Can Volunteer Community Health Workers Decrease Child Morbidity and Mortality in Southwestern Uganda? An Impact Evaluation

Jennifer L Brenner,Alberto Nettel-Aguirre,Nalini Singhal,John Godel,Jerome Kabakyenga,Kathryn A Wotton,Fred Norman Bagenda,James Kayizzi,Moses Ntaro,Edgar Mulogo,Carolyn Pim,Teddy Kyomuhangi,Ndaruhutse Ruzazaaza Gad,Douglas Mcmillan,Zulfiqar A Bhutta

doi:10.1371/journal.pone.0027997

Abstract

BackgroundThe potential for community health workers to improve child health in sub-Saharan Africa is not well understood. Healthy Child Uganda implemented a volunteer community health worker child health promotion model in rural Uganda. An impact evaluation was conducted to assess volunteer community health workers' effect on child morbidity, mortality and to calculate volunteer retention.Methodology/Principal FindingsTwo volunteer community health workers were selected, trained and promoted child health in each of 116 villages (population ∼61,000) during 2006–2009. Evaluation included a household survey of mothers at baseline and post-intervention in intervention/control areas, retrospective reviews of community health worker birth/child death reports and post-intervention focus group discussions. Retention was calculated from administrative records. Main outcomes were prevalence of recent child illness/underweight status, community health worker reports of child deaths, focus group perception of effect, and community health worker retention. After 18–36 months, 86% of trained volunteers remained active. Post-intervention surveys in intervention households revealed absolute reductions of 10.2% [95%CI (−17.7%, −2.6%)] in diarrhea prevalence and 5.8% [95%CI (−11.5%, −0.003%)] in fever/malaria; comparative decreases in control households were not statistically significant. Underweight prevalence was reduced by 5.1% [95%CI (−10.7%, 0.4%)] in intervention households. Community health worker monthly reports revealed a relative decline of 53% in child deaths (<5 years old), during the first 18 months of intervention. Focus groups credited community health workers with decreasing child deaths, improved care-seeking practices, and new income-generating opportunities.Conclusions/SignificanceA low-cost child health promotion model using volunteer community health workers demonstrated decreased child morbidity, dramatic mortality trend declines and high volunteer retention. This sustainable model could be scaled-up to sub-Saharan African communities with limited resources and high child health needs.

Highlights

IntroductionAlmost half of all child deaths occur in sub-Saharan Africa, mostly from conditions that are preventable and treatable [2]
7.7 million children under the age of five die each year [1]
Coverage and community health worker demographics Volunteer community health workers were trained in all 118 intervention villages in the 12 intervention parishes

Summary

Introduction

Almost half of all child deaths occur in sub-Saharan Africa, mostly from conditions that are preventable and treatable [2]. Uganda has approximately 190,000 child deaths each year [2] and is not on track to achieve Millennium Development Goal 4 targets [3]. Primary health care delivered by community health workers is a potential way to extend the reach of child health promotion interventions to rural communities and evidence for community health workers improving child health is mounting [4,5,6]. The potential for community health workers to improve child health in sub-Saharan Africa is not well understood. Healthy Child Uganda implemented a volunteer community health worker child health promotion model in rural Uganda. An impact evaluation was conducted to assess volunteer community health workers’ effect on child morbidity, mortality and to calculate volunteer retention

Methods

Results

Conclusion