Lay health workers can help reduce childhood mortality

Lay health workers can improve the health of poor children

Lay persons in many countries who are given special training to promote or carry out some health care services may reduce childhood mortality.

This is among the results of a new international report developed by researchers at the National Knowledge Centre for the Health Services and SINTEF. The report was published on March 17, and is a meta-analysis of 82 studies about the effects on health services of specially trained lay health workers.

Severe shortage of doctors

The studies looked at the use of lay health workers in both poor countries and low-income areas in better-off nations.

Interest in the potential contribution of lay workers to health services is growing. The background to this is the lack of doctors and nurses particularly in poorer countries.

Lower rates of infection

The analysis of the 82 studies showed that in many places, non-professional health workers may reduce the incidence of serious infectious diseases in children and lower mortality rates in children less than five years old.

Strengthen breastfeeding and vaccination programmes

"However, the clearest effect of lay workers on the health of mothers and children was found in breast-feeding and children's vaccination programmes," say senior scientists Simon Lewin of the  National Knowledge Centre for the Health Services and Claire Glenton of SINTEF Health Research.

Effective in fighting TB

The report also points out that in many places, the use of non-professional health workers has improved people's prospects of being cured of tuberculosis.

Database for health authorities

The meta-analysis was financed by the Research Council of Norway, and the results will be published in the well-known Cochrane Library. This international database provides health authorities, health-sector personnel and other decision-makers access to information from different fields of the medical literature, put together and evaluated by teams of experts.

The expert group of which Lewin and Glenton are members studied research projects on lay persons working in the health sector of public authorities or non governmental organisations.

Probable gains

The group concluded that poor countries and regions that include lay workers as part of their health services will probably find that more mothers will exclusively breastfeed and not wean their babies prematurely onto other foods, that more children complete their vaccination programmes, and that more people are cured of TB.

On the subject of childhood diseases and mortality, the report says that employing lay workers can lead to a slight drop in cases of severe diarrhoea and pneumonia, fewer deaths of children below the age of five and an increase in the number of parents who seek help for sick children.

Uneven access to medical services

Lewin and Glenton explain that the high level of interest in the services provided by lay health workers is because the lack of professional health personnel is a threat to public health in low and middle income countries.

The most seriously affected parts of the world are South-east Asia and Sub-Saharan Africa. The two researchers say that the people of these two regions bear about a quarter of the global burden of disease, but have access to only three percent of the world's health personnel.

Information and treatment

The researchers explain that lay personnel are used to provide both information and treatment.

In the breast-feeding projects, lay health workers encourage mothers to breast-feed and give them practical help.

In the vaccination projects, some of them are used to motivate and encourage parents to vaccinate their children and help them to visit clinics, while other are trained to give injections.

The efforts of lay health personnel in the field of infectious diseases of children range from providing preventive care information to parents to starting antibiotic treatment.

"The challenge of overcoming tuberculosis is due to the fact that treatment requires a long-term regime of taking tablets, and patients very often stop taking their tablets too early. The success of lay personnel in improving the prospects of treatment in these studies was related to the fact that they were usually people from the same local society, or who had had TB themselves. They usually visited patients at home, offered them information and support, and in some cases also made sure that they actually took their tablets," explain Simon Lewin and Claire Glenton.