Trial reportHuman resources for health2021
Does supportive supervision intervention improve community health worker knowledge and practices for community management of childhood diarrhea and pneumonia? Lessons for scale-up from Nigraan and Nigraan Plus trials in Pakistan.
Trial report in Human resources for health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 14 citations in OpenAlex.
- Occurrence of diarrhea in pediatric bronchopneumonia patients: relevance to nursing management.Italian journal of pediatrics · 2026Article
- Improving mental health literacy of frontline community health workers in a rural district of Pakistan: mPareshan project.BJPsych open · 2026Article
- Effects of the Challenge Initiative's Community Health Volunteers (CHVs) on Public Sector Service Provision of Family Planning Services in Urban Sindh, Pakistan.International journal of environmental research and public health · 2025Article
- Home-based digital counselling by frontline community workers for anxiety and depression symptoms in rural Sindh, Pakistan: the mPareshan intervention.BMC public health · 2025Article
- Implementation status, drivers and barriers to the sick children quality of care improving interventions in the Oromia region, Ethiopia: case study design.BMC health services research · 2025Article
- Article
- Common pediatric surgical conditions and associated health-seeking behaviors in Pakistan: An urban and rural comparative assessment.PLOS global public health · 2024Article
- Six Recommendations for Provider Behavior Change in Family Planning.Global health, science and practice · 2023Review
- Addition of mental health to the lady health worker curriculum in Pakistan: now or never.Human resources for health · 2023Article
- Changing Perceptions of Rural Frontline Workers and Caregivers About Management of Childhood Diarrhea and Pneumonia Despite Several Inequities: The Nigraan Plus Trial in Pakistan.Journal of multidisciplinary healthcare · 2021Article
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Authors and funding
3 authors at 1 institution in 1 country.
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Abstract
backgroundLack of programmatic support and supervision is one of the underlying reasons of the poor performance of Pakistan's Lady Health Worker Program (LHWP). This study describes the findings and potential for scale-up of a supportive supervision intervention in two districts of Pakistan for improving LHWs skills for integrated community case management (iCCM) of childhood diarrhea and pneumonia.
methodsThe intervention comprised an enhanced supervision training to lady health supervisors (LHSs) and written feedback to LHWs by LHSs, implemented in Districts Badin and Mirpur Khas (MPK). Clinical skills of LHWs and LHSs and supervision skills of LHSs were assessed before, during, and after the intervention using structured tools.
resultsLHSs' practice of providing written feedback improved between pre- and mid-intervention assessments in both trials (0% to 88% in Badin and 25% to 75% in MPK) in the study arm. Similarly, supervisory performance of study arm LHSs was better than that in the comparison arm in reviewing the treatment suggested by workers' (94% vs 13% in MPK and 94% vs 69% in Badin) during endline skills assessment in both trials. There were improvements in LHWs' skills for iCCM of childhood diarrhea and pneumonia in both districts. In intervention arm, LHWs' performance for correctly assessing for dehydration (28% to 92% in Badin and 74% to 96% in MPK), and measuring the respiratory rate correctly (12% to 44% in Badin and 46% to 79% in MPK) improved between baseline and endline assessments in both trials. Furthermore, study arm LHWs performed better than those in comparison arm in classifying diarrhea correctly during post-intervention skills assessment (68% vs 40% in Badin and 96% vs 83% in MPK).
conclusionSupportive supervision including written feedback and frequent supervisor contact could improve the performance of community-based workers in managing diarrhea and pneumonia among children. Positive lessons for provincial scale-up can be drawn. Trial registration Both trials are registered with the 'Australian New Zealand Clinical Trials Registry'. Registration numbers: Nigraan Trial: ACTRN1261300126170; Nigraan Plus: ACTRN12617000309381.
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