Leveraging Community Health Workers and a Digital Health System to Improve the Timeliness of Child Well Visits

NCT ID: NCT06024317

Last Updated: 2025-12-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

800 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-03-01

Study Completion Date

2027-07-31

Brief Summary

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The goal of this cluster-randomized type 1 effectiveness implementation hybrid trial is to evaluate whether a community health worker led, integrated digital health intervention (Huduma Kwa Wakati; "Timely Services" in Kiswahili) can improve rates of timely well visits and receipt of key recommended preventive interventions among children in their first year of life. The hypothesis is that Huduma Kwa Wakati will improve the timeliness and rates of completion of child well visits and receipt of recommended preventive services before age 1 year, compared to the standard of care. Researchers will compare outcomes among children enrolled from intervention clusters and no-intervention comparison clusters. Outcomes will also be compared to a cross-sectional retrospective comparison sample. This study will address the lack of rigorous evidence on the effectiveness of a community-based digital health intervention for promoting rates and timeliness of preventive service receipt among children from sub-Saharan Africa, and identify implementation strategies to facilitate the deployment of integrated community-based digital health interventions in low- and middle-income country settings.

Detailed Description

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Background and Objective:

In Tanzania, only 68% of children receive key recommended preventive health interventions within their first year of life. Prior research identified substantial rural-urban disparities in rates and timeliness of preventive service receipt in Tanzania, with children in rural settings being more like to receive delayed or no services. This type 1 effectiveness implementation hybrid study will evaluate the effect of Huduma Kwa Wakati ("Timely Services" in Kiswahili), a community-based, integrated digital health intervention, on the timeliness of child well visits and receipt of recommended preventive services in children's first year of life. The intervention combines a knowledge intervention, mobile phone-based reminders, and incentives with the goal to promote timely service receipt.

Methods:

The study will be conducted in the catchment areas of 40 rural health facilities in two predominantly rural regions in Tanzania. From each catchment area, three cohorts of mother-child dyads, one retrospective cohort and two prospective cohorts, will be enrolled into the study. The prospective cohort, comprising mothers from eighty communities ("clusters") within these catchment areas, will be randomized to an intervention or control arm. The timeliness (primary outcome) and coverage (secondary outcome) of child well visits will be observed for 1200 children (800 prospective children and 400 retrospective children). Details of the clinical trial refer to the prospective cohort of 800 mother-child dyads. Study logs, fidelity checklists, quantitative surveys, child health records, and qualitative interviews with mothers and key informants will be used to inform the five constructs of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Results will be used to develop an implementation blueprint that can guide future adaptations, sustainability, and scale-up of Huduma Kwa Wakati.

Hypothesis:

The hypothesis is that Huduma Kwa Wakati is effective for increasing the timeliness of child well visits and rates of preventive services receipt before age 1 year compared to the standard of care.

Expected impact:

This study will address the lack of rigorous evidence on the effectiveness of a community-based digital health intervention for promoting rates and timeliness of recommended health service receipt among children from sub-Saharan Africa, and identify implementation strategies to facilitate the deployment of integrated interventions in low- and middle-income country settings.

Conditions

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Short Message Service (SMS) Incentives Knowledge, Attitudes, Practice Preventive Services

Keywords

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Timeliness Digital Health Community Health Workers Tanzania Low and middle-income country SMS reminder Conditional incentive Preventive services Children

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This type 1 effectiveness-implementation hybrid study uses a cluster-randomized trial design to evaluate intervention effectiveness.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Intervention arm (Huduma Kwa Wakati)

Within the catchment areas of 40 health facilities, 40 communities ("clusters"; 1 per catchment area) will be assigned to the intervention arm. 40 communities ("clusters"; 1 per catchment area) will be assigned to the control arm. 10 pregnant women in their last trimester of pregnancy will be enrolled from each cluster. Women enrolled from intervention clusters will receive all components of the Huduma Kwa Wakati intervention.

Group Type EXPERIMENTAL

Huduma Kwa Wakati - Knowledge Intervention

Intervention Type BEHAVIORAL

Counseling scripts assessing and addressing child health-related knowledge gaps

Huduma Kwa Wakati - Reminders

Intervention Type BEHAVIORAL

Reminders of upcoming well visit due dates, sent to the mother's mobile phone

Huduma Kwa Wakati - Incentives

Intervention Type BEHAVIORAL

Conditional incentives for timely service receipt, tailored to each child's well visit schedule

Huduma Kwa Wakati - Service notifications

Intervention Type BEHAVIORAL

Service notifications (e.g., related to stockouts or service non-availability), sent to the mother's mobile phone

Control (Standard of care)

Within the catchment areas of 40 health facilities, 40 communities ("clusters"; 1 per catchment area) will be assigned to the intervention arm. 40 communities ("clusters"; 1 per catchment area) will be assigned to the control arm. 10 pregnant women in their last trimester of pregnancy will be enrolled from each cluster. Women enrolled from control arm will receive baseline and follow-up assessments only.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Huduma Kwa Wakati - Knowledge Intervention

Counseling scripts assessing and addressing child health-related knowledge gaps

Intervention Type BEHAVIORAL

Huduma Kwa Wakati - Reminders

Reminders of upcoming well visit due dates, sent to the mother's mobile phone

Intervention Type BEHAVIORAL

Huduma Kwa Wakati - Incentives

Conditional incentives for timely service receipt, tailored to each child's well visit schedule

Intervention Type BEHAVIORAL

Huduma Kwa Wakati - Service notifications

Service notifications (e.g., related to stockouts or service non-availability), sent to the mother's mobile phone

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* mothers of children ages 12-23 months
* residing in the sampling area


* pregnant women in their last trimester of pregnancy
* residing in the sampling area
* expected to reside in the sampling area until the child reaches age 1 year

Exclusion Criteria

* Women who are not living in catchment areas of participating health facilities (which routinely provide maternal and child health services). Facilities must be operational, must have at least 2 community health workers, and must have reported at least 100 pregnancies or births in the year prior to study implementation.)
Minimum Eligible Age

15 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Duke University

OTHER

Sponsor Role collaborator

Emory University

OTHER

Sponsor Role collaborator

University of North Carolina

OTHER

Sponsor Role collaborator

National Institute for Medical Research, Tanzania

OTHER_GOV

Sponsor Role collaborator

University of South Carolina

OTHER

Sponsor Role lead

Responsible Party

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Jan Ostermann

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jan Ostermann, PhD

Role: PRINCIPAL_INVESTIGATOR

University of South Carolina

Locations

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National Institute for Medical Research

Dar es Salaam, , Tanzania

Site Status

Countries

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Tanzania

Central Contacts

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Jan Ostermann, PhD

Role: CONTACT

Phone: 18037778747

Email: [email protected]

Lavanya Vasudevan, PhD

Role: CONTACT

Email: [email protected]

Facility Contacts

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Esther Ngadaya, MD, PhD

Role: primary

References

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Yelverton V, Hair NL, Ghosh SH, Mfinanga SG, Ngadaya E, Baumgartner JN, Ostermann J, Vasudevan L. Beyond coverage: Rural-urban disparities in the timeliness of childhood vaccinations in Tanzania. Vaccine. 2022 Sep 2;40(37):5483-5493. doi: 10.1016/j.vaccine.2022.07.020. Epub 2022 Aug 10.

Reference Type BACKGROUND
PMID: 35961796 (View on PubMed)

Vasudevan L, Baumgartner JN, Moses S, Ngadaya E, Mfinanga SG, Ostermann J. Parental concerns and uptake of childhood vaccines in rural Tanzania - a mixed methods study. BMC Public Health. 2020 Oct 20;20(1):1573. doi: 10.1186/s12889-020-09598-1.

Reference Type BACKGROUND
PMID: 33081744 (View on PubMed)

Ostermann J, Vasudevan L, Baumgartner JN, Ngadaya E, Mfinanga SG. Do mobile phone-based reminders and conditional financial transfers improve the timeliness of childhood vaccinations in Tanzania? Study protocol for a quasi-randomized controlled trial. Trials. 2019 Jul 4;20(1):397. doi: 10.1186/s13063-019-3430-4.

Reference Type BACKGROUND
PMID: 31272487 (View on PubMed)

Ostermann J, Hair NL, Moses S, Ngadaya E, Godfrey Mfinanga S, Brown DS, Noel Baumgartner J, Vasudevan L. Is the intention to vaccinate enough? Systematic variation in the value of timely vaccinations and preferences for monetary vs non-monetary incentives among pregnant women in southern Tanzania. Vaccine X. 2023 Jan 23;13:100266. doi: 10.1016/j.jvacx.2023.100266. eCollection 2023 Apr.

Reference Type BACKGROUND
PMID: 36814594 (View on PubMed)

Vasudevan L, Ostermann J, Moses SM, Ngadaya E, Mfinanga SG. Patterns of Mobile Phone Ownership and Use Among Pregnant Women in Southern Tanzania: Cross-Sectional Survey. JMIR Mhealth Uhealth. 2020 Apr 8;8(4):e17122. doi: 10.2196/17122.

Reference Type BACKGROUND
PMID: 32267240 (View on PubMed)

Vasudevan L, Ostermann J, Thielman N, Baumgartner JN, Solomon D, Mosses A, Hobbie A, Hair NL, Liang C, van Zwetselaar M, Mfinanga S, Ngadaya E. Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study. JMIR Res Protoc. 2024 Jan 12;13:e52523. doi: 10.2196/52523.

Reference Type DERIVED
PMID: 38214956 (View on PubMed)

Other Identifiers

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Pro00120675

Identifier Type: -

Identifier Source: org_study_id