Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases

Bibliographic Data

ID23384245
AuthorsSimon Lewin (0000-0001-7521-9515, Norwegian Knowledge Centre for the Health Services; Preventive and International Health Care Unit; Box 7004 St Olavsplass Oslo Norway N-0130), Susan Munabi-Babigumira (0000-0003-4253-8960, Norwegian Knowledge Centre for the Health Services; Preventive and International Health Care Unit; Box 7004 St Olavsplass Oslo Norway N-0130), Claire Glenton (0000-0002-7558-7737, SINTEF Health Research; Department of Global Health and Welfare; P.O. Box 124 Blindern Oslo Norway N-0314), Ken Daniels (0000-0002-4345-5406, South African Medical Research Council), Karen Daniels (0000-0002-6604-1353, Medical Research Council; Health Systems Research Unit; PO Box 19070 Tygerberg South Africa 7505), Xavier Bosch‐capblanch (0000-0002-4469-0395, Swiss Tropical and Public Health Institute), Xavier Bosch-Capblanch (Swiss Tropical and Public Health Institute; Swiss Centre for International Health; Socinstrasse 57 Basel Switzerland 4002), Brian Van Wyk (0000-0003-1032-1847, University of the Western Cape), Brian E van Wyk (University of the Western Cape; School of Public Health; Modderdam Road Bellville South Africa 7535), Jan Odgaard-Jensen (Norwegian Knowledge Centre for the Health Services; PO Box 7004, St. Olavs Plass Oslo Norway N-0130), Jan Odgaard‐Jensen (0000-0001-6776-1849, Nasjonalt Kunnskapssenter for Helsetjenesten), Marit Johansen (0000-0002-0116-7828, Norwegian Knowledge Centre for the Health Services; PO Box 7004, St. Olavs Plass Oslo Norway N-0130), Godwin Nwadibia Aja (0000-0001-6747-8875, Babcock University), Merrick Zwarenstein (0000-0003-0162-7027, Sunnybrook Health Sciences Centre; Combined Health Services Sciences; 2075 Bayview Ave., Room G1 06 Toronto ON Canada M4N 3M5), Inger B Scheel (0000-0003-2338-3174, SINTEF Health Research; Department of Global Health and Welfare; P.O. Box 124 Blindern Oslo Norway N-0314)
Year2010
Volume2010
Issue3
PagesCD004015-CD004015
Publication date2010-03-17
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueCochrane Database of Systematic Reviews (JOURNAL)
Journal identifiersISSN: 1361-6137 • E-ISSN: 1465-1858
PublisherWiley (PUBLISHER • GB)
DOI10.1002/14651858.cd004015.pub3
PMID20238326
OpenAlexW1499200948
LanguageEN
Citations received179
References cited202

BACKGROUND: Lay health workers (LHWs) are widely used to provide care for a broad range of health issues. Little is known, however, about the effectiveness of LHW interventions. OBJECTIVES: To assess the effects of LHW interventions in primary and community health care on maternal and child health and the management of infectious diseases. SEARCH STRATEGY: For the current version of this review we searched The Cochrane Central Register of Controlled Trials (including citations uploaded from the EPOC and the CCRG registers) (The Cochrane Library 2009, Issue 1 Online) (searched 18 February 2009); MEDLINE, Ovid (1950 to February Week 1 2009) (searched 17 February 2009); MEDLINE In-Process & Other Non-Indexed Citations, Ovid (February 13 2009) (searched 17 February 2009); EMBASE, Ovid (1980 to 2009 Week 05) (searched 18 February 2009); AMED, Ovid (1985 to February 2009) (searched 19 February 2009); British Nursing Index and Archive, Ovid (1985 to February 2009) (searched 17 February 2009); CINAHL, Ebsco 1981 to present (searched 07 February 2010); POPLINE (searched 25 February 2009); WHOLIS (searched 16 April 2009); Science Citation Index and Social Sciences Citation Index (ISI Web of Science) (1975 to present) (searched 10 August 2006 and 10 February 2010). We also searched the reference lists of all included papers and relevant reviews, and contacted study authors and researchers in the field for additional papers. SELECTION CRITERIA: Randomised controlled trials of any intervention delivered by LHWs (paid or voluntary) in primary or community health care and intended to improve maternal or child health or the management of infectious diseases. A 'lay health worker' was defined as any health worker carrying out functions related to healthcare delivery, trained in some way in the context of the intervention, and having no formal professional or paraprofessional certificate or tertiary education degree. There were no restrictions on care recipients. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data using a standard form and assessed risk of bias. Studies that compared broadly similar types of interventions were grouped together. Where feasible, the study results were combined and an overall estimate of effect obtained. MAIN RESULTS: Eighty-two studies met the inclusion criteria. These showed considerable diversity in the targeted health issue and the aims, content, and outcomes of interventions. The majority were conducted in high income countries (n = 55) but many of these focused on low income and minority populations. The diversity of included studies limited meta-analysis to outcomes for four study groups. These analyses found evidence of moderate quality of the effectiveness of LHWs in promoting immunisation childhood uptake (RR 1.22, 95% CI 1.10 to 1.37; P = 0.0004); promoting initiation of breastfeeding (RR = 1.36, 95% CI 1.14 to 1.61; P < 0.00001), any breastfeeding (RR 1.24, 95% CI 1.10 to 1.39; P = 0.0004), and exclusive breastfeeding (RR 2.78, 95% CI 1.74 to 4.44; P <0.0001); and improving pulmonary TB cure rates (RR 1.22 (95% CI 1.13 to 1.31) P <0.0001), when compared to usual care. There was moderate quality evidence that LHW support had little or no effect on TB preventive treatment completion (RR 1.00, 95% CI 0.92 to 1.09; P = 0.99). There was also low quality evidence that LHWs may reduce child morbidity (RR 0.86, 95% CI 0.75 to 0.99; P = 0.03) and child (RR 0.75, 95% CI 0.55 to 1.03; P = 0.07) and neonatal (RR 0.76, 95% CI 0.57 to 1.02; P = 0.07) mortality, and increase the likelihood of seeking care for childhood illness (RR 1.33, 95% CI 0.86 to 2.05; P = 0.20). For other health issues, the evidence is insufficient to draw conclusions regarding effectiveness, or to enable the identification of specific LHW training or intervention strategies likely to be most effective. AUTHORS' CONCLUSIONS: LHWs provide promising benefits in promoting immunisation uptake and breastfeeding, improving TB treatment outcomes, and reducing child morbidity and mortality when compared to usual care. For other health issues, evidence is insufficient to draw conclusions about the effects of LHWs.

CINAHL · Cochrane Library · Family medicine · MEDLINE · Meta-analysis · Psychological intervention · Global Maternal and Child Health · Internal Medicine · Interprofessional Education and Collaboration · Medicine · Nursing · Nursing Roles and Practices