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Meta-Analysis
. 2010 Mar 17;2010(3):CD004015.
doi: 10.1002/14651858.CD004015.pub3.

Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases

Simon Lewin  1 , Susan Munabi-Babigumira, Claire Glenton, Karen Daniels, Xavier Bosch-Capblanch, Brian E van Wyk, Jan Odgaard-Jensen, Marit Johansen, Godwin N Aja, Merrick Zwarenstein, Inger B Scheel
Affiliations
Meta-Analysis

Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases

Simon Lewin et al. Cochrane Database Syst Rev. .

Abstract

Background: Lay health workers (LHWs) are widely used to provide care for a broad range of health issues. Little is known, however, about the effectiveness of LHW interventions.

Objectives: To assess the effects of LHW interventions in primary and community health care on maternal and child health and the management of infectious diseases.

Search strategy: For the current version of this review we searched The Cochrane Central Register of Controlled Trials (including citations uploaded from the EPOC and the CCRG registers) (The Cochrane Library 2009, Issue 1 Online) (searched 18 February 2009); MEDLINE, Ovid (1950 to February Week 1 2009) (searched 17 February 2009); MEDLINE In-Process & Other Non-Indexed Citations, Ovid (February 13 2009) (searched 17 February 2009); EMBASE, Ovid (1980 to 2009 Week 05) (searched 18 February 2009); AMED, Ovid (1985 to February 2009) (searched 19 February 2009); British Nursing Index and Archive, Ovid (1985 to February 2009) (searched 17 February 2009); CINAHL, Ebsco 1981 to present (searched 07 February 2010); POPLINE (searched 25 February 2009); WHOLIS (searched 16 April 2009); Science Citation Index and Social Sciences Citation Index (ISI Web of Science) (1975 to present) (searched 10 August 2006 and 10 February 2010). We also searched the reference lists of all included papers and relevant reviews, and contacted study authors and researchers in the field for additional papers.

Selection criteria: Randomised controlled trials of any intervention delivered by LHWs (paid or voluntary) in primary or community health care and intended to improve maternal or child health or the management of infectious diseases. A 'lay health worker' was defined as any health worker carrying out functions related to healthcare delivery, trained in some way in the context of the intervention, and having no formal professional or paraprofessional certificate or tertiary education degree. There were no restrictions on care recipients.

Data collection and analysis: Two review authors independently extracted data using a standard form and assessed risk of bias. Studies that compared broadly similar types of interventions were grouped together. Where feasible, the study results were combined and an overall estimate of effect obtained.

Main results: Eighty-two studies met the inclusion criteria. These showed considerable diversity in the targeted health issue and the aims, content, and outcomes of interventions. The majority were conducted in high income countries (n = 55) but many of these focused on low income and minority populations. The diversity of included studies limited meta-analysis to outcomes for four study groups. These analyses found evidence of moderate quality of the effectiveness of LHWs in promoting immunisation childhood uptake (RR 1.22, 95% CI 1.10 to 1.37; P = 0.0004); promoting initiation of breastfeeding (RR = 1.36, 95% CI 1.14 to 1.61; P < 0.00001), any breastfeeding (RR 1.24, 95% CI 1.10 to 1.39; P = 0.0004), and exclusive breastfeeding (RR 2.78, 95% CI 1.74 to 4.44; P <0.0001); and improving pulmonary TB cure rates (RR 1.22 (95% CI 1.13 to 1.31) P <0.0001), when compared to usual care. There was moderate quality evidence that LHW support had little or no effect on TB preventive treatment completion (RR 1.00, 95% CI 0.92 to 1.09; P = 0.99). There was also low quality evidence that LHWs may reduce child morbidity (RR 0.86, 95% CI 0.75 to 0.99; P = 0.03) and child (RR 0.75, 95% CI 0.55 to 1.03; P = 0.07) and neonatal (RR 0.76, 95% CI 0.57 to 1.02; P = 0.07) mortality, and increase the likelihood of seeking care for childhood illness (RR 1.33, 95% CI 0.86 to 2.05; P = 0.20). For other health issues, the evidence is insufficient to draw conclusions regarding effectiveness, or to enable the identification of specific LHW training or intervention strategies likely to be most effective.

Authors' conclusions: LHWs provide promising benefits in promoting immunisation uptake and breastfeeding, improving TB treatment outcomes, and reducing child morbidity and mortality when compared to usual care. For other health issues, evidence is insufficient to draw conclusions about the effects of LHWs.

PubMed Disclaimer

Conflict of interest statement

JOJ, MZ, SL, and SMB are editors for the Cochrane Effective Practice and Organisation of Care Review Group. SL and CG are editors for the Cochrane Consumers and Communication Review Group. MJ is a trial search coordinator for the Cochrane Effective Practice and Organisation of Care Review Group. MZ was the principal investigator on one of the included trials (Zwarenstein 2000).

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Forest plot of comparison: 1 LHW interventions to promote immunisation uptake in children under five compared with usual care, outcome: 1.5 Immunisation schedule up to date.
4
4
Forest plot of comparison: 1 LHW interventions to promote immunisation uptake in children under five compared with usual care, outcome: 1.8 Immunisation schedule up to date (excl. Gökcay and Krieger).
5
5
Forest plot of comparison: 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, outcome: 3.2 Mortality among children < 5 years old.
6
6
Forest plot of comparison: 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, outcome: 3.3 Mortality among children < 5 years old (excluding Pence 2005).
7
7
Forest plot of comparison: 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, outcome: 3.5 Neonatal mortality.
8
8
Forest plot of comparison: 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, outcome: 3.7 Morbidity; reported illness in children.
9
9
Forest plot of comparison: 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, outcome: 3.9 Morbidity; care‐seeking practice.
10
10
Forest plot of comparison: 2 LHW interventions to promote breastfeeding compared with usual care, outcome: 2.6 Initiated Breastfeeding ‐ adjusted for clustering.
11
11
Forest plot of comparison: 2 LHW interventions to promote breastfeeding compared with usual care, outcome: 2.7 Any breastfeeding ‐ adjusted for clustering.
12
12
Forest plot of comparison: 2 LHW interventions to promote breastfeeding compared with usual care, outcome: 2.8 Exclusive breastfeeding ‐ adjusted for clustering.
13
13
Forest plot of comparison: 4 LHW interventions to improve TB treatment outcomes compared with other forms of adherence support, outcome: 4.10 Cure for smear positive TB patients (new and retreatment) ‐ adjusted for clustering.
14
14
Forest plot of comparison: 4 LHW interventions to improve TB treatment outcomes compared with other forms of adherence support, outcome: 4.1 Cure for smear positive TB patients (new and retreatment), excluding Mohan 2003 and Clarke 2005 ‐ adjusted for clustering.
15
15
Forest plot of comparison: 4 LHW interventions to improve TB treatment outcomes compared with other forms of adherence support, outcome: 4.11 New smear positives cured ‐ adjusted for clustering.
16
16
Forest plot of comparison: 4 LHW interventions to improve TB treatment outcomes compared with other forms of adherence support, outcome: 4.13 Combined cure and treatment completion for all pulmonary TB patients ‐ adjusted for clustering.
17
17
Forest plot of comparison: 4 LHW interventions to improve TB treatment outcomes compared with other forms of adherence support, outcome: 4.14 TB Preventive therapy with Isoniazid ‐ completed therapy.
1.1
1.1. Analysis
Comparison 1 LHW interventions to promote immunisation uptake in children under five compared with usual care, Outcome 1 Immunisation schedule up to date ‐ unadjusted.
1.2
1.2. Analysis
Comparison 1 LHW interventions to promote immunisation uptake in children under five compared with usual care, Outcome 2 Immunisation schedule up to date ‐ adjusted for clustering.
1.3
1.3. Analysis
Comparison 1 LHW interventions to promote immunisation uptake in children under five compared with usual care, Outcome 3 Immunisation schedule up to date (excl. Gökcay and Krieger).
2.1
2.1. Analysis
Comparison 2 LHW interventions to promote breastfeeding compared with usual care, Outcome 1 Initiated Breastfeeding.
2.2
2.2. Analysis
Comparison 2 LHW interventions to promote breastfeeding compared with usual care, Outcome 2 Any Breastfeeding.
2.3
2.3. Analysis
Comparison 2 LHW interventions to promote breastfeeding compared with usual care, Outcome 3 Exclusive breastfeeding (6 weeks ‐ 6 months).
2.4
2.4. Analysis
Comparison 2 LHW interventions to promote breastfeeding compared with usual care, Outcome 4 Initiated Breastfeeding ‐ adjusted for clustering.
2.5
2.5. Analysis
Comparison 2 LHW interventions to promote breastfeeding compared with usual care, Outcome 5 Any Breastfeeding ‐ adjusted for clustering.
2.6
2.6. Analysis
Comparison 2 LHW interventions to promote breastfeeding compared with usual care, Outcome 6 Exclusive Breastfeeding ‐ adjusted for clustering.
3.1
3.1. Analysis
Comparison 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, Outcome 1 Mortality among children < 5 years old ‐ unadjusted.
3.2
3.2. Analysis
Comparison 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, Outcome 2 Mortality among children < 5 years old.
3.3
3.3. Analysis
Comparison 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, Outcome 3 Mortality among children < 5 years old (Excl. Pence).
3.4
3.4. Analysis
Comparison 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, Outcome 4 Neonatal mortality ‐ unadjusted.
3.5
3.5. Analysis
Comparison 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, Outcome 5 Neonatal mortality.
3.6
3.6. Analysis
Comparison 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, Outcome 6 Morbidity; reported illness in children ‐ unadjusted.
3.7
3.7. Analysis
Comparison 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, Outcome 7 Morbidity; reported illness in children.
3.8
3.8. Analysis
Comparison 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, Outcome 8 Morbidity; care‐seeking practice ‐ unadjusted.
3.9
3.9. Analysis
Comparison 3 LHW interventions to reduce mortality/morbidity in children under five compared with usual care, Outcome 9 Morbidity; care‐seeking practice.
4.1
4.1. Analysis
Comparison 4 LHW interventions to improve TB treatment outcomes compared with other forms of adherence support, Outcome 1 Cure for smear positive TB patients (new and retreatment) ‐ adjusted for clustering.
4.2
4.2. Analysis
Comparison 4 LHW interventions to improve TB treatment outcomes compared with other forms of adherence support, Outcome 2 Cure for smear positive TB patients (new and retreatment).
4.3
4.3. Analysis
Comparison 4 LHW interventions to improve TB treatment outcomes compared with other forms of adherence support, Outcome 3 Cure for smear positive TB patients (new and retreatment) ‐ adjusted for clustering.
4.4
4.4. Analysis
Comparison 4 LHW interventions to improve TB treatment outcomes compared with other forms of adherence support, Outcome 4 New smear positives cured ‐ adjusted for clustering.
4.5
4.5. Analysis
Comparison 4 LHW interventions to improve TB treatment outcomes compared with other forms of adherence support, Outcome 5 Combined cure and treatment completion for all pulmonary TB patients.
4.6
4.6. Analysis
Comparison 4 LHW interventions to improve TB treatment outcomes compared with other forms of adherence support, Outcome 6 Combined cure and treatment completion for all pulmonary TB patients ‐ adjusted for clustering.
4.7
4.7. Analysis
Comparison 4 LHW interventions to improve TB treatment outcomes compared with other forms of adherence support, Outcome 7 TB Preventive therapy with Isoniazid ‐ completed therapy.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Kartin 2002 {published data only}
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Kidane 2000 {published data only}
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Kouyate 2008 {published data only}
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Malchodi 2003 {published data only}
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Malotte 2001 {published data only}
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Manandhar 2004 {published data only}
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Merewood 2006 {published data only}
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Mohan 2003 {published data only}
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Morisky 2001 {published data only}
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Morrow 1999 {published data only}
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    1. Parker EA, Israel BA, Robins TG, Mentz G, Xihong Lin, Brakefield‐Caldwell W, et al. Evaluation of Community Action Against Asthma: a community health worker intervention to improve children's asthma‐related health by reducing household environmental triggers for asthma. Health Education and Behavior 2008;35(3):376‐95. - PMC - PubMed
Pence 2005 {published data only}
    1. Pence BW, Nyarko P, Phillips JF, Debpuur C. The effects of community nurses and health volunteers on child mortality: The Navrongo Community Health Family Planning Project. Population Council 2005;200:1‐27. - PubMed
Rodewald 1999 {published data only}
    1. Rodewald LE, Szilagyi PG, Humiston SG, Barth R, Kraus R, Raubertas RF. A randomized study of tracking with outreach and provider prompting to improve immunization coverage and primary care. Pediatrics 1999;103(1098‐4275 (Electronic), 1):31‐8. - PubMed
Rohr 2004 {published data only}
    1. Rohr F, Munier A, Sullivan D, Bailey I, Gennaccaro M, Levy H, et al. The Resource Mothers Study of Maternal Phenylketonuria: preliminary findings. Journal of Inherited Metabolic Disease 2004;27(0141‐8955 (Print), 2):145‐55. - PubMed
Sazawal 1996 {published data only}
    1. Sazawal S, Black RE, Bhan MK, Jalla S, Bhandari N, Sinha A, et al. Zinc supplementation reduces the incidence of persistent diarrhea and dysentery among low socioeconomic children in India. Journal of Nutrition 1996;126(2):443‐50. - PubMed
Schuler 2000 {published data only}
    1. Schuler ME, Nair P, Black MM, Kettinger L. Mother‐infant interaction: effects of a home intervention and ongoing maternal drug use. Journal of Clinical Child Psychology 2000;29(3):424‐31. - PMC - PubMed
Siegel 1980 {published data only}
    1. Siegel E, Bauman KE, Schaefer ES, Saunders MM, Ingram DD. Hospital and home support during infancy: impact on maternal attachment, child abuse and neglect, and health care utilization. Pediatrics 1980;66(2):183‐90. - PubMed
Silver 1997 {published data only}
    1. Silver E, Ireys HT, Bauman LJ, Stein RE. Psychological outcomes of a support intervention in mothers of children with ongoing health conditions. The parent‐to‐parent network. Journal of Community Psychology 1997;25(3):249‐64.
Singer 1999 {published data only}
    1. Singer GHS, Marquis J, Powers LK, Blanchard L, Divenere N, Santelli B, et al. A multi‐site evaluation of parent to parent programs for parents of children with disabilities. Journal of Early Intervention 1999;22(3):217‐29.
Sloan 2008 {published data only}
    1. Sloan NL, Ahmed S, Mitra SN, Choudhury N, Chowdhury M, Rob U, et al. Community‐based kangaroo mother care to prevent neonatal and infant mortality: a randomized, controlled cluster trial. Pediatrics 2008;121(5):e1047‐59. - PubMed
Spencer 1989 {published data only}
    1. Spencer B, Thomas H, Morris J. A randomized controlled trial of the provision of a social support service during pregnancy: the South Manchester Family Worker Project. BJOG 1989;96(0306‐5456 (Print), 3):281‐8. - PubMed
Sripaipan 2002 {published data only}
    1. Sripaipan T, Schroeder DG, Marsh DR, Pachon H, Dearden KA, Ha TT, et al. Effect of an integrated nutrition program on child morbidity due to respiratory infection and diarrhea in northern Viet Nam. Food and Nutrition Bulletin 2002;23 Suppl(0379‐5721 (Print), 4):70‐7. - PubMed
Stevens‐Simon 2001 {published data only}
    1. Stevens‐Simon C, Nelligan D, Kelly L. Adolescents at risk for mistreating their children. Part II: A home‐ and clinic‐based prevention program. Child Abuse and Neglect 2001;25(0145‐2134 (Print), 6):753‐69. - PubMed
Sullivan 2002 {published data only}
    1. Sullivan CM, Byebee DI, Allen NE. Findings from a community‐based program for battered women and their children. Journal of Interpersonal Violence 2002;17(9):915‐36.
Sullivan‐Bolyai 2004 {published data only}
    1. Sullivan‐Bolyai S, Grey M, Deatrick J, Gruppuso P, Giraitis P, Tamborlane W. Helping other mothers effectively work at raising young children with type 1 diabetes. The Diabetes Educator 2004;30(0145‐7217 (Print), 3):476‐84. - PubMed
Swart 2008 {published data only}
    1. Swart L, Niekerk A, Seedat M, Jordaan E. Paraprofessional home visitation program to prevent childhood unintentional injuries in low‐income communities: a cluster randomized controlled trial. Injury Prevention 2008;14(3):164‐9. - PubMed
Tough 2006 {published data only}
    1. Tough SC, Johnston DW, Siever JE, Jorgenson G, Slocombe L, Lane C, et al. Does supplementary prenatal nursing and home visitation support improve resource use in a universal health care system? A Randomized Controlled Trial in Canada. Birth 2006;33(3):183‐94. - PubMed
Tulsky 2000 {published data only}
    1. Pilote L, Tulsky JP, Zolopa AR, Hahn JA, Schecter GF, Moss AR. Tuberculosis prophylaxis in the homeless. A trial to improve adherence to referral. Archives of Internal Medicine 1996;156(2):161‐5. - PubMed
    1. Tulsky JP, Pilote L, Hahn JA, Zolopa AJ, Burke M, Chesney M, et al. Adherence to isoniazid prophylaxis in the homeless: a randomized controlled trial. Archives of Internal Medicine 2000;160(0003‐9926 (Print), 5):697‐702. - PubMed
Vogler 2002 {published data only}
    1. Vogler SD, Davidson AJ, Crane LA, Steiner JF, Brown JM. Can paraprofessional home visitation enhance early intervention service delivery?. Journal of Developmental and Behavioral Pediatrics 2002;23(0196‐206X (Print), 4):208‐16. - PubMed
Wang 2007 {published data only}
    1. Wang L, Li J, Chen H, Li F, Armstrong GL, Nelson C, et al. Hepatitis B vaccination of newborn infants in rural China: evaluation of a village‐based, out‐of‐cold‐chain delivery strategy. Bulletin of the World Health Organization 2007;85(9):688‐94. - PMC - PubMed
Watt 2009 {published data only}
    1. Watt RG, Tull KI, Hardy R, Wiggins M, Kelly Y, Molloy B, et al. Effectiveness of a social support intervention on infant feeding practices: randomised controlled trial. Journal of Epidemiology and Community Health 2009;63(2):156‐62. - PubMed
Weindling 2007 {published data only}
    1. Weindling AM, Cunningham CC, Glenn SM, Edwards RT, Reeves DJ. Additional therapy for young children with spastic cerebral palsy: a randomised controlled trial. Health Technology Assessment 2007;11(16):iii‐x, 1. - PubMed
Wohl 2006 {published data only}
    1. Wohl AR, Garland WH, Valencia R, Squires K, Witt MD, Kovacs A, et al. A randomized trial of directly administered antiretroviral therapy and adherence case management intervention. Clinical Infectious Diseases 2006;42(1537‐6591 (Electronic), 11):1619‐27. - PubMed
Zaman 2008 {published data only}
    1. Zaman S, Ashraf RN, Martines J. Training in complementary feeding counselling of healthcare workers and its influence on maternal behaviours and child growth: A cluster randomized controlled trial in Lahore, Pakistan. Journal of Health, Population, and Nutrition 2008;26(2):210‐22. - PMC - PubMed
Zwarenstein 2000 {published data only}
    1. Zwarenstein M, Schoeman JH, Vundule C, Lombard CJ, Tatley M. A randomised controlled trial of lay health workers as direct observers for treatment of tuberculosis. The International Journal of Tuberculosis and Lung Disease 2000;4(6):550‐4. - PubMed

References to studies excluded from this review

Akram 1997 {published data only}
    1. Akram DS, Agboatwalla M, Shamshad S. Effect of intervention on promotion of exclusive breast feeding. JPMA. The Journal of the Pakistan Medical Association 1997;47(2):46‐8. - PubMed
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Andresen 1992 {published data only}
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Arlotti 1998 {published data only}
    1. Arlotti JP, Cottrell BH, Lee SH, Curtin JJ. Breastfeeding among low‐income women with and without peer support. Journal of Community Health Nursing 1998;15(3):163‐78. - PubMed
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Bailey 1996 {published data only}
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Bang 1994 {published data only}
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Bang 1999 {published data only}
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Bhandari 2003 {published data only}
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Bhandari 2008 {published data only}
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Bhutta 2008 {published data only}
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Brennan 1991 {published data only}
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Brown 2007 {published data only}
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Brugha 1996 {published data only}
    1. Brugha RF, Kevany JP. Maximizing immunization coverage through home visits: a controlled trial in an urban area of Ghana. Bulletin of the World Health Organization 1996;74(0042‐9686 (Print), 5):517‐24. - PMC - PubMed
Bullough 1989 {published data only}
    1. Bullough CH, Msuku RS, Karonde L. Early suckling and postpartum haemorrhage: controlled trial in deliveries by traditional birth attendants. Lancet 1989;2(8662):522‐5. - PubMed
Chen 1999 {published data only}
    1. Chen M. The effectiveness of health promotion counseling to family caregivers. Public Health Nursing (Boston, Mass.) 1999;16(2):125‐32. - PubMed
Christopher 1990 {published data only}
    1. Christopher FS, Roosa MW. An evaluation of an adolescent pregnancy prevention programme: is 'just say no' enough?. Family Relations 1990;39(1):68‐72.
Cox 1998 {published data only}
    1. Cox GB, Walker RD, Freng SA, Short BA, Meijer L, Gilchrist L. Outcome of a controlled trial of the effectiveness of intensive case management for chronic public inebriates. Journal of Studies on Alcohol 1998;59(5):523‐32. - PubMed
Das 2008 {published data only}
    1. Das Lalit K, Jambulingam Purushothaman, Sadanandane Candasamy. Impact of community‐based presumptive chloroquine treatment of fever cases on malaria morbidity and mortality in a tribal area in Orissa State, India. Malaria Journal 2008;7:75. - PMC - PubMed
Davies‐Adetugbo 1997 {published data only}
    1. Davies‐Adetugbo AA, Adebawa HA. The Ife South Breastfeeding Project: training community health extension workers to promote and manage breastfeeding in rural communities. Bulletin of the World Health Organization 1997;75(4):323‐32. - PMC - PubMed
Delacollette 1996 {published data only}
    1. Delacollette C, Stuyft P, Molima K. Using community health workers for malaria control: experience in Zaire. Bulletin of the World Health Organization 1996;74(4):423‐30. - PMC - PubMed
DiCenso 1997 {published data only}
    1. Mitchell‐DiCenso A, Thomas BH, Devlin MC, Goldsmith CH, Willan A, Singer J, et al. Evaluation of an educational program to prevent adolescent pregnancy. Health Education & Behavior 1997;24(3):300‐12. - PubMed
Dick 1997 {published data only}
    1. Dick J, Clarke M, Tibbs J, Schoeman H. Combating tuberculosis‐‐lessons learnt from a rural community project in the Klein Drakenstein area of the Western Cape. South African Medical Journal 1997;87 Suppl(8):1042‐7. - PubMed
Doherty 2006 {published data only}
    1. Doherty William J, Erickson Martha Farrell, LaRossa Ralph. An intervention to increase father involvement and skills with infants during the transition to parenthood. Journal of Family Psychology 2006;20(3):438‐47. - PubMed
Drummond 2008 {published data only}
    1. Drummond JE, Letourneau N, Neufeld SM, Stewart M, Weir A. Effectiveness of teaching an early parenting approach within a community‐based support service for adolescent mothers. Research in Nursing & Health 2008;31(1):12‐22. - PubMed
Durand 1992 {published data only}
    1. Duran AM. The safety of home birth: the farm study. American Journal of Public Health 1992;82(3):450‐3. - PMC - PubMed
Durlak 1981 {published data only}
    1. Durlak JA. Evaluating comparative studies of paraprofessional and professional helpers: a reply to Nietzel and Fisher. Psychological Bulletin 1981;89(3):566‐9. - PubMed
Gill 2007 {published data only}
    1. Gill SL, Reifsnider E, Lucke JF. Effects of support on the initiation and duration of breastfeeding. Western Journal of Nursing Research 2007;29(6):708‐23. - PubMed
Goodburn 2000 {published data only}
    1. Goodburn EA, Chowdhury M, Gazi R, Marshall T, Graham W. Training traditional birth attendants in clean delivery does not prevent postpartum infection. Health Policy and Planning 2000;15(4):394‐9. - PubMed
Graham 2002 {published data only}
    1. Graham A, Moore L, Sharp D, Diamond I. Improving teenagers' knowledge of emergency contraception: cluster randomised controlled trial of a teacher led intervention. BMJ 2002;324(7347):1179. - PMC - PubMed
Gray 1980 {published data only}
    1. Gray SW, Ruttle K. The family‐oriented home visiting program: a longitudinal study. Genetic Psychology Monographs 1980;102(2):299‐316. - PubMed
Greenwood 1989 {published data only}
    1. Greenwood BM, Greenwood AM, Snow RW, Byass P, Bennett S, Hatib‐N'Jie AB. The effects of malaria chemoprophylaxis given by traditional birth attendants on the course and outcome of pregnancy. Transactions of the Royal Society of Tropical Medicine and Hygiene 1989;83(5):589‐94. - PubMed
Gupta 1992 {published data only}
    1. Gupta PC, Mehta FS, Pindborg JJ, Bhonsle RB, Murti PR, Daftary DK, et al. Primary prevention trial of oral cancer in india: a 10‐year follow‐up study. Journal of Oral Pathology & Medicine 1992;21(10):433‐9. - PubMed
Haider 1997 {published data only}
    1. Haider R, Kabir I, Hamadani JD, Habte D. Reasons for failure of breast‐feeding counselling: mothers' perspectives in Bangladesh. Bulletin of the World Health Organization 1997;75(3):191‐6. - PMC - PubMed
Hampson 1980 {published data only}
    1. Hampson RB, Tavormina JB. Relative effectiveness of behavioral and reflective group training with foster mothers. Journal of Consulting and Clinical Psychology 1980;48(2):294‐5. - PubMed
Heikens 1993 {published data only}
    1. Heikens GT, Schofield WN, Dawson S. The Kingston Project. II. The effects of high energy supplement and metronidazole on malnourished children rehabilitated in the community: anthropometry. European Journal of Clinical Nutrition 1993;47(3):160‐73. - PubMed
Heins 1987 {published data only}
    1. Heins HC Jr, Nance NW, Ferguson JE. Social support in improving perinatal outcome: the Resource Mothers Program. Obstetrics and Gynecology 1987;70(2):263‐6. - PubMed
Hill 2000 {published data only}
    1. Hill AG, MacLeod WB, Joof D, Gomez P, Walraven G. Decline of mortality in children in rural Gambia: the influence of village‐level primary health care. Tropical Medicine & International Health 2000;5(2):107‐18. - PubMed
Hodnett 1989 {published data only}
    1. Hodnett ED, Osborn RW. A randomized trial of the effects of monitrice support during labor: mothers' views two to four weeks postpartum. Birth 1989;16(4):177‐84. - PubMed
    1. Hodnett ED, Osborn RW. Effects of continuous intrapartum professional support on childbirth outcomes. Research in Nursing & Health 1989;12(5):289‐97. - PubMed
Hofmeyr 1991 {published data only}
    1. Hofmeyr GJ, Nikodem VC, Wolman WL, Chalmers BE, Kramer T. Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding. Br.J.Obstet.Gynaecol. 1991;98(0306‐5456 (Print), 8):756‐64. - PubMed
Jepson 1999 {published data only}
    1. J Jepson C, McCorkle R, Adler D, Nuamah I, Lusk E. Effects of home care on caregivers' psychosocial status. Image‐‐The Journal of Nursing Scholarship 1999;31(2):115‐20. - PubMed
Jessop 1991 {published data only}
    1. Jessop DJ, Stein RE. Who benefits from a pediatric home care program?. Pediatrics 1991;88(3):497‐505. - PubMed
Johnstone 2000 {published data only}
    1. Johnston B, Wheeler L, Deuser J, Sousa KH. Outcomes of the Kaiser Permanente Tele‐Home Health Research Project. Archives of Family.Medicine 2000;9(1):40‐5. - PubMed
Jokhio 2005 {published data only}
    1. Jokhio AH, Winter HR, Cheng KK. An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan. New England Journal of Medicine 2005;352(1533‐4406 (Electronic), 20):2091‐9. - PubMed
Kaag 1996 {published data only}
    1. Kaag ME, Wijkel D, Jong D. Primary health care replacing hospital care‐‐the effect on quality of care. International Journal for Quality in Health Care 1996;8(4):367‐73. - PubMed
Kamolratanakul 1999 {published data only}
    1. Kamolratanakul P, Sawert H, Lertmaharit S, Kasetjaroen Y, Akksilp S, Tulaporn C, et al. Randomized controlled trial of directly observed treatment (DOT) for patients with pulmonary tuberculosis in Thailand. Transactions of the Royal Society of Tropical Medicine and Hygiene 1999;93(5):552‐7. - PubMed
Kennell 1991 {published data only}
    1. Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continuous emotional support during labor in a US hospital. A randomized controlled trial. JAMA 1991;265(0098‐7484 (Print), 17):2197‐201. - PubMed
Kent 1997 {published data only}
    1. Kent RM, Chandler BJ. A comparison of community care services provided for younger and elderly disabled people. Clinical Rehabilitation 1997;11:265‐70.
Kitzman 2000 {published data only}
    1. Kitzman H, Olds DL, Sidora K, Henderson CR Jr, Hanks C, Cole R, et al. Enduring effects of nurse home visitation on maternal life course: a 3‐year follow‐up of a randomized trial. JAMA 2000;283(15):1983‐9. - PubMed
Langer 1998 {published data only}
    1. Langer A, Campero L, Garcia C, Reynoso S. Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers' wellbeing in a Mexican public hospital: a randomised clinical trial. British Journal of Obstetrics and Gynaecology 1998;105(0306‐5456 (Print), 10):1056‐63. - PubMed
Larson 1980 {published data only}
    1. Larson CP. Efficacy of prenatal and postpartum home visits on child health and development. Pediatrics 1980;66(2):191‐7. - PubMed
Lasater 1996 {published data only}
    1. Lasater M. The effect of a nurse‐managed CHF clinic on patient readmission and length of stay. Home Healthcare Nurse 1996;14(5):351‐6. - PubMed
Lefeber 1997 {published data only}
    1. Lefèber Y, Voorhoever H. Practices and beliefs of traditional birth attendants: lessons for obstetrics in the north?. Tropical Medicine & International Health 1997;2(12):1175‐9. - PubMed
Lindsay 1993 {published data only}
    1. Lindsay SW, Alonso PL, Armstrong Schellenberg JR, Hemingway J, Thomas PJ, Shenton FC, et al. A malaria control trial using insecticide‐treated bed nets and targeted chemoprophylaxis in a rural area of The Gambia, west Africa. 3. Entomological characteristics of the study area. Transactions of the Royal Society of Tropical Medicine and Hygiene 1993;87 Suppl 2:19‐23. - PubMed
Madi 1999 {published data only}
    1. Madi BC, Sandall J, Bennett R, MacLeod C. Effects of female relative support in labor: a randomized controlled trial. Birth 1999;26(0730‐7659 (Print), 1):4‐8. - PubMed
May 1986 {published data only}
    1. May D, McKeganey N, Flood M. Extra hands or extra problems?. Nursing Times 1986;82(36):35‐8. - PubMed
Mbonye 2007 {published data only}
    1. Mbonye Anthony K, Bygbjerg IC, Magnussen Pascal. A community‐based delivery system of intermittent preventive treatment of malaria in pregnancy and its effect on use of essential maternity care at health units in Uganda. Transactions of the Royal Society of Tropical Medicine and Hygiene 2007;101(11):1088‐95. - PubMed
McFarlane 1997 {published data only}
    1. McFarlane J, Wiist W. Preventing abuse to pregnant women: implementation of a "mentor mother" advocacy model. Journal of Community Health Nursing 1997;14(4):237‐49. - PubMed
McInnes 2000 {published data only}
    1. McInnes RJ, Love JG, Stone DH. Evaluation of a community‐based intervention to increase breastfeeding prevalance. Journal of Public Health Medicine 2000;22(2):138‐45. - PubMed
Menendez 1994a {published data only}
    1. Menendez C, Todd J, Alonso PL, Francis N, Lulat S, Ceesay S, et al. The effects of iron supplementation during pregnancy, given by traditional birth attendants, on the prevalence of anaemia and malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene 1994;88(5):590‐3. - PubMed
Menendez 1994b {published data only}
    1. Menendez C, Todd J, Alonso PL, Lulat S, Francis N, Greenwood BM. Malaria chemoprophylaxis, infection of the placenta and birth weight in Gambian primigravidae. Journal of Tropical Medicine and Hygiene 1994;97(4):244‐8. - PubMed
Mercier 1992 {published data only}
    1. Mercier C, Tempier R, Renaud C. Community services and quality of life: a study of the impact in a remote region [Services communautaires et qualiité de la vie: une étude d'Impact en région éloignée]. Canadian Journal of Psychiatry 1992;37(8):553‐63. - PubMed
Moongtui 2000 {published data only}
    1. Moongtui W, Gauthier DK, Turner JG. Using peer feedback to improve handwashing and glove usage among Thai health care workers. American Journal of Infection Control 2000;28(5):365‐9. - PubMed
Neittaanmaki 1980 {published data only}
    1. Neittaanmäki L, Koskela K, Puska P, McAlister AL. The role of lay workers in community health education: experiences of the North Karelia project. Scandinavian Journal of Social Medicine 1980;8(1):1‐7. - PubMed
Newell 2006 {published data only}
    1. Newell JN, Baral SC, Pande SB, Bam DS, Malla P. Family‐member DOTS and community DOTS for tuberculosis control in Nepal: cluster‐randomised controlled trial. Lancet 2006;367(1474‐547X (Electronic), 9514):903‐9. - PubMed
Niccols 2008 {published data only}
    1. Niccols A. 'Right from the Start': randomized trial comparing an attachment group intervention to supportive home visiting. Journal of Child Psychology and Psychiatry, and Allied Disciplines 2008;49(7):754‐64. - PubMed
Nikodem 2001 {published data only}
    1. Nikodem VC, Nolte AG, Wolman W, Gülmezoglu AM, Hofmeyr GJ. Companionship by a lay labour supporter to modify the clinical birth environment: long‐term effects on mother and child. Curationis 2001;21(1):8‐12. - PubMed
Pbert 2006 {published data only}
    1. Pbert L, Fletcher KE, Flint AJ, Young MH, Druker S, DiFranza J. Smoking prevention and cessation intervention delivery by pediatric providers, as assessed with patient exit interviews. Pediatrics 2006;118(3):e810‐24. - PubMed
Robinson 1988 {published data only}
    1. Robinson KM. A social skills training program for adult caregivers. ANS. Advances in Nursing Science 1988;10(2):59‐72. - PubMed
Rubenstein 1978 {published data only}
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Saylor 1983 {published data only}
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Scarano 1987 {published data only}
    1. Scarano S. Victim volunteers mobilize to minister. Emergency 1987;19(3):47‐9. - PubMed
Schafer 1998 {published data only}
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Sciacca 1995 {published data only}
    1. Sciacca JP, Dube DA, Phipps BL, Ratliff MI. A breast feeding education and promotion program: effects on knowledge, attitudes, and support for breast feeding. Journal of Community Health 1995;20(0094‐5145 (Print), 6):473‐90. - PubMed
Shamir 2007 {published data only}
    1. Shamir A, Lazerovitz T. Peer mediation intervention for scaffolding self‐regulated learning among children with learning disabilities. European Journal of Special Needs Education 2007;22(3):255‐73.
Shargie 2006 {published data only}
    1. Shargie EB, Morkve O, Lindtjorn B. Tuberculosis case‐finding through a village outreach programme in a rural setting in southern Ethiopia: community randomized trial. Bulletin of the World Health Organization 2006;84(0042‐9686 (Print), 2):112‐9. - PMC - PubMed
Shaughnessy 1996 {published data only}
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Shaw 1999 {published data only}
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Smith 2000a {published data only}
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Sosa 1980 {published data only}
    1. Sosa R, Kennell J, Klaus M, Robertson S, Urrutia J. The effect of a supportive companion on perinatal problems, length of labor, and mother‐infant interaction. New England Journal of Medicine 1980;303(0028‐4793 (Print), 11):597‐600. - PubMed
Spiby 1999 {published data only}
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Strawczynski 1973 {published data only}
    1. Strawczynski H, Stachewitsch A, Morgenstern G, Shaw ME. Delivery of care to hemophilic children: home care versus hospitalization. Pediatrics 1973;51(6):986‐91. - PubMed
Terefe 1993 {published data only}
    1. Terefe A, Larson CP. Modern contraception use in Ethiopia: does involving husbands make a difference?. American Journal of Public Health 1993;83(11):1567‐71. - PMC - PubMed
Tessaro 1997 {published data only}
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