Browsing by Author "Bruce, Jane"

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    Evaluation of a data-informed community engagement strategy to increase immunisation coverage in northern Uganda: a cluster-randomised controlled trial with an embedded process evaluation
    (The Lancet Global Health, 2018) Bruce, Jane; Chantler, Tracey; Kumakech, Edward; Mawanda, Ashiraf; Olorunsaiye, Comfort; Schmucker, Laura; Kiapi, Lilian; Landegger, Justine; Webster, Jayne
    Background The 2016 Ugandan Demographic and Health Survey indicated that only 86% of children (aged 12–23 months) in northern Uganda had received the third dose of diphtheria-tetanus-pertussis vaccine (DTP3) and only 65% were fully immunised. To help close this gap, the International Rescue Committee developed a data-informed community engagement intervention, the Fifth Child Project, informed by a theory of change and including: (1) an mhealth tool used by health-facility-based staff and defaulter tracing forms used by community health workers aimed at improving data accuracy, (2) training of health workers in interpersonal skills, and (3) involvement of community leaders in planning vaccine outreaches. To test the impact of this intervention and examine its underlying hypothesis that a data-informed community engagement strategy will increase immunisation coverage, we conducted a clusterrandomised controlled trial with an embedded process evaluation. Methods At baseline, a household two-stage cluster survey was conducted in 32 clusters (16 intervention and 16 control health facility catchment areas) from mid-June to mid-July, 2016. The survey collected information on vaccinations, caregivers’ interactions with community-based and facility-based health workers, and reasons for non-vaccination of eligible children. The primary outcome was DPT3 and measles coverage in children aged 9–23 months. Process evaluation activities included: quarterly monitoring reports, interviews, focus group discussions, and observations conducted in four intervention and two control clusters (March–April, 2017). The endline survey was conducted from Sept 19, 2017, to Oct 2, 2017. Findings The sample included 916 households (935 children aged 9–23 months) in the intervention clusters and 881 households (897 children aged 9–23 months) in control clusters. Baseline estimates of immunisation coverage were similar for intervention and control arms. Both arms combined baseline coverage of DTP3 and measles vaccines using information from child immunisation cards, and caregiver recall was 78·3% (95% CI 76·0–81·5) and 64·6% (95% CI 60·9–67·3%), respectively. About 19% of children who received DTP1 had not received the measles vaccine in the intervention arm, compared with 21% of children in the control arm at baseline. The major barriers to complete immunisation included caregivers’ lack of awareness of immunisation schedule and vaccine stock-outs. Interpretation Endline and process evaluation findings will be available in March 2018 and will provide a more complete assessment of the impact of the Fifth Child Project.
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    Impacts of IRC’s Fifth Child community engagement strategy to increase immunisation in northern Uganda
    (2019) Webster, Jayne; Landegger, Justine; Bruce, Jane; Malunda, Dickson; Chantler, Tracey; Kumakech, Edward; Schmucker, Laura; Kiapi, Lilian; Kozuki, Naoko; Olorunsaiye, Comfort; Byrne, Erin
    The 2011 Uganda Demographic and Health Survey (UDHS) reported that the national coverage of the third dose of the combined diphtheria, pertussis, tetanus vaccine (DPT3) among children 12-23 months of age was 73%, and only 52% were fully immunized. Intervention overview In search of innovative ways to increase immunization coverage, the IRC, in coordination with the Uganda Ministry of Health, piloted from August 2015-April 2016 an mReach application (mReach) and community engagement strategy (the ‘Fifth Child’ intervention), working with Village Health Teams (VHTs) to identify immunization defaulters and re-enter them into the vaccination schedule. Based on positive results of this pilot, the IRC received funding from 3ie to scale and evaluate the impact of this intervention. The goal of the ‘Fifth Child’ intervention was to increase immunization coverage through defaulter tracing and targeted service delivery, facilitated by the mReach data platform and community engagement strategies. The intervention was implemented from mid-September 2016 to mid-September 2017. The underlying hypothesis of the intervention is that data-driven, targeted community engagement would facilitate more effective defaulter tracing and contribute to increased immunization coverage in hard-to-reach communities. The project has two main components. The first is supporting activities aimed at strengthening the health system (support for outreaches, transport of vaccines and supplies, financial support for VHTs to attend community engagement meetings with health care workers and community leaders, etc.). The second component, mReach with community engagement, included continuous newborn registration, quality VHT home visits for immunization due and defaulter tracking, and community leader involvement and co-management of outreaches based on defaulter data.