Article type
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Abstract
Background:
Although lay health workers (LHWs) are widely used to provide health care, little is known about their effectiveness.Objective:
To assess the effects of LHW interventions in primary care and community health.Methods:
We searched multiple databases for randomised controlled trials (RCTs) of interventions delivered by LHWs. A LHW was defined as any health worker delivering health care; trained in the context of the intervention; and having no formal professional certificated or degreed tertiary education. Two reviewers independently extracted data for each study. Studies comparing similar interventions were grouped for analysis.Results:
43 RCTs met the inclusion criteria. These show considerable heterogeneity in the targeted health issue and the aims, content and outcomes of interventions. Most were conducted in high income countries (n=35). The intervention was delivered to consumers in their homes in thirty studies and in a primary care facility in four studies. Nine studies combined home, primary care and community based interventions.Study heterogeneity limited meta analysis to outcomes for five subgroups (n=15 studies). LHWs increased immunisation uptake in children and adults (RR=1.30 [95% CI 1.14, 1.48] p=0.0001) and reduced mortality and morbidity for selected infectious diseases through improved diagnosis and treatment (RR=0.74 [95% CI 0.58, 0.93) p=0.01) show promising benefits, when compared to no intervention. There is weak evidence for the effectiveness of LHWs in promoting breast cancer screening uptake (RR=1.05 [95% CI 0.99, 1.12] p=0.10) and some evidence to support their effectiveness in promoting breastfeeding uptake, when compared to no intervention. For the remaining subgroups (n=18 studies), the outcomes were too heterogenous to allow statistical pooling and no conclusions on effectiveness can be drawn. Ten studies could not be assigned to subgroups.