Home visits by community health workers to improve identification of serious illness and care seeking in newborns and young infants from low- and middle-income countries

Abstract

The objectives of this review were to evaluate the effect of home visits by trained community health workers (CHWs) to successfully identify newborns and young infants (up to 59 days of age) with serious illness and improve care seeking from a health facility. The authors searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. Abstracts of all articles were read by two authors independently and relevant articles selected. Data were extracted in a pretested questionnaire by two authors independently. Statistical analysis was performed using Review Manager software. A meta-analysis of included randomized controlled trials (RCTs) was carried out. Pooled estimates (risk ratios (RRs) with 95% confidence intervals (CIs)) of the evaluated outcome measures were calculated by the generic inverse variance method. Seven articles were identified for inclusion in the review. None of them compared the diagnosis of serious illness in young infants by health workers to a ‘gold standard' diagnosis. Three studies were available for evaluating the ability of CHWs to identify seriously ill young infants/signs of serious illness. These studies suggest that sensitivity to identify serious illness ranged from 33.3 to 90.5% and specificity from 75.61 to 98.4%. For the outcome of improved care seeking from a health facility, after pooling the data from six RCTs with 4760 subjects in the intervention and 4398 subjects in the control arm, there was a significant improvement in care seeking in the home visit arm (RR=1.35; 95% CI=1.15 to 1.58). Moderate quality evidence indicated that home visits by trained CHWs were associated with improved care-seeking for sick young infants from health facilities by appropriate health care providers in resource-limited settings. However, there is a lack of data regarding successful identification of serious illness. Evidence from validation studies supports the implementation of home visits by trained CHWs for improving outcomes in sick newborns and young infants in resource-limited areas. Further well-designed studies evaluating the effect of home visits by CHWs on successful identification of seriously ill newborns and young infants should include verification by a ‘gold standard'.

Role of home visits by volunteer community health workers: to improve the coverage of micronutrient powders in rural Bangladesh

“…Our analysis has demonstrated that caregivers who received visits from the BRAC's CHWs before 1 year of the survey had received information about the MNP product and its provision to children in their everyday foods. We did not find a similar study in the literature although there is evidence that home visits by CHWs are an effective intervention to improve infants' and young children's health (23,24) and maternal health (25) . Previous *Z-test (P values <0·05 were regarded as statistically significant).…”

HIV/TB Integrated Services: Perception of HIV and TB Clients in a Tertiary Health Facility in Lagos State Nigeria

“…This emphasizes the limited number of health workers available in the health care system, as reported by closely related studies which outcomes also reported similar shortage of health workers in their surveys [11,12,13]. Allison et al [14] outcomes further support health care workers visitation to increase positive health outcomes as the neonatal mortality rate of 7.1 per 1000 live births was recorded among population studied for one year compared to the National value of 38 per 1000 live births while Tripathi et al [15] reported "quality evidence that home visits by trained community health workers are associated with improved care-seeking for ill young infants to health facilities in resource-limited settings".…”

The Long Road to Newborn Survival: Working with Parents, Families and Communities to Reduce Preventable Neonatal Deaths

“…of community health workers (CHW)/volunteers: This is a very important component of primary care system and has been successful in many settings [20][21][22][23]. In some countries they are fully recognised and paid by the government [24] and this is what it should be. However in some countries they are just volunteers.…”