Community health worker service delivery for maternal and child health: an observational study from Afghanistan

ObjectiveTo understand the reach of the community health worker (CHW) programme in remote and non-remote districts of Afghanistan.MethodsUsing data collected from the Ministry of Public Health’s National Health Management Information System, we conducted a population-based study from 2018 to 2019 in 401 districts across 34 provinces of Afghanistan. We assessed the availability of CHWs, antenatal visits (ANV) and postnatal visits (PNV) conducted by the CHWs, and the availability of CHW supplies. Districts were classified as remote if the district centre was >2 hours by any form of transport from provincial capital, and non-remote if <2 hours. Data were analysed using multivariable regression models.Results15 562 CHWs were working in the districts of Afghanistan, 13 482 (87%) in remote and 2080 (13%) in non-remote districts. The mean of the proportion of CHWs per pregnant woman was higher in remote (0.019 (SD 0.011)) compared with non-remote (0.012 (SD 0.006)) districts (adjusted mean difference (AMD) 0.008, 95% CI 0.004 to 0.01). The mean of the proportion of ANVs received from a CHW per pregnant women was higher in remote (0.88 (SD 0.82)) compared with non-remote (0.62 (SD 0.50)) districts (AMD 0.28, 95% CI 0.02 to 0.54). The mean of the proportion of PNVs received from a CHW per pregnant women was higher in remote (0.54 (SD 0.53)) compared with non-remote (0.36 (SD 0.25)) districts (AMD 0.19, 95% CI 0.02 to 0.36). The mean of the proportion of CHWs who reported that they had stocks of cotrimoxazole and oral contraceptives in the previous month per district was higher in remote compared with non-remote districts.ConclusionsIn Afghanistan, the CHW programme appears to be effective and proportionate to need in remote regions.

mHealth technology supporting community health worker-led surgical site infection diagnosis after cesarean section in rural Rwanda: A randomized control trial (Preprint)

BACKGROUND The development of a surgical site infection (SSI) after cesarean section (c-section) is a significant cause of morbidity and mortality in low- and middle-income countries, including Rwanda. Rwanda has a robust community health worker (CHW)-led, home-based paradigm for delivering follow-up care for women after childbirth. However, this program does not currently include post-operative care for women after c-section, such as SSI checks. OBJECTIVE This trial assessed whether CHW/mobile health (mHealth) interventions improved rates of return to care among women developing an SSI following c-section at a rural Rwandan district hospital. METHODS 1,025 women aged ≥18 years who underwent a c-section between November 2017 and September 2018 at Kirehe District Hospital were randomized into three post-operative arms: 1) home visit, 2) phone call, and 3) routine health center follow-up. A CHW-led, mHealth-supported SSI diagnostic protocol was delivered in intervention arms. We assessed intervention completion in each intervention arm and used logistic regression to assess impact on return to care. RESULTS We randomized 335 women to Arm 1, 334 to Arm 2, and 356 to Arm 3. 88.1% of women in Arm 1 and 68.3% in Arm 2 were successfully assessed for an SSI. There were high rates of returning to clinic within 30-days across arms (Arm 1: 99.7%, Arm 2: 98.4%, Arm 3: 99.7%; P=.209). CONCLUSIONS Home-based post-c-section follow-up is feasible in rural Africa when performed by mHealth-supported CHWs. There was no difference in return to care rates but given the significant expense of traveling to a health center, this intervention could create substantial benefit. CLINICALTRIAL ClinicalTrials.gov NCT03311399

Community Health Worker Intervention to Address Social Determinants of Health for Children Hospitalized With Asthma

BACKGROUND Social determinants of health (SDOH) contribute to racial disparities in asthma outcomes. Community health worker (CHW) programs represent a promising way to screen for SDOH and connect patients to resources, but the impact of CHW programs in the inpatient pediatric setting has been examined in few studies. In this study, we aimed to evaluate a CHW program for children hospitalized with asthma in a predominantly Hispanic community by examining rates of SDOH and social resource navigation. METHODS This pilot study involved a CHW intervention to improve pediatric asthma care. Patients were included if they were hospitalized with asthma over an 18-month period and enrolled in the CHW program during their hospitalization. In an intake interview, CHWs screened caregivers for SDOH and provided tailored social resource navigation. Descriptive statistics were used to assess rates of social risk factors and social resource navigation. RESULTS Eighty patients underwent SDOH screening. The majority of patients were Hispanic (81.3%, n = 65). Half of caregivers reported food or housing insecurity over the past 12 months (50.0%, n = 40), and most reported inadequate housing conditions (63.8%, n = 51). CHWs coordinated social resources for the majority of families (98.8%, n = 79), with the most common being food resources (42.5%, n = 34), housing resources (82.5%, n = 66), and appointment navigation (41.3%, n = 33). CONCLUSIONS CHWs identified a high burden of unmet social needs and provided associated social resource navigation in a largely Hispanic pediatric population hospitalized for asthma. CHW programs have potential to improve asthma outcomes by linking high-risk patients with social resources.