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
Introduction Despite 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, s...
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BMJ Publishing Group
2024-12-01
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| Online Access: | https://gh.bmj.com/content/9/12/e014940.full |
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| author | Osondu Ogbuoji Caroline Whidden Emily Treleaven Youssouf Keita Kassoum Kayentao Ari Johnson Jenny X Liu Minahil Shahid Mohamed Berthé Armand Zimmerman David Charles Boettiger Coumba Traoré Mahamadou Sogoba Saibou Doumbia Amadou Beydi Cissé |
| author_facet | Osondu Ogbuoji Caroline Whidden Emily Treleaven Youssouf Keita Kassoum Kayentao Ari Johnson Jenny X Liu Minahil Shahid Mohamed Berthé Armand Zimmerman David Charles Boettiger Coumba Traoré Mahamadou Sogoba Saibou Doumbia Amadou Beydi Cissé |
| author_sort | Osondu Ogbuoji |
| collection | DOAJ |
| description | Introduction Despite 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.Methods The 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.Results Proactive 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.Conclusion Our 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. |
| format | Article |
| id | doaj-art-4bf277768f0b400981ca6d0709d26dec |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2024-12-01 |
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| spelling | doaj-art-4bf277768f0b400981ca6d0709d26dec2025-01-13T14:35:10ZengBMJ Publishing GroupBMJ Global Health2059-79082024-12-0191210.1136/bmjgh-2023-014940Cost-effectiveness analysis of proactive home visits compared with site-based community health worker care on antenatal care outcomes in Mali: a cluster-randomised trialOsondu Ogbuoji0Caroline Whidden1Emily Treleaven2Youssouf Keita3Kassoum Kayentao4Ari Johnson5Jenny X Liu6Minahil Shahid7Mohamed Berthé8Armand Zimmerman9David Charles Boettiger10Coumba Traoré11Mahamadou Sogoba12Saibou Doumbia13Amadou Beydi Cissé142 Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA5 Muso, Bamako, Mali; San Francisco, USA7 Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA5 Muso, Bamako, Mali; San Francisco, USA4 Malaria Research and Training Centre, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali10 Department of Medicine, Insitute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA3 Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA1 Duke Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, USA9 Ministère de la Santé et du Développement Social, Bamako, Mali1 Duke Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, USA3 Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA5 Muso, Bamako, Mali; San Francisco, USA5 Muso, Bamako, Mali; San Francisco, USA5 Muso, Bamako, Mali; San Francisco, USA5 Muso, Bamako, Mali; San Francisco, USAIntroduction Despite 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.Methods The 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.Results Proactive 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.Conclusion Our 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.https://gh.bmj.com/content/9/12/e014940.full |
| spellingShingle | Osondu Ogbuoji Caroline Whidden Emily Treleaven Youssouf Keita Kassoum Kayentao Ari Johnson Jenny X Liu Minahil Shahid Mohamed Berthé Armand Zimmerman David Charles Boettiger Coumba Traoré Mahamadou Sogoba Saibou Doumbia Amadou Beydi Cissé 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 BMJ Global Health |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | https://gh.bmj.com/content/9/12/e014940.full |
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