Table 1 Summary of included studies
S/N | Author | Title | Aim | Evaluation tool | Study design | Key results-PICO |
|---|---|---|---|---|---|---|
1 | Kelly et al. (2001) Kenya | Community health worker performance in the management of multiple childhood illnesses: Siaya District, Kenya, 1997–2001 | To characterize community health worker (CHW) performance using an algorithm for managing common childhood illnesses | An algorithm for managing common childhood illnesses | Cross-sectional studie followed up in 1998, 1999, and 2001 | Participants- 100, 108, and 114 CHWs Intervention- Community case management Comparison- Baseline and end line data Outcome- Performance deficiencies were found in the management of sick children by CHWs, although care was not consistently poor |
2 | Chanda et al. (2011) Zambia | Community case management of malaria with RDT | To evaluate the effectiveness of using CHWs as delivery points for ACT and RDTs in the home management of malaria in two districts in Zambia | Direct observation-Practical | A mixed method prospective study | Participants- CHW and facility staff Intervention- CCM with RDT and ACT Comparison- None Outcome- Community case management of malaria by CHWs using RDTs and ACT is feasible, acceptable by the communities, and efficient including referral of cases for further management at the health facility |
3 | Kawakatsu et al. (2015) Kenya | Individual and contextual factors associated with CHW performance in Nyanza province, Kenya- A multilevel analysis | To assess the CHWs’ performance in Western Kenya and describe determinants of that performance | Generated by three indicators: reporting rate, health knowledge, and household coverage | Cross-sectional survey | Participants- CHW Intervention- CHW strategy Comparison- None Outcome- Performance varied according to indicators. The significant factors associated with the CHWs’ performance were some demographic factors, supervisions received and health knowledge |
4 | MOH-Rwanda (2009) Rwanda | Community case management-Evaluation report of CHW performance—Kigali Rwanda | To analyze CHWs performance in order to use early lessons learned to inform the program expansion | Observation of the CHW demonstrating key competencies | Cross-sectional study with retrospective review of the records | Participant- 35 CHWs Intervention- CCM Comparison- Baseline and end line data Outcome- CHWs performance are strongly linked to the level of simplicity of the management tools, the quality of the training they received—which should be a competency-based training and the quality of the mentoring they received on site after the training |
5 | Bagonza et al. (2014) Uganda | Performance of CHW in ICCM- Uganda | To assess factors influencing performance of CHWs managing malaria, pneumonia, and diarrhea under the Integrated Community Case Management (ICCM) program in Wakiso District, central Uganda | Composite scores based on the core activities of CHWs under the ICCM program | A cross-sectional study for quantitative methods | Participants- 336 CHW Intervention- ICCM Comparison- None Outcome- Only one in every five CHWs performed optimally under the ICCM program |
6 | Kalyango et al. (2012) Uganda | Performance of community health workers under integrated community case management of childhood illnesses in eastern Uganda | Compared performance of CHWs managing malaria and pneumonia with performance of CHWs managing malaria alone in and the factors influencing performance | Knowledge tests, case scenarios of sick children, review of CHWs’ registers, and observation of CHWs | Cross-sectional with mixed methods study (June–July 2011) | Participants- CHW-125 CHW Intervention- ICCM by CHWs Comparison- CHWs managing malaria alone and malaria and pneumonia Outcome- The factors perceived to influence CHWs’ performance were community support and confidence, continued training, availability of drugs and other necessary supplies, and cooperation from formal health workers CHWs providing dual-illness management handled malaria cases as well as CHWs providing single-illness management, and also performed reasonably well in the management of pneumonia |
7 | Chinbuah et al. (2013) Ghana | Assessment of the adherence of community health workers to dosing and referral guidelines for the management of fever in children under 5 years: a study in Dangme West District, Ghana | Assessed CHWs’ adherence to dosing and referral guidelines | IMCI guidelines, data collection forms, and analysis of records | A cluster-randomized, stepped-wedge, controlled, open trial | Participants- 660 CHWs, 100 children (12–59 months)/14 clusters Intervention- Antimalarial versus an antimalarial plus an antibiotic for the treatment of fever among children aged 2–59 months Comparison- Antimalarial only vs. antimalarial with antibiotic Outcome- Adherence to dosing guidelines was high. Adherence to referral guidelines was inadequate |
8 | Druetz et al. (2015) Burkina Faso | Utilization of CHW for malaria treatment: Results from a three-year panel study in the districts of Kaya and Zorgho, Burkina Faso | To assess effectiveness or feasibility/acceptability of ICCM under real-world conditions of implementation at national scale | Questionnaires | Cross-sectional household panel study from 2011 to 2013 | Participants- Children under 60 months of age were enrolled in the panel (N = 2237) Intervention- CHW strategy for malaria treatment Comparison- Urban and rural Outcome- In urban areas less than 1% of sick children consulted a CHW while 1–9% in rural areas. CHW rarely used |
9 | Perez et al. (2009) Mali | The role of community health workers in improving child health programs in Mali | To assess the performance of CHWs in the promotion of basic child health services in rural Mali | Questionnaires | Community-based cross-sectional survey | Participants- CHW (72) and caregivers households) Intervention- CHW intervention Comparison- Households with and without CHW visits Outcome- A positive influence of CHWs on family health practices |
10 | Mubi et al. (2011) Tanzania | Malaria Rapid Testing by community health workers is effective and safe for targeting malaria treatment: Randomized cross-over trial in Tanzania | Assessing the impact of rapid malaria diagnostic tests (RDTs) by community health workers (CHWs) on provision of artemisinin-based combination therapy (ACT) and health outcome in fever patients | Direct observation-Practical | Randomized cross-over trial | Participants- Twenty-two CHWs and 2930 fever patients Intervention- RDTs by CHWs Comparison- None Outcome- CHWs adhered to the RDT results in 1411 of 1457 patients |
11 | Yeboah-Antwi et al. (2010) Zambia | Community case management of fever due to malaria and pneumonia in children under five in Zambia: A cluster randomized controlled trial | To assess the effectiveness and feasibility of using CHWs to manage non-severe pneumonia and uncomplicated malaria with the aid of rapid diagnostic tests (RDTs) | Checking of the registers and records, direct observation to interpret the results of RDTs | Cluster randomized controlled trial that compared cross-sectional household surveys | Participants- CHW and children—3125 with 18 CHWs and 2084 with 19 CHWs in control children Intervention- CHWs performed RDTs, treated test-positive children with AL Control CHWs did not perform RDTs, treated all febrile children with AL Comparison- Intervention and control arm—two models for community-based management of malaria in children Baseline and post-study Outcome-primary outcomes were the use of AL in children with fever and early Secondary outcome was the proportion ofchildren who experienced treatment failure |
12 | Searle et al. (2016) Zambia | Evaluation of the operational challenges in implementing reactive screen-and-treat and implications for malaria elimination in a region of low transmission in southern Zambia | To evaluate operational challenges in implementing reactive screen-and-treat | Records, ground truth evaluation of community health worker performance | Serial cross-sectional surveys | Participants- CHW Intervention- Test and treat Comparison- None Outcome- Poor coverage—with limited resources, coverage and diagnostic tools, reactive screen-and-treat will likely not be sufficient to achieve malaria elimination in this setting |
13 | Kisia et al. (2012) Kenya | Factors associated with utilization of community health workers in improving access to malaria treatment among children in Kenya | Examines factors associated with utilization of CHWs in improving access to malaria treatment among children under five years of age by women caregivers in two malaria endemic districts in Kenya | Conducted using a standardized malaria indicator questionnaire | A cross-sectional household survey | P-Households- Baseline (n = 1187) and one year later at end line assessment (n = 1374) I- CHW under CCM C- Before intervention and after intervention O- Increase in utilization of CHWs as source of advice/treatment for child fevers from 2% at baseline to 35% at end line, accompanied by a decline in care-seeking from government facilities and other sources including shops |
14 | Wanduru et al. (2016) Uganda | The performance of community health workers in the management of multiple childhood infectious diseases in Lira, northern Uganda | Assess the performance of CHWs in managing malaria, pneumonia, and diarrhea in the rural district of Lira, in northern Uganda | Combining scores from knowledge assessment and case management | Mixed methods cross-sectional study | P- 428 CHWs, 7 key informants I- CHW management of multiple illnesses C- None O- Low performance in malaria management-education level, duration of training, number of households allocated to each CHW, and supervision frequency were significant |
15 | Nsona et al. (2012) Malawi | Scaling up integrated community case management of childhood illness: update from Malawi | To provide an overview of the implementation of CCM in Malawi | Program records and Health Management Information System (HMIS) reports from the Integrated Management of Childhood Illness (IMCI) unit in the Ministry of Health (MOH) | Cross-sectional study | P- Program managers and health surveillance Assistants (HSA) I- ICCM by HSA C- Baseline implementation data and 3-year post implementation data O- ICCM strategy has the potential to achieve the government’s goal of universal coverage of key child health interventions because of strong MOH support for both policy and practice |
16 | Banek et al. (2015) Uganda | Community case management of malaria: exploring support, capacity, and motivation of community medicine distributors in Uganda | To understand the level of support available and the capacity and motivation of community health workers to deliver these expanded services | Questionnaires to gather information about the CMDs’ work experience and to assess knowledge of fever case management, and in-depth interviews | Mixed methods cross-sectional design | P- 100 CMDs interviews and 35 for full transcription and analysis. I- Home-based management of fever (HBMF) program, (ICCM) by CMDs C- None O- CMDs demotivated and faced multiple challenges including high patient load, limited knowledge and supervision, lack of compensation, limited drugs and supplies, and unrealistic expectations of community members |