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Table 2 Characteristics of included studies

From: A systematic review of economic evaluations of CHW interventions aimed at improving child health outcomes

Study Setting Cost year Size of the population served by the programme being analysed Currency Type of evaluation Method Perspective Target population/goal of intervention
Tozan, 2010 [14] Broadly stated as rural African settings in which care seeking was low 2008 Cohort of 1 000 new born babies until 5 years of age International dollar Cost-effectiveness analysis Decision tree used to model costs and impacts of treating severe childhood malaria with pre-referral artesunate. What would be the added gains if CHWs rather than health professionals are used? Provider/health system Children in rural areas where burden of malaria remains high
Malaria reduction
Gonzalez, 2000 [13] Tanzania (SSA) 1996 2 322 infants under 1 year US$ Decision analysis/cost-effectiveness analysis Used life table method to estimate number of years of life lost that would be prevented if 3 strategies (2 involving CHWs) were used to manage malaria and anaemia in children Health provider/societal Infants living in Kilombero district in 1996
Malaria/anaemia reduction
Conteh et al. 2010 [15] Hohoe district, Ghana 2008 1 801 children aged 2–59 months US$ Cost-effectiveness analysis Measured the costs and impacts of delivering malaria prophylaxis using CHWs (termed community-based volunteers) and how that differs with usual care and no intervention approach Provider/societal Children aged 3–59 months who resided in the study district
Malaria reduction
Nonvignon et al. 2013 Rural Ghana 2009 13 135 children under the age of five US$ Cost-effectiveness analysis based on cluster randomized trial Compared the costs and impacts of using community health workers to manage fevers at home with standard practice of self-medication or seeking care at health centres Societal Febrile children under 5 years
Reducing mortality from suspected malaria/infections
Pagnoni et al. 1997 [18] Rural Burkina Faso 1994 35 000 mothers US$ Cost-consequence analysis Measured the costs and benefits of using community-based workers to provide prompt and adequate treatment for malaria and compared outcomes with pre-intervention period Provider Mothers within study setting
Reduce severity of malaria morbidity
Chola, 2011 [19] Uganda (SSA) 2007 406 breastfeeding mothers US$ Cost analysis Estimated actual costs incurred as a result of individual peer-counselling visits to breastfeeding mothers. Alternative peer support intervention modelled and cost Local provider’s perspective Pregnant women within the study sites
Promote exclusive breastfeeding
Desmond et al. 2008 [17] South Africa N/A 2 781 pregnant women US$ Cost-effectiveness analysis based on cohort study of pregnant women attending government antenatal clinic coupled with modelled analysis of alternative intervention Compared the rates of exclusive breastfeeding when intervention was offered at different coverage levels Health systems/provider Pregnant women attending a government antenatal clinic
Promote exclusive breastfeeding
Frick et al. 2012 [28] Mid-Atlantic region, USA N/A 328 low-income women US$ Cost analysis Measured the costs of providing support to breastfeeding low-income women and compared the costs offset as a result of reduced health care utilization Provider Women undergoing postpartum hospitalization at a large medical centre
Promote breastfeeding
Pugh et al. 2002 [29] Mid-Atlantic region, USA N/A 41 low-income women US$ Cost-effectiveness analysis Compared cost-effectiveness of community-based randomized trial aimed at improving exclusive breastfeeding rates amongst low-income mothers against usual care Societal Women undergoing postpartum hospitalization at a large medical centre
Promote exclusive breastfeeding
Morrell et al. 2006 United Kingdom   311 women British Pound Cost analysis Cost and impact assessment of CHW providing postnatal support at home Societal Women delivering at Sheffield Hospital older than 17 years
Mainly maternal health outcomes plus breastfeeding
Margellos-Anast 2012 [30] USA Not specified 135 women with children US$ Cost analysis Calculated costs of urgent health resource utilization averted in absence of intervention
Urgent HRU = emergency visits, hospitalizations, and urgent clinic visits
Not specified Asthmatic children within study setting of Chicago
Puett et al. 2013 [24] Southern Bangladesh 2010 724 care givers US$ Cost analysis Compared the impact and costs of using CHWs to manage cases of malnutrition vs. facility-based inpatient treatment of SAM at health centres as the existing standard of care in Bangladesh Societal Children with severe acute malnutrition (SAM) in Bhola District
Melville et al. 1995 [27] Jamaica N/A 88 children US$ Cost analysis Measured nutritional status and growth of children whose caregivers received nutritional advice from CHWs pre-intervention and post-intervention Provider Children <36 months
Nutritional status
Gowani et al. 2014 [21] Rural Sindh, Pakistan N/A 1 121 infants US$ Cost-effectiveness analysis Measured the improvement in cognitive, language, and motor development skills when responsive stimulation and enhanced nutrition were added into an existing package of services offered by lay health workers Provider Children less than 2 years
Improve early childhood development
Aracena et al. 2009 [26] Chile N/A 45 adolescent US$ Cost-effectiveness analysis Compared what the rate of maternal depression and linguistic skills development of children would be when CHWs (termed health educators) provided home support to adolescent mothers vs. usual care at health facility Not explicitly stated Adolescent mothers
Children’s linguistic skills
Barzgar et al. 1997 [20] Rural Pakistan N/A Services provided to about 50 000 people US$ Cost analysis Measured crude birth rates, maternal mortality rates, and infant mortality rates following an intervention that utilized community health workers for promoting uptake of health services and family planning. Rates compared with pre-intervention period Provider Community within the 3 districts but primary focus seemed to be on women and children
Reduce under-5 mortality
Hafeez et al. 2011 [22] Pakistan N/A Each lay health worker served a population of 1 000 people. The programme employed 90 000 lay health workers. US$ Cost analysis Measured the reduction in mortality that resulted from using lay health workers to perform preventive activities and basic curative functions within the study site Provider Pregnant women, children under 5 years, couples in catchment population eligible to use contraception, general community
Improve maternal and child key health indicators
Borghi, 2005 [23] Rural Nepal (Asia) 2003 14 884—number of married women of reproductive age in the intervention area US$ Cost-effectiveness analysis Women’s groups as lay health workers—what would be the pregnancy outcomes if they did not exist?
Based on cluster randomized trial
Provider Women residing within the study population
Reduce neonatal mortality
San Sebastian et al. 2001 [25] Ecuador 1994 180 children less than 1 year old US$ Cost-consequence analysis Measured the costs and health impacts of using 2 different approaches to improve immunization, one using CHWs, another using health facility-level staff Provider and patient Children eligible for immunization