Effect of deploying community health assistants on appropriate treatment for diarrhoea, malaria and pneumonia: quasi‐experimental study in two districts of Zambia

Abstract

Abstractobjective A critical shortage of human resources for health in Zambia remains a great challenge. In response, the Zambian Ministry of Health developed a national community health assistant (CHA) programme, aiming to create a well-trained and motivated community-based health workforce. This study assessed whether CHAs increased treatment rates for diarrhoea, confirmed malaria or pneumonia in the first programme year.methods This study used a quasi-experimental difference-in-difference design, comparing changes in the catchment areas of health posts with CHAs to those without. Baseline and end line household surveys were conducted to measure the proportion of children under 5 years treated for diarrhoea, malaria or pneumonia in the 2 weeks before the survey and immunisation rates and malaria rapid diagnostic test rates.results We surveyed 2330 women with children under five from the intervention area and 2314 from comparison areas at baseline and end line. Treatment for diarrhoea, malaria or pneumonia increased by 18.0% (P < 0.01) and 23.5% (P < 0.01) in the intervention and comparison groups, respectively, but DID analysis was not significant (P = 0.27). The proportion of fully immunised children grew by 7.5% in the intervention, but shrank by 7.5% in the comparison group (DID: 0.14; 95% CI 0.12-0.16, P < 0.01).conclusion Although we observed no significant difference between the intervention and comparison groups in the DID estimates for the primary outcome, there were significant increases after one year in treatment for all three diseases in the intervention group from baseline to end line and in the proportion of fully immunised children.

Variation in the quality and out-of-pocket cost of treatment for childhood malaria, diarrhoea, and pneumonia: Community and facility based care in rural Uganda

“…It is important to note that the iCCM-VHT programme was relatively new in this area at the time of the survey and some improvement will have occurred since then as functionality increases. Our findings nonetheless echo recent research in the region showing that whilst iCCM programme implementation can improve access to appropriate treatment for sick children, coverage of treatment is often far from adequate [ 48 – 50 ]. The reasons for these gaps are myriad and often complex.…”

Use of community engagement interventions to improve child immunisation in low-income and middle-income countries: a systematic review and meta-analysis

“…We excluded articles at full-text for not satisfying the inclusion criteria by country (129), study type (evaluation study) (304), evaluation method (213), outcome (235) and community engagement type (172). We ultimately identified 61 impact evaluations (table 2)31–92 that assessed the effects of community engagement interventions on outcomes related to routine child immunisation in LMICs. We identified one publication in Spanish,45 with all others in English.…”

Use of community engagement interventions to improve child immunisation in low‐ and middle‐income countries: A systematic review and meta‐analysis

“…This was particularly clear in Olayo et al (2014); which reported that '… most of the components of the strategy were implemented and sustained in different socio-demographic contexts'. We found that small sample or narrow sample sizes were the biggest challenge in establishing external validity, as in Biemba et al (2016); which '…was limited to two districts and only six CHAs, making it difficult to fully generalise the results to the whole country'. Authors note that, while there were positive impacts with relatively small sample sizes, it may be hard to maintain delivery quality at scale (e.g., Borkum, 2014;Johri et al, 2020).…”

“…Involvement of community members such as traditional and religious leaders in planning and implementation of an intervention also came up as a reason for success (Oyo-Ita, 2020). In a few instances, success was also attributed to acceptance of health worker cadres by the communities as long as these health workers belonged to the communities they served (Biemba et al, 2016).…”