Effect of community health clubs on child diarrhoea inudwestern Rwanda: cluster-randomised controlled trial

摘要

Background Community health clubs are multi-session village-level gatherings led by trained facilitators and designedudto promote healthy behaviours mainly related to water, sanitation, and hygiene. They have been implemented inudseveral African and Asian countries but have never been evaluated rigorously. We aimed to evaluate the effect ofudtwo versions of the community health club model on child health and nutrition outcomes.udMethods We did a cluster-randomised trial in Rusizi district, western Rwanda. We defined villages as clusters.udWe assessed villages for eligibility then randomly selected 150 for the study using a simple random sampling routineudin Stata. We stratified villages by wealth index and by the proportion of children younger than 2 years with caregiverreporteduddiarrhoea within the past 7 days. We randomly allocated these villages to three study groups: no interventionud(control; n=50), eight community health club sessions (Lite intervention; n=50), or 20 community health club sessionsud(Classic intervention; n=50). Households in these villages were enrolled in 2013 for a baseline survey, then re-enrolledudin 2015 for an endline survey. The primary outcome was caregiver-reported diarrhoea within the previous 7 days inudchildren younger than 5 years. Analysis was by intention to treat and per protocol. This trial is registered withudClinicalTrials.gov, number NCT01836731.udFindings At the baseline survey undertaken between May, 2013, and August, 2013, 8734 households with childrenudyounger than 5 years of age were enrolled. At the endline survey undertaken between Sept 21, 2015, andudDec 22, 2015, 7934 (91%) of the households were re-enrolled. Among children younger than 5 years, the prevalenceudof caregiver-reported diarrhoea in the previous 7 days was 514 (14%) of 3616 assigned the control, 453 (14%)udof 3196 allocated the Lite intervention (prevalence ratio compared with control 0·97, 95% CI 0·81–1·16; p=0·74),udand 495 (14%) of 3464 assigned the Classic intervention (prevalence ratio compared with control 0·99, 0·85–1·15;udp=0·87).udInterpretation Community health clubs, in this setting in western Rwanda, had no effect on caregiver-reporteduddiarrhoea among children younger than 5 years. Our results question the value of implementing this intervention atudscale for the aim of achieving health gains.