TY - JOUR
T1 - A community health worker intervention to increase childhood disease treatment coverage in rural Liberia
T2 - A controlled before-and-after evaluation
AU - White, Emily E.
AU - Downey, Jordan
AU - Sathananthan, Vidiya
AU - Kanjee, Zahir
AU - Kenny, Avi
AU - Waters, Ami
AU - Rabinowich, Jenny
AU - Raghavan, Mallika
AU - Dorr, Lorenzo
AU - Halder, Amal
AU - Nyumah, Joseph
AU - Duokie, Derry
AU - Boima, Tamba
AU - Panjabi, Raj
AU - Siedner, Mark J.
AU - Kraemer, John D.
N1 - Publisher Copyright:
© 2018 American Public Health Association Inc. All rights reserved.
PY - 2018/9
Y1 - 2018/9
N2 - Objectives. To assess a community health worker (CHW) program's impact on childhood illness treatment in rural Liberia. Methods.We deployed CHWs in half of Rivercess County in August 2015 with the other half constituting a comparison group until July 2016. All CHWs were provided cash incentives, supply chain support, and monthly clinical supervision. We conducted stratified cluster-sample population-based surveys at baseline (March-April 2015) and follow-up (April-June 2016) and performed a difference-in-differences analysis, adjusted by inverse probability of treatment weighting, to assess changes in treatment of fever, diarrhea, and acute respiratory infection by a qualified provider. Results. We estimated a childhood treatment difference-in-differences of 56.4 percentage points (95% confidence interval [CI]=36.4, 76.3). At follow-up, CHWs provided 57.6% (95% CI =42.8, 71.2) of treatment in the intervention group. The difference-in-differences diarrhea oral rehydration therapy was 22.4 percentage points (95% CI=-0.7, 45.5). Conclusions. Implementation of a CHW program in Rivercess County, Liberia, was associated with large, statistically significant improvements treatment by a qualified provider; however, improvements in correct diarrhea treatment were lower than improvements in coverage. Findings from this study offer support for expansion of Liberia's new National Community Health Assistant Program.
AB - Objectives. To assess a community health worker (CHW) program's impact on childhood illness treatment in rural Liberia. Methods.We deployed CHWs in half of Rivercess County in August 2015 with the other half constituting a comparison group until July 2016. All CHWs were provided cash incentives, supply chain support, and monthly clinical supervision. We conducted stratified cluster-sample population-based surveys at baseline (March-April 2015) and follow-up (April-June 2016) and performed a difference-in-differences analysis, adjusted by inverse probability of treatment weighting, to assess changes in treatment of fever, diarrhea, and acute respiratory infection by a qualified provider. Results. We estimated a childhood treatment difference-in-differences of 56.4 percentage points (95% confidence interval [CI]=36.4, 76.3). At follow-up, CHWs provided 57.6% (95% CI =42.8, 71.2) of treatment in the intervention group. The difference-in-differences diarrhea oral rehydration therapy was 22.4 percentage points (95% CI=-0.7, 45.5). Conclusions. Implementation of a CHW program in Rivercess County, Liberia, was associated with large, statistically significant improvements treatment by a qualified provider; however, improvements in correct diarrhea treatment were lower than improvements in coverage. Findings from this study offer support for expansion of Liberia's new National Community Health Assistant Program.
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U2 - 10.2105/AJPH.2018.304555
DO - 10.2105/AJPH.2018.304555
M3 - Article
C2 - 30024811
AN - SCOPUS:85051189495
SN - 0090-0036
VL - 108
SP - 1252
EP - 1259
JO - American journal of public health
JF - American journal of public health
IS - 9
ER -