Implementation of the Liberia National Community Health Assistant (NCHA) Program and Under-five Mortality: A study protocol

Introduction Between 2018 and 2022 the Liberian Government implemented the National Community Health Assistant (NCHA) program to improve provision of maternal and child health care to underserved rural areas of the country. Whereas the contributions of this and similar community health worker (CHW) based healthcare programs have been associated with improved process measures, the impact of a governmental CHW program at scale on child mortality has not been fully established. Methods/Design We will conduct a cluster sampled, community-based survey with landmark event calendars to retrospectively assess child births and deaths among all children born to women in the Grand Bassa District of Liberia. We will use a mixed effects discrete survival model, taking advantage of the staggered program implementation in Grand Bassa districts over a period of 4 years to compare rates of under-5 child mortality between the pre- and post-NCHA program implementation periods. Discussion This study will be the first to estimate the impact of the Liberian NCHA program on under-5 mortality. Trial registration [clinicaltrials.gov][1] NCT: [NCT05123378][2] ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The research is funded by Cargill, USAID DIV and UBS Optimus Foundation. www.cargill.com www.usaid.gov www.ubs.com The funders have no role in the study design, data collection, management, manuscript writing or decision to submit the report for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approval for the surveys was obtained from the University of Liberia-Pacific Institute for Research and Evaluation Institutional Review Board (18-11-140) and Advarra Institutional Review Board (Pro00048901), United States. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. * ARI : acute respiratory infections iCCM : integrated Community Case Management CHA : Community Health Assistants CHW : community health worker DHS : Demographic and Health Survey MOH : Ministry of Health NCHA : National Community Health Assistant U5M : Under-5 mortality [1]: http://clinicaltrials.gov [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05123378&atom=%2Fmedrxiv%2Fearly%2F2022%2F12%2F30%2F2022.07.15.22277669.atom