Changes in childhood malnutrition and mortality after institution of a Community Health Worker program in four rural Guatemalan villages

While community health workers (CHWs) are being implemented in several developing countries, there has been little work done to evaluate their effectiveness in reducing childhood malnutrition among participating communities. Our study evaluates the effectiveness of CHWs in three Guatemalan villages by comparing anthropomorphic measures and mortality rates of children under five before and after the implementation of a CHW program. While one community showed no significant change in malnutrition rates in terms of height-for-age calculations, two other communities showed improved malnutrition rates in terms of height-for-age. Weight-for-age comparisons were not statistically significant, and while childhood mortality remained unchanged in one community, there was a 5% improvement in childhood mortality for the other communities combined

Evaluation of a Community Health Worker Project in Three Guatemalan Villages

While community health care workers (CHCW) are being implemented in several developing countries, there is little information as to their effectiveness in reducing childhood malnutrition and mortality. Our study was conducted in three Guatemalan villages and aimed to investigate trends in utilization of the CHCWs and whether or not they are correlated with either the socio-economic status (SES) of the caregiver or the care receiver, as it may have implications for how CHCWs are chosen in the future. We found that in larger more suburban villages CHCWs were utilized less often, and were not necessarily serving those in the greatest need, while in the rural village surveyed CHCWs did seem to visit those of the lower SES with greater frequency. There was no correlation between the SES of the CHCW and their propensity to visit people of the same or different SES

Gender-Based Differences in Counseling Time in a Community Health Worker

Smoking represents a serious public health burden that crosses gender, racial, and socioeconomic lines. Although the majority of smoking cessation counseling traditionally occurs in the setting of a Primary Care Providers office, clinicians often lack the necessary time and/or cultural and language skills to provide adequate help to smokers prepared to quit. A Community Health Worker (CHW) smoking cessation project utilizing CHWs in San Diego, CA evaluated by Woodruff, et al effectively increased patient\u27s abstinence rates in the intervention group. A similar project undertaken by the University of New Mexico Department of Family and Community Medicine employed bilingual CHWs to counsel patients regarding smoking cessation in a clinic with both Spanish and English-speaking patients. This study analyzes the differences in CHW counseling time required (using visitations and phone calls) based on gender. Ancillary outcomes of counseling time required based on language and ethnicity are also evaluated. Female smokers (N = 25) averaged mean total counseling times of 247.4 minutes (80-410) and male smokers (N = 9) averaged 217.8 (90-350), a difference that did not reach statistical significance (p = 0.4343). English speakers (N = 20) averaged total mean counseling times of 198.8 minutes while Spanish speakers (N = 14) averaged 297.9 minutes, a statistically significant result (p = 0.0017). Our findings are inconclusive with respect to the influence of gender on counseling times for a Community Health Worker based smoking cessation project. The difference in counseling times between men and women, though not reaching statistical significance, could be of clinical importance but would require further study with a larger sample size. Although several limitations exist in this project, these results indicate it is necessary to design counseling strategies to better treat certain target populations based on gender, language, and ethnicity more effectively and more research is needed to determine the most appropriate method.\u2

From home deliveries to health care facilities: establishing a traditional birth attendant referral program in Kenya

Objective: To assess the effectiveness of a traditional birth attendant (TBA) referral program on increasing the number of deliveries overseen by skilled birth attendants (SBA) in rural Kenyan health facilities before and after the implementation of a free maternity care policy. Methods: In a rural region of Kenya, TBAs were recruited to educate pregnant women about the importance of delivering in healthcare facilities and were offered a stipend for every pregnant woman whom they brought to the healthcare facility. We evaluated the percentage of prenatal care (PNC) patients who delivered at the intervention site compared with the percentage of PNC patients who delivered at rural control facilities, before and after the referral program was implemented, and before and after the Kenya government implemented a policy of free maternity care. The window period of the study was from July of 2011 through September 2013, with a TBA referral intervention conducted from March to September 2013. Results: The absolute increases from the pre-intervention period to the TBA referral intervention period in SBA deliveries were 5.7 and 24.0 % in the control and intervention groups, respectively (p < 0.001). The absolute increases in SBA delivery rates from the pre-intervention period to the intervention period before the implementation of the free maternity care policy were 4.7 and 17.2 % in the control and intervention groups, respectively (p < 0.001). After the policy implementation the absolute increases from pre-intervention to post-intervention were 1.8 and 11.6 % in the control and intervention groups, respectively (p < 0.001). Conclusion: The percentage of SBA deliveries at the intervention health facility significantly increased compared to control health facilities when TBAs educated women about the need to deliver with a SBA and when TBAs received a stipend for bringing women to local health facilities to deliver. Furthermore, this TBA referral program proved to be far more effective in the target region of Kenya than a policy change to provide free obstetric care

Changes in childhood malnutrition and mortality after institution of a Community Health Worker program in four rural Guatemalan villages

While community health workers (CHWs) are being implemented in several developing countries, there has been little work done to evaluate their effectiveness in reducing childhood malnutrition among participating communities. Our study evaluates the effectiveness of CHWs in three Guatemalan villages by comparing anthropomorphic measures and mortality rates of children under five before and after the implementation of a CHW program. While one community showed no significant change in malnutrition rates in terms of height-for-age calculations, two other communities showed improved malnutrition rates in terms of height-for-age. Weight-for-age comparisons were not statistically significant, and while childhood mortality remained unchanged in one community, there was a 5% improvement in childhood mortality for the other communities combined