title: Can volunteer community health workers decrease child morbidity and mortality in southwestern Uganda? An impact evaluation.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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
  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.
authors.affiliation: Faculty of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. hcu@ucalgary.ca
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Brenner
authors.forename: Jerome
authors.initials: J
authors.lastname: Kabakyenga
authors.forename: Teddy
authors.initials: T
authors.lastname: Kyomuhangi
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Wotton
authors.forename: Carolyn
authors.initials: C
authors.lastname: Pim
authors.forename: Moses
authors.initials: M
authors.lastname: Ntaro
authors.forename: Fred Norman
authors.initials: FN
authors.lastname: Bagenda
authors.forename: Ndaruhutse Ruzazaaza
authors.initials: NR
authors.lastname: Gad
authors.forename: John
authors.initials: J
authors.lastname: Godel
authors.forename: James
authors.initials: J
authors.lastname: Kayizzi
authors.forename: Douglas
authors.initials: D
authors.lastname: McMillan
authors.forename: Edgar
authors.initials: E
authors.lastname: Mulogo
authors.forename: Alberto
authors.initials: A
authors.lastname: Nettel-Aguirre
authors.forename: Nalini
authors.initials: N
authors.lastname: Singhal
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D046688:Child Mortality; D003150:Community Health Workers / Q000706:statistics & numerical data*; D003710:Demography; D005069:Evaluation Studies as Topic; D005191:Family Characteristics; D017144:Focus Groups; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D009752:Nutritional Status; D014454:Uganda / Q000453:epidemiology; D014838:Volunteers / Q000706:statistics & numerical data*; D055815:Young Adult