Impact of Integrated Community Case Management of Malaria on health literacy of caregivers, child morbidity and its associated costs

Projekter: ProjektForskning

Se relationer på Aarhus Universitet


Background: In Ghana, the prevalence of malaria among children under 5 in 2011 was as high as 51% in some regions and malaria accounted for 29.5% of child mortality. Integrated Community Case Management of malaria (iCCMm) is a recent strategy adapted to provide early treatment and control malaria. The iCCMm is provided by community based agents (CBA) who operate in the villages. Despite some success with iCCMm, Ghana still faces the paradox of underuse and abuse of anti-malaria drugs. This double burden of malaria control could be a problem of low health literacy. Evidence from studies show that iCCMm through CBAs could have an influence on the health literacy of caregivers however, the extensive studies in iCCMm provide little to no evidence on the extent to which the iCCMm empowers caregivers and mothers to make informed decision. The proposed study is the first of its kind to assess the potency of iCCMm on health literacy of users and ultimately, child morbidity.
Objective: To analyze the impact of iCCMm with increased focus on health literacy of caregivers with children under 5 on malaria morbidity and its associated costs.
Methodology: The objective will be addressed through 4 sub-studies. The study sites will be two comparable districts, Ejisu-Juaben and Kwabre East, in the Ashanti region. Ejisu-Juaben is one of the pioneer districts where iCCMm was introduced; Kwabre East is currently not involved in the programme and will serve as control district.
Study 1 will be a cross sectional baseline study which will compare the health literacy levels, use of health care and costs of three groups: users and non-users of the iCCMm in Ejisu, and iCCMm non-exposed group from Kwabre.
Study 2 will be a qualitative study among caregivers, CBAs and other stakeholders in Ejisu to assess the perceptions that guide the caregiver’s choice of using or not using the iCCMm option. Based on the health literacy gaps identified in the quantitative analysis in Study 1, the barriers and enabling factors identified in Study 2 and literature review, an intervention to strengthen the health literacy aspects of the iCCMm will be designed.
Study 3 is an intervention study, which will be implemented in Ejisu in the communities included in Study 1. Randomization to intervention and control groups will be undertaken at CBA level to minimize contamination of effects. After 6 months, the intervention will be evaluated on its impact on health literacy of caregivers and child morbidity.
Study 4 is a cost effectiveness analysis of the intervention undertaken from the perspective of both the provider and the user. Study 4 is based on the assumption that a positive effect is observed in study 3. An alternative study in case of no effect is to analyze the association between health literacy levels; use of health care and health expenditures, which in worst case can also be conducted based on the data from Study 1.
Data sampling and collection: Quantitative data for Study 1, 3 and 4 will be obtained through two surveys. A baseline survey in both districts (study 1) and a follow-up survey in Ejisu (study 3&4). We will adopt a multistage stratified random sampling method in selection of caregivers to be enrolled in the study. The expected sample size based on preliminary power calculation will be around 1270. In the qualitative second study (study 2), we will have focus group discussions and in-depth interviews with caregivers (both users and non-users), CBAs and other stakeholders.
Data Content: Various instruments will be reviewed for appropriateness, but preliminary review suggests that the Parental Health Literacy Activity Test (PHLAT) is a relevant instrument to measure health literacy of caregivers. Measures of child morbidity will include: duration from onset of illness to action taken and days of illness. The symptoms of illnesses and cases of death will also be registered. In addition, information on use of health care, health care costs and background information of caregivers will be collected. Information on health service cost for the intervention and malaria management will be collected alongside the trial.
Data Analysis: In study 1 the health literacy levels, use of care and health care costs will be assessed through relevant statistical tests depending on the category of variable and with adjustment for confounders. For study 3 & 4 a difference-in-difference approach will be used. For the qualitative study, we will adopt phenomenology approach to the analysis. For standard treatment at health Centre and hospital level recent unit cost estimates from Ghana will be relied on.
Perspectives: This study will add new knowledge on management and control of malaria through health literacy of caregivers which has the potential to improve use of health service as a whole. The results may help strengthen the iCCMm programme for malaria in Ghana and other countries and similar approaches could be taken for other illnesses. The results have the potential to promote health literacy in healthcare, which is a low cost instrument for changing behavior towards more appropriate use of health care and to some extent relieving the pressure on the health system.
Effektiv start/slut dato01/09/201623/11/2020

ID: 171042157