Trial in northern Nigeria: Lessons Learned in Child Mortality Reduction
Northern Nigeria has one of the highest mortality rates for children globally – in Jigawa, 1 in 6 children still die before their 5th birthday. The INSPIRING trial aimed to reduce child mortality with a package of interventions focused on participatory approaches to capacity building and empowerment.
32 primary health centre catchment areas were randomised to receive the intervention, or control – consisting of a basic package of essential equipment given to each facility. The research team followed 3800 families over 2 years to evaluate mortality, alongside an ethnographic process evaluation to understand how the intervention worked – or didn’t.
"Despite the comprehensive intervention, we did not find any significant mortality reduction or improvements in preventive and protective behaviours (e.g. vaccine coverage). However, ethnographic observations highlighted positive changes in shared decision-making, and wellbeing, focusing on ‘living in peace’. " says Carina King, researcher at the Department for Global Public Health.
Shifting community norms, and leveraging community resources take time, especially in this context of multiple over-lapping disasters.
"Through this trial, we have learnt a lot about what didn’t work, but also a lot about what would – we are currently thinking how to adapt the intervention, to then go back and try again." concludes Ayobami Bakare, PhD student at the department of Global Public health.
Publication
Effect of a participatory whole-systems approach on mortality in children younger than 5 years in Jigawa state, Nigeria (INSPIRING trial): a community-based, parallel-arm, pragmatic, cluster randomised controlled trial and concurrent mixed-methods process evaluation - The Lancet Global Health King, Carina, Ahmar, Samy, Ayobami Bakare, Paula Valentine and Funmilayo Shittu et al. The Lancet Global Health, Volume 0, Issue 0