Emily E White1, Jordan Downey1, Vidiya Sathananthan1, Zahir Kanjee1, Avi Kenny1, Ami Waters1, Jenny Rabinowich1, Mallika Raghavan1, Lorenzo Dorr1, Amal Halder1, Joseph Nyumah1, Derry Duokie1, Tamba Boima1, Raj Panjabi1, Mark J Siedner1, John D Kraemer1. 1. Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC.
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.
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.
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