Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review

BMC Public Health

Eilish McAuliffe¹  Brynne Gilmore¹ 

[1] Centre for Global Health, Trinity College, Dublin, Ireland

关键词: Human resources for health;    Intervention;    Prevention;    Low-and middle-income countries;    Maternal and child health;    Community health workers;   

Others  :  1161786
DOI  :  10.1186/1471-2458-13-847

 received in 2013-02-01, accepted in 2013-09-10,  发布年份 2013

【 摘 要 】

Background

Community Health Workers are widely utilised in low- and middle-income countries and may be an important tool in reducing maternal and child mortality; however, evidence is lacking on their effectiveness for specific types of programmes, specifically programmes of a preventive nature. This review reports findings on a systematic review analysing effectiveness of preventive interventions delivered by Community Health Workers for Maternal and Child Health in low- and middle-income countries.

Methods

A search strategy was developed according to the Evidence for Policy and Practice Information and Co-ordinating Centre’s (EPPI-Centre) guidelines and systematic searching of the following databases occurred between June 8 – 11^th, 2012: CINAHL, Embase, Ovid Nursing Database, PubMed, Scopus, Web of Science and POPLINE. Google, Google Scholar and WHO search engines, as well as relevant systematic reviews and reference lists from included articles were also searched. Inclusion criteria were: i) Target beneficiaries should be pregnant or recently pregnant women and/or children under-5 and/or caregivers of children under-5; ii) Interventions were required to be preventive and delivered by Community Health Workers at the household level. No exclusion criteria were stipulated for comparisons/controls or outcomes. Study characteristics of included articles were extracted using a data sheet and a peer tested quality assessment. A narrative synthesis of included studies was compiled with articles being coded descriptively to synthesise results and draw conclusions.

Results

A total of 10,281 studies were initially identified and through the screening process a total of 17 articles detailing 19 studies were included in the review. Studies came from ten different countries and consisted of randomized controlled trials, cluster randomized controlled trials, before and after, case control and cross sectional studies. Overall quality of evidence was found to be moderate. Five main preventive intervention categories emerged: malaria prevention, health education, breastfeeding promotion, essential newborn care and psychosocial support. All categories showed some evidence for the effectiveness of Community Health Workers; however they were found to be especially effective in promoting mother-performed strategies (skin to skin care and exclusive breastfeeding).

Conclusions

Community Health Workers were shown to provide a range of preventive interventions for Maternal and Child Health in low- and middle-income countries with some evidence of effective strategies, though insufficient evidence is available to draw conclusions for most interventions and further research is needed.

【 授权许可】

   
2013 Gilmore and McAuliffe; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]WHO: Trends in Maternal Mortality: 1990 to 2010. Geneva: The World Health Organization; 2012.
• [2]You D, Jones G, Wardlaw T: Levels & Trends in Child Mortality: Report 2011. Estimates Developed by the UN Inter-Agency Group for Child Mortality Estimation (35th edition). New York: United Nations Children’s Fund; 2011:1-24. http://www.childinfo.org/files/Child_Mortality_Report_2011.pdf webcite
• [3]Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, Bellagio Child Survival Group: How many child deaths can we prevent this year? Lancet 2003, 362:65-71.
• [4]Campbell OMR, Graham WJ: Strategies for reducing maternal mortality: getting on with what works. Lancet 2006, 368:1284-1299.
• [5]Althabe F, Bergel E, Cafferata ML, Gibbons L, Ciapponi A, Aleman A, Colantonio L, Palacios AR: Strategies for improving the quality of health care in maternal and child health in low- and middle- income countries: an overview of systematic reviews. Paediatr Perinat Epidemiol 2008, 22:42-60.
• [6]Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L: Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 2005, 365:977-988.
• [7]Haines A, Sanders D, Lehmann U, Rowe AK, Lawn JE, Jan S, Walker DG: Achieving child survival goals: potential contribution of community health workers. Lancet 2007, 369:2121-2131.
• [8]Victoria CG, Wagstaff A, Armstrong-Schellenberg J, Gwatkin D, Claeson M: Applying an equity lens to child health and mortality: more of the same is not enough. Lancet 2003, 362:233-241.
• [9]WHO: Working Together for Health: The World Health Report 2006. Geneva: World Health Organization; 2006.
• [10]Christopher JB, Le May A, Lewin S, Ross DA: 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. Hum Res Hth 2011, 9:27.
• [11]Lehmann U, Sanders D: Community health workers: What do we know about them? The state of evidence on programs, activities, costs and impact on health outcomes of using community health workers. Geneva: World Health Organization: Evidence and Information for Policy; 2007.
• [12]The Earth Institute: One Million Community Health Workers: Technical Task Force Report. New York: Columbia University; 2011.
• [13]UNFPA: The State of World Population 2011: People and possibilities in a world of 7 billion. New York: New York: United Nations Population Fund; 2011.
• [14]Bhutta ZA, Lassi ZS, Pariyo G, Huicho L: Global experience of community health workers for delivery of health related Millennium Development Goals: a systematic review, country case studies, and recommendations for scaling up. Geneva: The World Health Organization and Global Health Workforce Alliance; 2010.
• [15]Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB: Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev 2010., 3
• [16]Armstrong R, Waters E, Jackson N, Oliver S, Popay J, Shepherd J, Petticrew M, Anderson L, Bailie R, Brunton G, Hawe P, Kristjansson E, Naccarella L, Norris S, Pienaar E, Roberts H, Rogers W, Sowden A, Thomas H: Guidelines for Systematic reviews of health promotion and public health interventions. Australia: Melbourne University; 2007.
• [17]Jackson N, Waters E, and the Guidelines for Systematic Reviews of Health Promotion and Public Health Interventions Taskforce: The challenges of systematically reviewing public health interventions. J Public Health 2004, 26:303-307.
• [18]EPPI-Centre: EPPI-Centre Methods for Conducting Systematic Reviews. Version 1.1. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London; 2010.
• [19]Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, Petticrew M, Altman DG: Evaluating non-randomised intervention studies. Health Technol Assess 2003, 7(27):1-173.
• [20]Gordon RS: An operational classification of disease prevention. Public Health Rep 1983, 98:107-109.
• [21]Sutherland SE: An introduction to systematic reviews. J Evidence-Based Dental Pract 2004, 4:47-51.
• [22]Tylleskar T, Jackson D, Meda N, Engebretsen IMS, Chopra M, Diallo AH, Doherty T, Ekstrom EC, Fadnes LT, Goga A, Kankasa C, Klungsoyr J, Lombard C, Nankabirwa V, Nankunda JK, Van de Perre P, Sanders D, Shanmugam R, Sommerfelt H, Wamani H, Tumwine JK: Exclusive breastfeeding promotion by peer counselors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial. Lancet 2011, 378:420-427.
• [23]Haider R, Ashworth A, Kabir I, Huttly SR: Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet 2000, 356:1643-1647.
• [24]Mannan I, Rahman SM, Sania A, Seraji HR, Arifeen SE, Winch PJ, Darmstadt GL, Baqui A: Can early postpartum home visits by training community health workers improve breastfeeding of newborns? J Perinatol 2008, 28:632-640.
• [25]Bari S, Mannan I, Rahman MA, Darmstadt GL, Seraji MHR, Baqui AH, El Arifeen S, Rahman SM, Saha SK, Ahmen NU, Ahmed S, Santosham M, Black RE, Winch PJ, Bangladesh Projahnmo-II Study Group: Trends in Use of Referral Hospital Services for Care of Sick Newborns in a Community-based Intervention in Tangail District, Bangladesh. J Health Popul Nutr 2006, 24:519-529.
• [26]Quasem I, Sloan NL, Chowdhury A, Ahmed S, Winikoff B, Chowdhury AMR: Adaptation of Kangaroo Mother care for community-based application. J Perinatol 2003, 23:646-651.
• [27]Sloan NL, Ahmed S, Mitra SN, Choudhury N, Chowdhury M, Rob U, Winikoff B: Community-based Kangaroo Mother care to prevent neonatal and infant mortality: a randomized, controlled cluster trial. Pediatrics 2008, 121:1047-1059.
• [28]Sheth M, Obrah M: Diarrhea prevention through food safety education. Indian J Pediatr 2004, 71:879-882.
• [29]Darmstadt GL, Kumar V, Yadav R, Singh V, Singh P, Mohanty S, Baqui AH, Bharti N, Gupta S, Misra RP, Awasthi S, Singh JV, Santosham M: Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India. J Perinatol 2006, 26:597-604.
• [30]Kumar V, Mohanty S, Kumar A, Misra RP, Santosham M, Awasthi S, Baqui AH, Singh P, Singh V, Ahuja RC, Singh JV, Malik GK, Ahmed S, Black RE, Bhandari M, Darmstadt GL: Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial. Lancet 2008, 372:1151-1162.
• [31]Owais A, Hanif B, Siddiqui AR, Agha A, Zaidi AK: Does improving maternal knowledge of vaccines impact infant immunization rates? A community-based randomized-controlled trial in Karachi, Pakistan. BMC Publ Health 2011, 11(1):239. BioMed Central Full Text
• [32]Rahman A, Malik A, Sikander S, Roberts C, Creed F: Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet 2008, 372:902-909.
• [33]Brenner JL, Kabakyenga J, Kyomuhangi T, Wotton KA, Pim C, Ntaro M, Bagenda FN, Gad NR, Godel J, Kayizzi J, McMillan D, Mulogo E, Nettel-Aguirre A, Singhal N: Can volunteer community health workers decrease child morbidity and mortality in southwestern Uganda? An impact evaluation. PLoS One 2011, 6:e27997.
• [34]Cooper PJ, Tomlinson M, Swartz L, Landman M, Molteno C, Stein A, McPherson K, Murray L: Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial. BMJ (Online) 2009, 338:997.
• [35]Okeibunor JC, Orji BC, Brieger W, Ishola G, Otolorin E, Rawlins B, Ndekhedehe EU, Onyeneho N, Fink G: Preventing malaria in pregnancy through community-directed interventions: evidence from Akwa Ibom State, Nigeria. Malaria J 2011., 10
• [36]Ahorlu CS, Koram KA, Seakey AK, Weiss MG: Effectiveness of intermittent preventive treatment for children (IPTC) combined with timely treatment at home for malaria control. Malar J 2009, 8:292. BioMed Central Full Text
• [37]Morrow AL, Guerreo ML, Shults J, Calva JJ, Lutter C, Bravo J, Ruiz-Palacios G, Morrow RC, Butterfoss FD: Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet 1999, 353:1226-1231.
• [38]Agrasada GV, Gustafsson J, Kylberg E, Ewald U: Postnatal peer counseling on exclusive breastfeeding of low-birthweight infants: a randomized, controlled trial. Acta Paediatr 2005, 94:1109-1115.
• [39]WHO Working Group: Strengthening the Performance of Community Health Workers in Primary Heath Care. Geneva; 1989.
• [40]Effective Public Health Practice Project: Quality Assessment Tool For Quantitative Studies. Geneva: The World Health Organization; 1989.
• [41]Armijo-Olivo S, Stiles CR, Hagen NA, Biondo PD, Cummings GG: Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract 2012, 18:12-18.
• [42]United Nations: The Millennium Development Goals Report 2011. New York; 2011.
• [43]Perry H, Zulliger R: How Effective Are Community Health Workers? An Overview of Current Evidence with Recommendations for Strengthening Community Health Worker Programs to Accelerate Progress in Achieving the Health-related Millennium Development Goals. Baltimore: John’s Hopkins Bloomberg School of Public Health; 2012.
• [44]Perry H, Freeman P, Gupta S, Rassekh BM: How Effective is Community-based Primary Health Care in Improving the Health of Children? Summary Findings of a Review of the Evidence and Report to the Expert Review Panel. Washington DC: Working Group on Community-based Primary Health Care, International Health Section, American Public Health Association; 2009.
• [45]Rowe AK, de Savigny D, Lanata CF, Victoria CG: How can we achieve and maintain high-quality performance of health workers in low-resource settings? Lancet 2005, 366:1026-1035.
• [46]Sanghvi H, Ansari N, Prata NJV, Gibson H, Ehsan AT, Smith JM: Prevention of postpartum haemorrhage at home birth in Afghanistan. Int J Gynecol Obstet 2010, 108:276-281.
• [47]WHO: Building a Future for Women and Children: The 2012 Report. Geneva: The World Health Organization; 2012.
• [48]WHO: Implications of Community Health Workers Distributing Drugs: A case study of Thailand. Thailand: The World Health Organization; 1995.
• [49]UNICEF: Tracking Progress on Child and Maternal Nutrition, A survival and development priority. New York: UNICEF; 2009.
• [50]WHO: Maternal mental health and child health and development in low and middle income countries: report of the meeting held in Geneva, Switzerland, 30 January - 1 February 2008. Geneva: The World Health Organization; 2008.
• [51]Halbreich U, Karkun S: Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. J Affect Disorders 2006, 91:97-111.
• [52]Saxena S, Thornicroft G, Knapp M, Whiteford H: Resources for mental health: scarcity, inequity, and inefficiency. Lancet 2007, 370:878-889.