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| Name | Class |
|---|---|
| Kenya Ministry of Health | OTHER_GOV |
| Cheikh Anta Diop University, Senegal | OTHER |
| Senegal Ministry of Health | UNKNOWN |
| Henike Consultants |
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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention | Experimental | The intervention arm receives the optimized package of child essential health and nutrition services |
|
| Control | Other | The control arm receives the current standard package of health and nutrition services |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Optimized package of child essential health and nutrition services | Other | Optimized package of child essential health and nutrition services |
|
| Measure | Description | Time Frame |
|---|---|---|
| Children who received their age-appropriate VAS | The proportion of children 12-59 months of age who received their age-appropriate VAS | From enrollment to the end of intervention at 12 months |
| Children who are immunized with measles vaccine | 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 | From enrollment to the end of intervention at 12 months |
| Implementation feasibility of new model perceived by health service providers, as assessed by key informant interviews and focus groups | 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 | From enrollment to the end of intervention at 12 months |
| Fidelity of implementing the new model | 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%. | From enrollment to the end of intervention at 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Co-coverage of VAS and measles vaccine | 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 | From enrollment to the end of intervention at 12 months |
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Inclusion Criteria:
Exclusion Criteria:
- None
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Daniel Lopez de Romana, Ph.D. | Contact | 613-782-6837 | dlopezderomana@nutritionintl.org | |
| Banda Ndiaye, B.S. | Contact | +254780457298 | bndiaye@nutritionintl.org |
| Name | Affiliation | Role |
|---|---|---|
| Mandana Arabi, M.D., Ph.D. | Nutrition International | Principal Investigator |
| Elijah Mbiti, Ph.D. | Nutrition International | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Nutrition International- Kenya | Recruiting | Nairobi | Kenya |
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| UNKNOWN |
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
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| Standard package of essential child and nutrition services | Other | Standard package of essential child and nutrition services |
|
| Children screened for malnutrition in the last 6 months | The proportion of children 12-59 months of age who were screened for malnutrition in the last 6 months | From enrollment to the end of intervention at 12 months |
| Children who have received growth monitoring service | The proportion of children 12-59 months who have received growth monitoring service | From enrollment to the end of intervention at 12 months |
| Children who have received age-appropriate immunizations | The proportion of children 12-59 months who have received age-appropriate immunizations according to EPI schedule | From enrollment to the end of intervention at 12 months |
| Caregivers who report receiving more than one service | 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 | From enrollment to the end of intervention at 12 months |
| Caregivers who indicate are satisfied with the way the services are being delivered | The proportion of caregivers indicate are satisfied with the way the Essential Child Health and Nutrition Package services are being delivered to their children | From enrollment to the end of intervention at 12 months |
| Nutrition International - Senegal | Recruiting | Dakar | Senegal |
|
| ID | Term |
|---|---|
| D044623 | Nutrition Therapy |
| ID | Term |
|---|---|
| D013812 | Therapeutics |
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