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Health SystemsC-it-DU-itNCT05929586

Digital Data Linkage and Scheduling to Track Pregnancy With or Without Community Data Use to Increase Antenatal Clinic Uptake in Western Kenya.

A study testing The combined "C-it DU-it" intervention: community data use for ANC in people with Health Systems and Electronic Community Health Information Systems, run by Liverpool School of Tropical Medicine at 1 site in Kenya.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The investigators propose to increase ANC uptake through a health systems strengthening approach that links digital data platforms and trains community Work Improvement Teams (WITs) to use these data to identify problems and come up with local solutions. Read more about this study

Who is it for?
Any age, women onlyHealthy volunteers can take part
What is being tested?
The combined "C-it DU-it" intervention: community data use for ANC
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,440 participants
Where
1 siteKenya
Study dates
29 Nov 2024to 30 Sep 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • Women only
  • Healthy volunteers accepted
  • Child, Adult, Older adult

Who may be able to join

  • Pregnant women of all ages willing to participate
  • Written informed consent
  • A resident of the study area (catchment area) for the duration of the pregnancy
  • Delivered and still within the 6-week post-partum period.

Who cannot join

  • Currently enrolled in another interventional study targeting pregnant women
  • Outside the 6-week post-partum period.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Hellen C Barsosio, MD contact

+254724464507

hbarsosio@kemri.go.ke

Kenya1 site, 1 recruiting
  • KEMRI Centre for Global Health Research

    Homa Bay

    Gerald N Ong'ayo, MD, +254737491526, gerald.ongayo@lstmed.ac.uk

    Recruiting

Other trials in Kenya

About this study

Official title: A Pragmatic Open-label, Community-based, Cluster Randomised Controlled Superiority Trial to Evaluate the Efficacy and Cost-effectiveness of Digital Data Linkage and Scheduling ('C-it') With or Without Community Data Use ('DU-it') to Increase Antenatal Clinic Uptake in Western Kenya.

The investigators propose to increase ANC uptake through a health systems strengthening approach that links digital data platforms and trains community Work Improvement Teams (WITs) to use these data to identify problems and come up with local solutions. Our short name C-it DU-it (pronounced "see-it; do-it") is an acronym intended to convey 'seeing' linked data (C-it) and 'doing' or acting on the data (DU-it). The trial design is a 2-arm, cluster-randomised controlled superiority trial in Homa Bay County to determine the efficacy of 'C-it DU-it' intervention (data use arm) to increase ANC contacts when compared to the 'C-it' enhanced standard of care (control arm).

Read the detailed description

Facility and community health data is being rapidly digitised using multiple parallel systems across the 47 devolved counties in Kenya, but data do not link. Setting up community-based antenatal care (ANC) to complement facility-based ANC and data systems that link these platforms is essential to support Kenya in adopting WHO's ambitious target of 8 ANC contacts. As of February 2023, national scale up of the national electronic community health information systems (eCHIS) for standard of care is ongoing, and there are increased efforts to scale-up use of the nationally approved Kenya Electronic Medical Records (KenyaEMR) Maternal and Child Health Module (MNH) to capture ANC, delivery and postnatal (PNC) data at health facilities. Data between eCHIS and Kenya EMR do not link. There are plans within the Community Health Division at national level to link eCHIS to facility EMRs, but this has yet to be developed. The investigators propose to increase ANC uptake through a health systems strengthening approach that links digital data platforms and trains community Work Improvement Teams (WITs) to use these data to identify problems and come up with local solutions. The short name C-it DU-it (pronounced "see-it; do-it") is an acronym intended to convey 'seeing' linked data (C-it) and 'doing' or acting on the data (DU-it). The overarching research question the investigators will seek to answer is "what is the effect of 'C-it DU it' on community health systems strengthening and what is required for effective transfer and scale-up?" The investigators will use mixed methods implementation research to evaluate this in 4 counties in Western Kenya (Homa Bay, Migori, Kisumu, Kakamega) over a period of four years. The proposed methods include: (a) Realist evaluation to generate, empirically test and refine a transferrable programme theory to understand the causal relationship between context, participant response and outcomes; (b) A 2-arm, cluster-randomised controlled superiority trial in Homa Bay County to determine the efficacy of 'C-it DU-it' intervention (data use arm) to increase ANC contacts when compared to the 'C-it' enhanced standard of care (control arm); (c) Health economic evaluation and equity analysis to compare costs and catastrophic health expenditure of women accessing and engaging with ANC care and determine costs and cost-effectiveness of C-it Du-it from a health systems perspective; and (d) Qualitative interviews will assess transferability and iterative scale-up of C-it DU-it across the three remaining counties using toolkits developed in Homa Bay. This protocol describes the pragmatic cluster randomised trial and health economic evaluation. The realist evaluation and scale up will be addressed in a separate sister protocol.

Being tested
The combined "C-it DU-it" intervention: community data use for ANC

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • The combined "C-it DU-it" intervention: community data use for ANCOther

    Also called community data use (DU-it)

    Combining data linkage ("C-it") with work improvement teams for community data use ("DU-it") to improve antenatal clinic uptake. Our short name C-it DU-it (pronounced "see-it; do-it") is an acronym intended to convey 'seeing' linked data (C-it) and 'doing' or acting on the data (DU-it)

Study groups in NCT05929586
Study groupRoleWhat they receive
Digital data linkage and scheduling ('C-it'): The "C-it" enhanced standard of careNo interventionLinking facility to community digital data via linkage-app: Data between electronic Community Health Information System (eCHIS) and facility-based Kenya Electronic Medical Record (Kenya EMR) do not link. We do not have an existing digital data linkage module or app to track successful pregnancy referrals or allow the facility staff to view community contacts and vice versa. We will engage with national and county teams and software developers to build a digital data linkage module, linking eCHIS and Kenya EMR Maternal and Child Health (MCH) module.
The combined "C-it DU-it" intervention: community data use for ANCExperimentalCombining "C-it" and work improvement teams (WITs) for community data use: We will establish and train integrated WITs in intervention sites consisting of community health members, health facility staff and community members and train them on how they will use linkage-app. The resultant combined "C-it DU-it" intervention has three building blocks: We make the following assumptions about the building blocks at the bottom of figure 1. 1. Building block 1: We assume that high-quality digital data that can trace the entire journey through pregnancy is accessible to CHVs 2. Building block 2: We also assume that integrated work improvement teams (WITs) will have the right people around the table with clearly defined roles and responsibilities will use the data. 3. Building block 3: Community ANC contacts will be implemented.
Receives: Other: The combined "C-it DU-it" intervention: community data use for ANC

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Increasing antenatal clinic uptake

    The proportion of women having at least eight ANC contacts during the antenatal period, defined as either a scheduled ANC visit in the facility or a scheduled ANC contact with a CHV in the community assessed at birth (or within the first 6-8 weeks for home births) using the ANC cards.

    Measured: 14 months

  2. Estimate socioeconomic impact and access to social protection

    Defined as the proportion of women using financial coping strategies and their frequency and distribution

    Measured: 14 months

  3. Estimate the costs to pregnant women and their households

    Absolute costs to the pregnant woman and their household and the costs as a proportion of the pregnant woman and their household's monthly income or expenditure/consumption will be calculated for the following variables:

    • Out-of-pocket medical costs
    • Out-of-pocket non-medical costs
    • Lost income, time, and productivity

    Measured: 14 months

Secondary outcomes (11)
  1. The proportion of women having at least four scheduled ANC visits in the facility

    assessed at birth (or within the first 6-8 weeks after birth for home births) using the ANC cards.

    Measured: 14 months

  2. The proportion of women having at least eight scheduled ANC visits in the facility

    assessed at birth (or within the first 6-8 weeks after birth for home births) using the ANC cards.

    Measured: 14 months

  3. The frequency (count) of scheduled ANC visits

    assessed at birth (or within the first 6-8 weeks after birth for home births) using the ANC cards.

    Measured: 14 months

  4. The frequency (count) of of ANC visits in the community

    assessed at birth (or within the first 6-8 weeks after birth for home births) using the ANC cards.

    Measured: 14 months

  5. Early antenatal clinic attendance

    The proportion of women with a first ANC contact before 16 weeks gestation.

    Measured: 14 months

  6. Quality of antenatal care

    • The proportion of women with at least three courses of IPTp
    • The proportion of women who received iron and folate for 90 days.
    • The proportion of women receiving testing and management for HIV.
    • The proportion of women receiving testing and management for malaria.
    • The proportion of women receiving testing and management for syphilis.
    • The proportion of women receiving testing and management for anaemia.

    Measured: 14 months

  7. Uptake of skilled birth attendance.

    The proportion of women who had a skilled birth attendance.

    Measured: 14 months

  8. Reducing the risk of adverse pregnancy outcomes.

    The proportion of women with adverse pregnancy outcomes- defined as a composite of foetal loss (stillbirth or spontaneous miscarriage), low birth weight or neonatal mortality)

    Measured: 14 months

  9. prevalence of catastrophic health expenditure (CHE) of accessing ANC care with "C-it" enhanced standard of care

    CHE prevalence at two World Health Organization-defined thresholds: out-of-pocket medical costs of more than 10% of a patient household's total monthly expenditure/consumption (10%-threshold); and out-of-pocket medical costs of more than 40% of a patient household's monthly capacity to pay (non-food/housing/utilities expenditure/consumption)

    • A sensitivity analysis of the proportion of women's households incurring CHE due to pregnancy and ANC visits using varying additional recognised calculations and thresholds including, as per WHO Tuberculosis Patient Cost Survey methodology, the addition of non-medical out-of-pocket costs and lost income in the numerator

    Measured: 14 months

  10. Cost-effectiveness of "C-it" and "C-it DU-it" intervention

    Incremental cost-effectiveness ratios (ICERs) compared across trial arms

    Measured: 14 months

  11. Assess equity of access to ANC and "C-it" and "C-it DU-it" intervention.

    Equity of access to ANC and the interventions will be evaluated by exploratory distributional (or "extended") cost-effectiveness analysis of the intervention across the following sub-groups: poverty quintiles, age groups including adolescents vs adults, study sites, HIV status, and by eligibility for health insurance including NHIF and Linda Mama.

    Measured: 14 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Jul 2023
  2. Study start29 Nov 2024
  3. Primary completion30 Sep 2026 (estimated)
  4. Study completion30 Sep 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Model description
Allocation: cluster randomised; intervention model: parallel assignment; arms: 2; allocation ratio: 1:1; restricted or stratified randomisation. Masking: none
Masking
None (open label)
Enrolment
1,440 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05929586
Sponsor's protocol ID
22-073
Acronym
C-it-DU-it
Status last verified
Jun 2025
First submitted
5 Apr 2023
Last updated
27 Jun 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Data will be shared via data transfer agreements with the collaborating institutions to minimise the risk of unauthorised analysis beyond the scope of the agreed parameters. The full protocol will be available on request to any interested professional and may be published in a peer-reviewed journal or deposited in an online repository. Individual, de-identified participant data will be made available for meta-analyses as soon as the data analysis is completed, with the understanding that the meta-analysis results will not be published before the individual trial results without the prior agreement of the investigators. The de-identified data set of the complete participant-level data will be available for sharing purposes. A Data Access Committee will consider all requests for data for secondary analysis to ensure that the use of data is within the terms of consent and ethics approval and in line with the Kenya Data Protection Act 2019.

Publications

  • Ong'ayo G, Barsosio HC, Otiso L, Kamau A, Dodd J, Okoth L, Oguche M, Doyle V, Ochodo E, Okomo G, Ter Kuile F, Taegtmeyer M. Evaluating community digital data linkage with or without community data use to increase antenatal care uptake in Western Kenya: protocol for a pragmatic open-label, cluster-randomised controlled superiority trial. Front Health Serv. 2026 Jan 27;5:1697161. doi: 10.3389/frhs.2025.1697161. eCollection 2025.

    PubMed 41675597

Questions about this trial

What is this clinical trial studying?

A study testing The combined "C-it DU-it" intervention: community data use for ANC in people with Health Systems and Electronic Community Health Information Systems, run by Liverpool School of Tropical Medicine at 1 site in Kenya.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 27 Jun 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Kenya. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Hellen C Barsosio, MD (+254724464507, hbarsosio@kemri.go.ke), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Increasing antenatal clinic uptake (time frame: 14 months). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05929586, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Jun 2025.

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