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 |