Faculty of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
PLoS One. 2011;6(12):e27997. doi: 10.1371/journal.pone.0027997. Epub 2011 Dec 14.
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.
METHODOLOGY/PRINCIPAL FINDINGS: 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 (<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/SIGNIFICANCE: A 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.
社区卫生工作者在改善撒哈拉以南非洲儿童健康方面的潜力尚未得到充分了解。健康儿童乌干达在乌干达农村实施了一个志愿者社区卫生工作者促进儿童健康的模式。进行了一项影响评估，以评估志愿者社区卫生工作者对儿童发病率和死亡率的影响，并计算志愿者保留率。
方法/主要发现：在 2006 年至 2009 年期间，在每个有 116 个村庄（人口约 61000 人）中，挑选并培训了两名志愿者社区卫生工作者来促进儿童健康。评估包括在干预和对照地区进行基线和干预后母亲的家庭调查、对社区卫生工作者的出生/儿童死亡报告的回顾性审查以及干预后焦点小组讨论。保留率是根据行政记录计算的。主要结果是近期儿童患病/体重不足的流行率、社区卫生工作者报告的儿童死亡情况、焦点小组对效果的看法以及社区卫生工作者的保留率。经过 18-36 个月，86%的培训志愿者仍然活跃。干预家庭的干预后调查显示，腹泻的流行率绝对降低了 10.2%[95%置信区间（-17.7%，-2.6%）]，发热/疟疾的流行率降低了 5.8%[95%置信区间（-11.5%，-0.003%）]；对照家庭的比较减少则没有统计学意义。干预家庭的体重不足流行率降低了 5.1%[95%置信区间（-10.7%，0.4%）]。社区卫生工作者每月报告显示，在干预的头 18 个月中，儿童死亡人数（5 岁以下）相对下降了 53%。焦点小组认为社区卫生工作者减少了儿童死亡，改善了寻求医疗的做法，并带来了新的创收机会。
结论/意义：使用志愿者社区卫生工作者的低成本儿童健康促进模式显示出降低儿童发病率的效果，死亡率呈显著下降趋势，且志愿者保留率较高。这种可持续的模式可以在资源有限、儿童健康需求高的撒哈拉以南非洲社区中扩大规模。
