The effect of community nurses and health volunteers on child mortality: The Navrongo Community Health and Family Planning Project

Pence, Brian W.; Nyarko, Philomena; Phillips, James G.; Debpuur, Cornelius

doi:10.31899/pgy6.1095

Cited by 17 publications

(36 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Navrongo and Gomoa studies in Ghana were of small-scale CHW programmes initiated by research institutes at the time of the study [28,29]. The number of CHWs included in the studies ranged from 8 to 17.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2011

View full text Add to dashboard Cite

BackgroundOver thirty years have passed since the Alma-Ata Declaration on primary health care in 1978. Many governments in the first decade following the declaration responded by developing national programmes of community health workers (CHWs), but evaluations of these often demonstrated poor outcomes. As many CHW programmes have responded to the HIV/AIDS pandemic, international interest in them has returned and their role in the response to other diseases should be examined carefully so that lessons can be applied to their new roles. Over half of the deaths in African children under five years of age are due to malaria, diarrhoea and pneumonia - a situation which could be addressed through the use of cheap and effective interventions delivered by CHWs. However, to date there is very little evidence from randomised controlled trials of the impacts of CHW programmes on child mortality in Africa. Evidence from non-randomised controlled studies has not previously been reviewed systematically.MethodsWe searched databases of published and unpublished studies for RCTs and non-randomised studies evaluating CHW programmes delivering curative treatments, with or without preventive components, for malaria, diarrhoea or pneumonia, in children in sub-Saharan Africa from 1987 to 2007. The impact of these programmes on morbidity or mortality in children under six years of age was reviewed. A descriptive analysis of interventional and contextual factors associated with these impacts was attempted.ResultsThe review identified seven studies evaluating CHWs, delivering a range of interventions. Limited descriptive data on programmes, contexts or process outcomes for these CHW programmes were available. CHWs in national programmes achieved large mortality reductions of 63% and 36% respectively, when insecticide-treated nets and anti-malarial chemoprophylaxis were delivered, in addition to curative interventions.ConclusionsCHW programmes could potentially achieve large gains in child survival in sub-Saharan Africa if these programmes were implemented at scale. Large-scale rigorous studies, including RCTs, are urgently needed to provide policymakers with more evidence on the effects of CHWs delivering these interventions.

show abstract

Section: Resultsmentioning

confidence: 99%

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

et al. 2011

View full text Add to dashboard Cite

show abstract

“…The lack of clarity of roles in the intervention also led to an environment of confusion (for CHWs, cadres of public health services and beneficiaries alike) and compromised the outcomes (performance of CHWs and the intervention outcomes)[25]. …”

Section: Resultsmentioning

confidence: 99%

A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries

Kane

Gerretsen

Scherpbier

et al. 2010

BMC Health Serv Res

112

132

View full text Add to dashboard Cite

BackgroundA key constraint to saturating coverage of interventions for reducing the burden of childhood illnesses in Low and Middle Income Countries (LMIC) is the lack of human resources. Community health workers (CHW) are potentially important actors in bridging this gap. Evidence exists on effectiveness of CHW in management of some childhood illnesses (IMCI). However, we need to know how and when this comes to be. We examine evidence from randomized control trials (RCT) on CHW interventions in IMCI in LMIC from a realist perspective with the aim to see if they can yield insight into the working of the interventions, when examined from a different perspective.MethodsThe realist approach involves educing the mechanisms through which an intervention produced an outcome in a particular context. 'Mechanisms' are reactions, triggered by the interaction of the intervention and a certain context, which lead to change. These are often only implicit and are actually hypothesized by the reviewer. This review is limited to unravelling these from the RCTs; it is thus a hypothesis generating exercise.ResultsInterventions to improve CHW performance included 'Skills based training of CHW', 'Supervision and referral support from public health services', 'Positioning of CHW in the community'. When interventions were applied in context of CHW programs embedded in local health services, with beneficiaries who valued services and had unmet needs, the interventions worked if following mechanisms were triggered: anticipation of being valued by the community; perception of improvement in social status; sense of relatedness with beneficiaries and public services; increase in self esteem; sense of self efficacy and enactive mastery of tasks; sense of credibility, legitimacy and assurance that there was a system for back-up support. Studies also showed that if context differed, even with similar interventions, negative mechanisms could be triggered, compromising CHW performance.ConclusionThe aim of this review was to explore if RCTs could yield insight into the working of the interventions, when examined from a different, a realist perspective. We found that RCTs did yield some insight, but the hypotheses generated were very general and not well refined. These hypotheses need to be tested and refined in further studies.

show abstract

“…However, sexual activity outside marriage may be more prevalent in certain areas than in others, and sexual activity within marriage is subject to variation caused by spousal separation for seasonal migration that may occur at a higher rate in some areas. We do not have information on spousal seasonal migration, although spousal separation among the parents of children under age five does not differ between experimental areas (Pence et al 2007).…”

Section: Lower Prevalence Of Sexual Activity Among Unmarried Women Inmentioning

confidence: 98%

Respondents’ Exposure to Community‐based Services and Reported Fertility‐Regulation Behavior: A Decade of Data from the Navrongo Community Health and Family Planning Project

Jackson

Bawah

Williams

et al. 2016

Studies in Family Planning

View full text Add to dashboard Cite

This article examines a decade of demographic surveillance data from rural northern Ghana linked with prospective panel survey data recording respondents' reported fertility-regulation behavior. We assess the impact of access to community-based contraceptive services, reported fertility-regulation behavior, and their interaction on the risk of a conception that results in a birth. The effects of service exposure differ by marital status. Reported use of any method to delay or avoid pregnancy appears to be more effective in reducing the risk of conception among the unmarried in areas offering community-based contraceptive services, relative to those in areas where services are facility based. Among both married and unmarried survey respondents who state that they are not using contraception, the risk of conception is lower among women in areas with community-based services than among women in communities without these services. The lower risk of conception among women who are receiving community-based services and who report that they are regulating their fertility may be due to increased efficacy and duration of fertility regulation. Among women who report that they are not regulating their fertility, under-reporting of contraceptive use in experimental areas is likely to play a role in explaining these findings.

show abstract

The effect of community nurses and health volunteers on child mortality: The Navrongo Community Health and Family Planning Project

Cited by 17 publications

References 9 publications

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

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

A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries

Respondents’ Exposure to Community‐based Services and Reported Fertility‐Regulation Behavior: A Decade of Data from the Navrongo Community Health and Family Planning Project

Contact Info

Product

Resources

About