A Community Health Worker Intervention to Increase Childhood Disease Treatment Coverage in Rural Liberia: A Controlled Before-and-After Evaluation

Downey, Jordan; Sathananthan, Vidiya; Kanjee, Zahir; Kenny, Avi; Waters, Adele; Rabinowich, Jenny; Raghavan, Mallika; Dorr, Lorenzo; Halder, Ajay; Nyumah, Joseph; Duokie, Derry; Boima, Tamba; Panjabi, Raj; Siedner, Mark J.; Kraemer, John

doi:10.2105/ajph.2018.304555

Cited by 20 publications

(29 citation statements)

References 25 publications

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“…This study found no improvement of the correct disease classification linked to the intervention. In contrast, a study conducted in rural Liberia suggested significant improvements in childhood illness treatment from qualified providers after implementation of a comprehensive intervention geared to capacitate community health workers [ 27 ]. The content, intensity and frequency of that intervention as well as the measures of outcome were different from the intervention in our study.…”

Section: Discussionmentioning

confidence: 99%

Association between a complex community intervention and quality of health extension workers’ performance to correctly classify common childhood illnesses in four regions of Ethiopia

et al. 2021

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Background Due to low care utilization, a complex intervention was done for two years to optimize the Ethiopian Health Extension Program. Improved quality of the integrated community case management services was an intermediate outcome of this intervention through community education and mobilization, capacity building of health workers, and strengthening of district ownership and accountability of sick child services. We evaluated the association between the intervention and the health extension workers’ ability to correctly classify common childhood illnesses in four regions of Ethiopia. Methods Baseline and endline assessments were done in 2016 and 2018 in intervention and comparison areas in four regions of Ethiopia. Ill children aged 2 to 59 months were mobilized to visit health posts for an assessment that was followed by re-examination. We analyzed sensitivity, specificity, and difference-in-difference of correct classification with multilevel mixed logistic regression in intervention and comparison areas at baseline and endline. Results Health extensions workers’ consultations with ill children were observed in intervention (n = 710) and comparison areas (n = 615). At baseline, re-examination of the children showed that in intervention areas, health extension workers’ sensitivity for fever or malaria was 54%, 68% for respiratory infections, 90% for diarrheal diseases, and 34% for malnutrition. At endline, it was 40% for fever or malaria, 49% for respiratory infections, 85% for diarrheal diseases, and 48% for malnutrition. Specificity was higher (89–100%) for all childhood illnesses. Difference-in-differences was 6% for correct classification of fever or malaria [aOR = 1.45 95% CI: 0.81–2.60], 4% for respiratory tract infection [aOR = 1.49 95% CI: 0.81–2.74], and 5% for diarrheal diseases [aOR = 1.74 95% CI: 0.77–3.92]. Conclusion This study revealed that the Optimization of Health Extension Program intervention, which included training, supportive supervision, and performance reviews of health extension workers, was not associated with an improved classification of childhood illnesses by these Ethiopian primary health care workers. Trial registration ISRCTN12040912, http://www.isrctn.com/ISRCTN12040912.

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Section: Discussionmentioning

confidence: 99%

Association between a complex community intervention and quality of health extension workers’ performance to correctly classify common childhood illnesses in four regions of Ethiopia

et al. 2021

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“…In addition to unadjusted estimates, we estimate intervention effects using inverse probability of treatment weighting (IPTW) [68,69]. The IPTW models generated weights to balance the following covariates across the four intervention‐by‐time groups: subnational region and staff members’ age, sex, employment category, employment tenure, work history in an HIV‐specific department and number of PLHIV personally treated.…”

Section: Methodsmentioning

confidence: 99%

Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

Nyblade

Addo²,

Atuahene

et al. 2020

J Intern AIDS Soc

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Introduction: Stigma undermines all aspects of a comprehensive HIV response, as reflected in recent global initiatives for stigma-reduction. Yet a commensurate response to systematically tackle stigma within country responses has not yet occurred, which may be due to the lack of sufficient evidence documenting evaluated stigma-reduction interventions. With stigma present in all life spheres, health facilities offer a logical starting point for developing and expanding stigma reduction interventions. This study evaluates the impact of a "total facility" stigma-reduction intervention on the drivers and manifestations of stigma and discrimination among health facility staff in Ghana. Methods: We evaluated the impact of a total facility stigma-reduction intervention by comparing five intervention to five comparable non-intervention health facilities in Ghana. Interventions began in September 2017. Data collection was in June 2017 and April 2018. The primary outcomes were composite indicators for three stigma drivers, self-reported stigmatizing avoidance behaviour, and observed discrimination. The principal intervention variable was whether the respondent worked at an intervention or comparison facility. We estimated intervention effects as differences-in-differences in each outcome, further adjusted using inverse probability of treatment weighting (IPTW). Results: We observed favourable intervention effects for all outcome domains except for stigmatizing attitudes. Preferring not to provide services to people living with HIV (PLHIV) or a key population member improved 11.1% more in intervention than comparison facility respondents (95% CI 3.2 to 19.0). Other significant improvements included knowledge of policies to protect against discrimination (difference-in-differences = 20.4%; 95% CI 12.7 to 28.0); belief that discrimination would be punished (11.2%; 95% CI 0.2 to 22.3); and knowledge of and belief in the adequacy of infection control policies (17.6%; 95% CI 8.3 to 26.9). Reported observation of stigma and discrimination incidents fell by 7.4 percentage points more among intervention than comparison facility respondents, though only marginally significant in the IPTW-adjusted model (p = 0.06). Respondents at intervention facilities were 19.0% (95% CI 12.2 to 25.8) more likely to report that staff behaviour towards PLHIV had improved over the last year than those at comparison facilities. Conclusions: These results provide a foundation for scaling up health facility stigma-reduction within national HIV responses, though they should be accompanied by rigorous implementation science to ensure ongoing learning and adaptation for maximum effectiveness and long-term impact.

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“…16 17 The use of community health workers to improve access and uptake of interventions to reduce child mortality among those in more remote areas is another example of equity focused interventions. 18 Improve better Move beyond conventional ways for improvement to include areas outside the scope of traditional QI and take a "whole quality management" approach. The work requires quality planning and leadership that intentionally prioritises equity; tackling gaps in the health system structure such as human resources, systems, health financing, and governance associated with disparities 1 19 ; and moving beyond the health system to include social determinants of disease and factors such as female empowerment and education associated with better access and survival.…”

Section: Measure and Use Data Bettermentioning

confidence: 99%

Aiming beyond equality to reach equity: the promise and challenge of quality improvement

Hirschhorn

Magge

Kiflie³

2021

BMJ

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A Community Health Worker Intervention to Increase Childhood Disease Treatment Coverage in Rural Liberia: A Controlled Before-and-After Evaluation

Cited by 20 publications

References 25 publications

Association between a complex community intervention and quality of health extension workers’ performance to correctly classify common childhood illnesses in four regions of Ethiopia

Association between a complex community intervention and quality of health extension workers’ performance to correctly classify common childhood illnesses in four regions of Ethiopia

Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

Aiming beyond equality to reach equity: the promise and challenge of quality improvement

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