Community health workers and stand-alone or integrated case management of malaria: a systematic literature review

Abstract

A systematic literature review was conducted to assess the effectiveness of strategies to improve community case management (CCM) of malaria. Forty-three studies were included; most (38) reported indicators of community health worker (CHW) performance, 14 reported on malaria CCM integrated with other child health interventions, 16 reported on health system capacity, and 13 reported on referral. The CHWs are able to provide good quality malaria care, including performing procedures such as rapid diagnostic tests. Appropriate training, clear guidelines, and regular supportive supervision are important facilitating factors. Crucial to sustainable success of CHW programs is strengthening health system capacity to support commodity supply, supervision, and appropriate treatment of referred cases. The little evidence available on referral from community to health facility level suggests that this is an area that needs priority attention. The studies of integrated CCM suggest that additional tasks do not reduce the quality of malaria CCM provided sufficient training and supervision is maintained.

Figure 1.

Flow chart of literature search and screening. CHWs = community health workers.

Figure 2.

Number of studies addressing each objective, by study design. RCT = randomized controlled trial; HS = health system.

Figure 3.

Number of studies addressing each objective, by classification of intervention. CCM = community case management; Tx = treatment; HS = health system.