
Outcome results
None listed