Table 1.
Characteristics and Findings of Studies
| Study (first author, publication date, reference) |
Setting | CHW programme | Intervention tested | Study design | Period when impact measured | Change in mortality (95% CIs) | Change in morbidity (95% CIs) |
|---|---|---|---|---|---|---|---|
|
Gambian PHC (Greenwood, 1988, [26]) |
North bank of river, Gambia. Rural |
National programme (all villages > 400 people have a CHW) |
13 CHWs delivering curative treatments, health education & malaria chemoprophylaxis | CBA | 9-21 months after CHWs began delivering anti-malarial chemoprophylaxis | 36% (-17, 63) reduction 1-4 yr old mortality | 84% (48, 95) reduction in fever and parasitaemia |
|
Gambian PHC (Menon, 1990, [24]) |
North bank of river, Gambia. Rural |
National programme (as above) |
13 CHWs delivering curative treatments, health education & malaria chemoprophylaxis | CBA | 3-4 yrs after CHWs began delivering anti-malarial chemoprophylaxis | 77% (51, 89) reduction in 1-4 yr old mortality | 84% (60, 94) reduction in fever and parasitaemia |
|
Gambian PHC (Hill, 2000, [25]) |
North bank of River Gambia. Rural |
National programme (as above) |
1 CHW & TBA per village (15 villages) Curative treatments & health education delivered. | CBA | Mortality measured in four successive 2-3 yr periods after programme onset in 1983, covering 14 years. | 33% (10, 50) reduction in 1-4 yr old mortality, 6 to 9 yrs after programme onset. | Not assessed |
|
Gambian PHC (Alonso, 1991, [27]) |
South bank of river, Gambia. Rural |
National programme (as above) |
1 CHW & TBA per village (17 villages) delivering ITNs, curative treatments & health education | CBA | 0-12 months following initiation of ITN delivery by CHWs | 63% (32, 80) reduction in 1-4 yr old mortality | Not assessed |
|
Navrongo (Pence, 2005, [28]) |
North Ghana. Rural |
Initiated by research institute | CHWs delivering health education, curative treatments, making referrals | Cluster RCT Only 4 clusters |
4-5 years after CHWs rolled out | 87% (27, 178) increase in 1-2 yr old mortality | Not assessed |
|
Gomoa (Afari, 1995, [29]) |
South Ghana. Rural | Initiated by research institute | Curative treatments & growth monitoring by 6 CHWs, 1 nurse & 1 physician. | Before and after study | 0-3 years after programme onset. | 61% (no CIs given) reduction in 0-4 yr old mortality, 36 months after programme onset | Not assessed |
|
Pahou (Velema, 1991, [30]) |
Coast of Benin. Rural |
National programme | 17 CHWs. Tasks included home visits, curative treatments, anti-malarial chemoprophylaxis, health education, growth monitoring, and referrals. | Case control study | Cases (deaths) & controls were assessed for exposure to CHWs in the preceding 3-year period | OR = 0.39 (0.16, 0.97) | Not assessed |
CHW: Community Health Worker; RCT: Randomized Controlled Trial
ITN: Insecticide-treated nets; NGO: Non-governmental organisation
TBA: Traditional birth attendant; CBA: Controlled before and after study
OR: Odds ratio of death in children exposed to CHW compared to those unexposed