Review article |
Intervention models for the management of children with signs of pneumonia or malaria by community health workers
1 Department of International Health, 2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, 3 Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland, 4 Save the Children Federation/USA, Westport, Connecticut, USA, 5 Health Section, Programme Division, United Nations Children's Fund, New York, USA and 6 CORE Group, Washington, DC, USA
Correspondence: Peter Winch, Associate Professor, Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Room E5030, 615 North Wolfe Street, Baltimore, MD 21205–2103, USA. Tel: +1 410–955 9854; E-fax: +1 413–556 4112. E-mail: pwinch{at}jhsph.edu
A systematic review was conducted to categorize and describe Intervention Models involving community health workers (CHWs) that aim to improve case management of sick children at the household and community levels. The review focused on management of children with signs of malaria or pneumonia. Seven Intervention Models were identified, and classified according to: (1) the role of CHWs and families in assessment and treatment of children, (2) system of referral to the nearest health facility (verbal or facilitated), and (3) the location in the community of the drug stock. Standardization of terminology for Intervention Models using this or a similar classification could facilitate comparison and selection of models, including deciding how to modify programmes when policies change concerning first-line drugs, and setting priorities for further research. Of the seven models, that of CHW pneumonia case management (Model 6) has the strongest evidence for an impact on mortality. Pneumonia case management by CHWs is a child health intervention that warrants considerably more attention, particularly in Africa and South Asia.
Key Words: childhood illnesses, malaria, pneumonia, acute respiratory infections (ARI), under-five mortality, community case management, household and community Integrated Management of Childhood Illness (IMCI), referral, community health worker (CHW)
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