Introduction Identifying design features and implementation strategies to optimise community health worker (CHW) programmes is important in the context of mixed results at scale. We systematically reviewed evidence of the effects of proactive case detection by CHWs in low-income and middle-income countries (LMICs) on mortality, morbidity and access to care for common childhood illnesses.
Methods Published studies were identified via electronic databases from 1978 to 2017. We included randomised and non-randomised controlled trials, controlled before–after studies and interrupted time series studies, and assessed their quality for risk of bias. We reported measures of effect as study investigators reported them, and synthesised by outcomes of mortality, disease prevalence, hospitalisation and access to treatment. We calculated risk ratios (RRs) as a principal summary measure, with CIs adjusted for cluster design effect.
Results We identified 14 studies of 11 interventions from nine LMICs that met inclusion criteria. They showed considerable diversity in intervention design and implementation, comparison, outcomes and study quality, which precluded meta-analysis. Proactive case detection may reduce infant mortality (RR: 0.52–0.94) and increase access to effective treatment (RR: 1.59–4.64) compared with conventional community-based healthcare delivery (low certainty evidence). It is uncertain whether proactive case detection reduces mortality among children under 5 years (RR: 0.04–0.80), prevalence of infectious diseases (RR: 0.06–1.02), hospitalisation (RR: 0.38–1.26) or increases access to prompt treatment (RR: 1.00–2.39) because the certainty of this evidence is very low.
Conclusion Proactive case detection may provide promising benefits for child health, but evidence is insufficient to draw conclusions. More research is needed on proactive case detection with rigorous study designs that use standardised outcomes and measurement methods, and report more detail on complex intervention design and implementation.
PROSPERO registration number CRD42017074621.
- child health
- health services research
- systematic review
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Handling editor Seye Abimbola
Contributors CW designed the study and wrote the protocol with input from JT, JG, BG, DC, KK and ADJ. CW developed and conducted the database searches. CW, JT and JG screened references for eligibility. CW and EW extracted data from included studies and conducted risk of bias assessments. CW analysed and synthesised data, with input from CL, KK, BG and DC. CW, JT and JG conducted GRADE quality assessments for all outcomes. CW drafted the manuscript. JT, JG, CL, BG and DC provided critical intellectual feedback and assisted in revising the manuscript. All authors read and approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer The findings and conclusions presented in this report are those of the authors and do not necessarily reflect the official position of the CDC.
Competing interests CW, KK and ADJ are coauthors on one (CW and KK) or two (ADJ) of the studies included in the review.
Patient and public involvement statement No patient or members of the public were involved in this study.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.
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