Evidence map›Paper›PMID 39732474›Full record

Trial reportBMJ global health2024

Cost-effectiveness analysis of proactive home visits compared with site-based community health worker care on antenatal care outcomes in Mali: a cluster-randomised trial.

Osondu Ogbuoji, Minahil Shahid, Armand Zimmerman, Jenny X Liu, Kassoum Kayentao, Caroline Whidden, Emily Treleaven, Coumba Traoré, Mahamadou Sogoba, Saibou Doumbia and 5 more

Registry-linked trialAbstract readRandomized Controlled TrialComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ global health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02694055 (Proactive Community Case Management and Child Survival), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02694055 nacompletednot on this map

Proactive Community Case Management and Child Survival: A Cluster-Randomized Controlled Trial

TypeinterventionalSponsorUniversity of California, San FranciscoRan2016 to 2020Enrolled135,149ConditionsUnder-five Child Mortality, Access to Health CareArmsProactive Community Case Management, Integrated Community Case Management, Removal of point-of-care user fees, Infrastructure improvements at primary health centre, Training of primary health centre staff
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Trial
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Osondu OgbuojiDuke Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, USA osondu.ogbuoji@duke.edu.ORCID http://orcid.org/0000-0003-2472-6861
Minahil ShahidDuke Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, USA.
Armand ZimmermanDuke Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, USA.
Jenny X LiuInstitute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA.
Kassoum KayentaoMalaria Research and Training Centre, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali.ORCID http://orcid.org/0000-0001-6877-0093
Caroline WhiddenMuso, Bamako, Mali; San Francisco, USA.
Emily TreleavenInstitute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.ORCID http://orcid.org/0000-0002-2667-9416
Coumba TraoréMuso, Bamako, Mali; San Francisco, USA.
Mahamadou SogobaMuso, Bamako, Mali; San Francisco, USA.
Saibou DoumbiaMuso, Bamako, Mali; San Francisco, USA.
David Charles BoettigerInstitute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA.
Amadou Beydi CisséMuso, Bamako, Mali; San Francisco, USA.
Youssouf KeitaMuso, Bamako, Mali; San Francisco, USA.
Mohamed BerthéMinistère de la Santé et du Développement Social, Bamako, Mali.
Ari JohnsonMuso, Bamako, Mali; San Francisco, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionDespite recommendations from the WHO, antenatal care (ANC) coverage remains low in many low-income and middle-income countries (LMICs). Community health workers (CHWs) can play an important role in expanding ANC coverage through pregnancy identification, provision of health education, screening for complications, delivery of therapeutic care and referral to higher levels of care. However, despite the success of CHW programmes in various countries, WHO has called for additional research to develop evidence-based models that optimise CHW service delivery and that can be replicated across geographies.

methodsThe ProCCM Trial was a cluster-randomised controlled trial to compare proactive home visits by CHWs (intervention, 69 village clusters) to the provision of CHW care at community fixed sites only (control, 68 village clusters) in the Bankass health district in Central Mali. In this study, we conducted a cost-effectiveness analysis of proactive CHW home visits in improving ANC utilisation, a secondary outcome of the ProCCM trial. We analysed five ANC outcomes: (1) number of ANC contacts, (2) at least one ANC contact, (3) at least four ANC contacts, (4) at least eight ANC contacts and (5) ANC initiated in the first trimester. We assumed two perspectives, a CHW programme's and the Full ANC programme's perspective, which included facility-based as well as community-based ANC. We estimated programme costs, incremental cost-effectiveness ratios (ICERs) and probabilities of the intervention being more cost-effective than the control at different willingness-to-pay (WTP) thresholds.

resultsProactive home visits were cost-saving from the CHW programme's perspective (ICERs: -$21.39 to -$79.20 per ANC utilisation outcome) and from the Full ANC programme perspective (ICERs: -$1.70 to -$6.30 per ANC utilisation outcome) compared with the fixed-site CHW care. The likelihood of the intervention being more cost-effective than the control was 100% at WTP thresholds $0 per ANC utilisation outcome and between $12.5 and $50.00 per ANC utilisation outcome in the CHW- and Full ANC programme perspectives, respectively.

conclusionOur results provide evidence that proactive home visits produce more value per dollar spent as a means of improving the uptake of ANC services compared with fixed-site CHW services. TRIAL REGISTRATION NUMBER: NCT02694055.

Indexed as

Community Health WorkersCost-Benefit AnalysisHouse CallsPrenatal CareAdultCluster AnalysisCost-Effectiveness AnalysisFemaleHumansMaliPregnancyGlobal HealthHealth economicsHealth services researchHealth systemsMaternal health

Identifiers

PMID39732474
PMCPMC12010333

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.