title: Effect of deploying community health assistants on appropriate treatment for diarrhoea, malaria and pneumonia: quasi-experimental study in two districts of Zambia.
abstract: OBJECTIVE
  A critical shortage of human resources for health in Zambia remains a great challenge. In response, the Zambian Ministry of Health developed a national community health assistant (CHA) programme, aiming to create a well-trained and motivated community-based health workforce. This study assessed whether CHAs increased treatment rates for diarrhoea, confirmed malaria or pneumonia in the first programme year.
  
  
  METHODS
  This study used a quasi-experimental difference-in-difference design, comparing changes in the catchment areas of health posts with CHAs to those without. Baseline and end line household surveys were conducted to measure the proportion of children under 5 years treated for diarrhoea, malaria or pneumonia in the 2 weeks before the survey and immunisation rates and malaria rapid diagnostic test rates.
  
  
  RESULTS
  We surveyed 2330 women with children under five from the intervention area and 2314 from comparison areas at baseline and end line. Treatment for diarrhoea, malaria or pneumonia increased by 18.0% (P < 0.01) and 23.5% (P < 0.01) in the intervention and comparison groups, respectively, but DID analysis was not significant (P = 0.27). The proportion of fully immunised children grew by 7.5% in the intervention, but shrank by 7.5% in the comparison group (DID: 0.14; 95% CI 0.12-0.16, P < 0.01).
  
  
  CONCLUSIONS
  Although we observed no significant difference between the intervention and comparison groups in the DID estimates for the primary outcome, there were significant increases after one year in treatment for all three diseases in the intervention group from baseline to end line and in the proportion of fully immunised children.
authors.affiliation: Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.|Department of Global Health, Boston University School of Public Health, Boston, MA, USA.|Zambia Centre for Applied Health Research and Development, Lusaka, Zambia.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Biemba
authors.affiliation: Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.|Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Kojo
authors.initials: K
authors.lastname: Yeboah-Antwi
authors.affiliation: Clinton Health Access Initiative, Boston, MA, USA.
authors.forename: Kathryn Bradford
authors.initials: KB
authors.lastname: Vosburg
authors.affiliation: Clinton Health Access Initiative, Boston, MA, USA.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Prust
authors.affiliation: Clinton Health Access Initiative, Boston, MA, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Keller
authors.affiliation: Clinton Health Access Initiative, Boston, MA, USA.
authors.forename: Yekoyesew
authors.initials: Y
authors.lastname: Worku
authors.affiliation: Zambia Centre for Applied Health Research and Development, Lusaka, Zambia.
authors.forename: Happy
authors.initials: H
authors.lastname: Zulu
authors.affiliation: Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.|Zambia Centre for Applied Health Research and Development, Lusaka, Zambia.
authors.forename: Emily
authors.initials: E
authors.lastname: White
authors.affiliation: Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.|Department of Global Health, Boston University School of Public Health, Boston, MA, USA.|Zambia Centre for Applied Health Research and Development, Lusaka, Zambia.
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
keywords: CHAs; acceso al tratamiento; access to treatment; accès au traitement; asistentes comunitarios de salud; assistant de santé communautaire; assistants de santé communautaire; community health assistants; diarrea; diarrhoea; diarrhée; malaria; neumonía; paludisme; pneumonia; pneumonie