A community health worker intervention to increase childhood disease treatment coverage in rural Liberia: A controlled before-and-after evaluation

Emily E. White, Jordan Downey, Vidiya Sathananthan, Zahir Kanjee, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, Joseph Nyumah, Derry Duokie, Tamba Boima, Raj Panjabi, Mark J. Siedner, John D. Kraemer

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1252-1259
Number of pages8
JournalAmerican Journal of Public Health
Volume108
Issue number9
DOIs
StatePublished - Sep 1 2018

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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    White, E. E., Downey, J., Sathananthan, V., Kanjee, Z., Kenny, A., Waters, A., Rabinowich, J., Raghavan, M., Dorr, L., Halder, A., Nyumah, J., Duokie, D., Boima, T., Panjabi, R., Siedner, M. J., & Kraemer, J. D. (2018). A community health worker intervention to increase childhood disease treatment coverage in rural Liberia: A controlled before-and-after evaluation. American Journal of Public Health, 108(9), 1252-1259. https://doi.org/10.2105/AJPH.2018.304555