A number of primary studies and systematic reviews focused on the contribution of community health workers (CHWs) in the delivery of essential health services. In many countries, a cadre of informal health workers also provide services on a volunteer basis [community health volunteers (CHV)], but there has been no synthesis of studies investigating their role and potential contribution across a range of health conditions; most existing studies are narrowly focused on a single condition. As this cadre grows in importance, there is a need to examine the evidence on whether and how CHVs can improve access to and use of essential health services in low- and middle-income countries (LMICs). We report an umbrella review of systematic reviews, searching PubMed, the Cochrane library, the database of abstracts of reviews of effects (DARE), EMBASE, ProQuest dissertation and theses, the Campbell library and DOPHER. We considered a review as ‘systematic’ if it had an explicit search strategy with qualitative or quantitative summaries of data. We used the Joanna Briggs Institute (JBI) critical appraisal assessment checklist to assess methodological quality. A data extraction format prepared a priori was used to extract data. Findings were synthesized narratively. Of 422 records initially found by the search strategy, we identified 39 systematic reviews eligible for inclusion. Most concluded that services provided by CHVs were not inferior to those provided by other health workers, and sometimes better. However, CHVs performed less well in more complex tasks such as diagnosis and counselling. Their performance could be strengthened by regular supportive supervision, in-service training and adequate logistical support, as well as a high level of community ownership. The use of CHVs in the delivery of selected health services for population groups with limited access, particularly in LMICs, appears promising. However, success requires careful implementation, strong policy backing and continual support by their managers.

BackgroundMost obstetric complications occur unpredictably during the time of delivery, but they can be prevented with proper medical care in the health facilities. Despite the Ethiopian government’s efforts to expand health service facilities and promote health institution-based delivery service in the country, an estimated 85% of births still take place at home.ObjectiveThe review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia.MethodsThe reviewed studies were accessed through electronic web-based search strategy from PubMed, HINARI, Mendeley reference manager, Cochrane Library for Systematic Reviews, and Google Scholar. Review Manager V5.3 software was used for meta-analysis. Mantel–Haenszel odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Heterogeneity of the study was assessed using I2 test.ResultsPeople living in urban areas (OR =13.16, CI =1.24, 3.68), with primary and above educational level of the mother and husband (OR =4.95, CI =2.3, 4. 8, and OR =4.43, CI =1.14, 3.36, respectively), who encountered problems during pregnancy (OR =2.83, CI =4.54, 7.39), and living at a distance <5 km from nearby health facility (OR =2.6, CI =3.33, 6.57) showed significant association with institutional delivery service utilization. Women’s autonomy was not significantly associated with institutional delivery service utilization.Conclusion and recommendationDistance to health facility and problems during pregnancy were factors positively and significantly associated with institutional delivery service utilization. Promoting couples education beyond primary education regarding the danger signs of pregnancy and benefits of institutional delivery through available communication networks such as health development army and promotion of antenatal care visits and completion of four standard visits by pregnant women were recommended.

BackgroundLow birth weight remains a major public health problem affecting developing countries. Evidence shows that low birth weight has long lasting negative health consequences through its contribution to stunting, mental impairment and non-communicable chronic diseases in later life. Thus, it is worth investigating the role of nutritional factors as determinants of low birth weight to suggest nutritional interventions to curb its negative health outcomes. This study aimed to investigate the determinants of low birth weight with main focus on the role of nutritional factors in Ethiopia.MethodsA facility-based case-control study was conducted from 3 February to 29 April, 2017. The data were collected using structured, pretested interviewer-administered questionnaire in all public health facilities of Dessie Town. Anthropometric measurements were made following standard procedures for both mothers and their newborns. Consecutive live births of < 2500 g and two succeeding normal weight babies were selected as cases and controls, respectively. Data were entered in to Epi-data software version 3.1, and exported to SPSS version 21, and analyzed using frequency, mean and percentage. Factors with p < 0.25 during bivariate analyses were entered into a multivariable logistic regression model to determine significant determinants of LBW. Statistical significance was considered at p < 0.05. Results were reported with odds ratio and 95% CI.ResultsMean ± SD of birth weight (g) was 2138 ± 207 for cases and 3145 ± 415 for controls. After adjusting for potential confounders using multivariable logistic regression analysis, the absence of iron and folate supplementation, receiving no nutritional counseling and consuming no additional meal, maternal undernutrition, maternal anemia and inadequate dietary diversity during the current pregnancy were found to be significant determinants of low birth weight in our study.ConclusionLack of nutritional counseling, absence of additional meal intake and iron and folate supplementation during pregnancy, and maternal undernutrition, maternal anemia and inadequate maternal dietary diversity were significant determinants of low birth weight. The importance of nutritional counseling, improving iron and folate supplementation during pregnancy, and nutritional status of pregnant women need to be strengthened to reduce the incidence of LBW in Ethiopia. In addition, behavioral change communications targeting pregnant women to improve women dietary diversity and their extra meal intake practice need to be enhanced in Ethiopia.

The current study revealed the presence of substantial dual burden of malnutrition. In such a setting, it is critical to draw a fine line and trade-off for eliminating morbidity and mortality of undernutrition, without triggering the risk of overweight/obesity.

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