Table 2 Characteristics of included studies
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 | Â | 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 17Â 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 Asthma |
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 |
Malnutrition | ||||||||
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 <36Â 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 1Â 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 |
Immunization |