A Cochrane review [Abstract] 1 included 82 studies assessing the effects of lay health worker (LHW) interventions in primary and community health care on maternal and child health and the management of infectious diseases. There was considerable diversity in the targeted health issue and the aims, content and outcomes of interventions. Most were conducted in high income countries (n=55), but many of these focused on low income and minority populations.
Promising benefits in comparison with usual care were shown for LHW interventions in promoting immunisation childhood uptake (RR 1.22, 95% CI 1.10 to 1.37; statistical heterogeneity I2 58%); promoting initiation of breastfeeding (RR 1.36, 95% CI 1.14 to 1.61; statistical heterogeneity I2 91%), any breastfeeding (RR 1.24, 95% CI 1.10 to 1.39; statistical heterogeneity I2 69%), and exclusive breastfeeding (RR 2.78, 95% CI 1.74 to 4.44; statistical heterogeneity I2 87%); and improving pulmonary tuberculosis (TB) cure rates (RR 1.22, 95% CI 1.13 to 1.31). LHW support had little or no effect on TB preventive treatment completion (RR 1.00, 95% CI 0.92 to 1.09). There was also low quality evidence that LHW may reduce child morbidity (RR 0.86, 95% CI 0.75 to 0.99; statistical heterogeneity I2 69%) and child (RR 0.75, 95% CI 0.55 to 1.03) and neonatal (RR 0.76, 95% CI 0.57 to 1.02; statistical heterogeneity I2 78%) mortality, and increase the likelihood of seeking care for childhood illness (RR 1.33, 95% CI 0.86 to 2.05; statistical heterogeneity I2 77%).
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment).
Primary/Secondary Keywords