Can volunteer community health workers decrease child morbidity and mortality in southwestern Uganda? An impact evaluation

• Published in: PloS one 2011-12, Vol.6 (12), p.e27997-e27997
• Main Authors: Brenner, Jennifer L, Kabakyenga, Jerome, Kyomuhangi, Teddy, Wotton, Kathryn A, Pim, Carolyn, Ntaro, Moses, Bagenda, Fred Norman, Gad, Ndaruhutse Ruzazaaza, Godel, John, Kayizzi, James, McMillan, Douglas, Mulogo, Edgar, Nettel-Aguirre, Alberto, Singhal, Nalini
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; Aged; AIDS; Analysis; Child; Child health; Child Mortality; Childrens health; Community; Community Health Workers - statistics & numerical data; Community relations; Consent; Demography; Diarrhea; Employee retention; Ethics; Evaluation; Evaluation Studies as Topic; Family Characteristics; Fatalities; Fever; Focus Groups; Health care costs; Health Care Surveys - statistics & numerical data; Health promotion; HIV; Households; Human immunodeficiency virus; Humans; Infant mortality; Intervention; Malaria; Mathematical models; Medical personnel; Medicine; Middle Aged; Morbidity; Mortality; Nutritional Status; Occupational health; Patient outcomes; Pediatrics; Physical fitness; Physicians; Polls & surveys; Primary care; Retention; Rural areas; Rural communities; Science; Statistical analysis; Studies; Surveys; Uganda - epidemiology; Underweight; Vector-borne diseases; Volunteers - statistics & numerical data; Workers; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0027997

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. Two 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 (