title: The effect of community nurses and health volunteers on child mortality: the Navrongo Community Health and Family Planning Project.
abstract: BACKGROUND
  Despite effective treatments and preventive measures for the major causes of child illness and death in less wealthy nations, child mortality remains high in resource-poor settings due in part to ineffective health service delivery models.
  
  
  METHODS
  The Navrongo Community Health and Family Planning Project is a longitudinal community trial of alternative organizational strategies for health service delivery in a rural, impoverished area of Ghana. In one area, nurses are placed in communities with doorstep visitation and service responsibilities. A second area includes training of a local health volunteer and community involvement in health delivery. A third area combines both strategies. Under-five mortality rates were calculated and Poisson regression was used to adjust for potential confounding characteristics.
  
  
  RESULTS
  In areas with village-based community nurse services, under-five child mortality fell by 14% during five years of program implementation compared with before the intervention, with reductions in infant (5%), early child (18%), and late child (39%) mortality. The volunteer intervention was associated with a 14% increase in mortality, primarily driven by a 135% increase in early child mortality. Areas with both nurses and volunteers saw an 8% increase, with small increases in all age groups. Mortality in a comparison area with standard Ministry of Health services fell by 4% during the same time period.
  
  
  CONCLUSIONS
  These results suggest that convenient, accessible professional nursing care can reduce child mortality in impoverished African settings. However, they do not demonstrate a beneficial effect of community volunteers and suggest a possible negative impact on children's survival.
authors.affiliation: Center for Health Policy, Health Inequalities Program, Duke University, Durham, NC 27708-0253, USA. bpence@aya.yale.edu
authors.forename: Brian Wells
authors.initials: BW
authors.lastname: Pence
authors.forename: Philomena
authors.initials: P
authors.lastname: Nyarko
authors.forename: James F
authors.initials: JF
authors.lastname: Phillips
authors.forename: Cornelius
authors.initials: C
authors.lastname: Debpuur
mesh_terms: D000328:Adult; D002423:Cause of Death; D046688:Child Mortality; D002675:Child, Preschool; D003152:Community Health Nursing; D003906:Developing Countries / Q000706:statistics & numerical data; D005193:Family Planning Services; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008297:Male; D011203:Poverty; D012424:Rural Population; D012959:Socioeconomic Factors; D014838:Volunteers