# Under-five mortality before and after implementation of the Liberia National Community Health Assistant (NCHA) program: A study protocol

## TL;DR

This study will assess how the Liberian NCHA program affected under-five child mortality in rural areas.

## Contribution

This is the first study to estimate the impact of the Liberian NCHA program on under-5 mortality.

## Key findings

- The study will use a mixed effects Cox proportional hazards model to compare mortality rates before and after the NCHA program.
- It will use a cluster sampled survey with landmark event calendars in the Grand Bassa District of Liberia.

## Abstract

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. 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 Cox proportional hazards 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. This study will be the first to estimate the impact of the Liberian NCHA program on under-5 mortality.