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Table 1 Characteristics and Findings of Studies

From: Thirty years after Alma-Ata: a systematic review of the impact of community health workers delivering curative interventions against malaria, pneumonia and diarrhoea on child mortality and morbidity in sub-Saharan Africa

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
  1. CHW: Community Health Worker; RCT: Randomized Controlled Trial
  2. ITN: Insecticide-treated nets; NGO: Non-governmental organisation
  3. TBA: Traditional birth attendant; CBA: Controlled before and after study
  4. OR: Odds ratio of death in children exposed to CHW compared to those unexposed