Community health worker service delivery for maternal and child health: an observational study from Afghanistan.

Autor:	Kelly CB; Department of Women's and Children's Health, Faculty of Life Sciences & Medicine, King's College London, London, UK., Hemat S; Ministry of Public Health, Kabul, Afghanistan., Naziri M; UNICEF, Afghanistan, Kabul, Afghanistan., Yousufi K; UNICEF, Afghanistan, Kabul, Afghanistan., Edmond KM; Department of Women's and Children's Health, Faculty of Life Sciences & Medicine, King's College London, London, UK karen.edmond@kcl.ac.uk.
Jazyk:	angličtina
Zdroj:	Archives of disease in childhood [Arch Dis Child] 2022 Aug; Vol. 107 (8), pp. 726-731. Date of Electronic Publication: 2021 Dec 16.
DOI:	10.1136/archdischild-2021-322968
Abstrakt:	Objective: To understand the reach of the community health worker (CHW) programme in remote and non-remote districts of Afghanistan. Methods: Using data collected from the Ministry of Public Health's National Health Management Information System, we conducted a population-based study from 2018 to 2019 in 401 districts across 34 provinces of Afghanistan. We assessed the availability of CHWs, antenatal visits (ANV) and postnatal visits (PNV) conducted by the CHWs, and the availability of CHW supplies. Districts were classified as remote if the district centre was >2 hours by any form of transport from provincial capital, and non-remote if <2 hours. Data were analysed using multivariable regression models. Results: 15 562 CHWs were working in the districts of Afghanistan, 13 482 (87%) in remote and 2080 (13%) in non-remote districts. The mean of the proportion of CHWs per pregnant woman was higher in remote (0.019 (SD 0.011)) compared with non-remote (0.012 (SD 0.006)) districts (adjusted mean difference (AMD) 0.008, 95% CI 0.004 to 0.01). The mean of the proportion of ANVs received from a CHW per pregnant women was higher in remote (0.88 (SD 0.82)) compared with non-remote (0.62 (SD 0.50)) districts (AMD 0.28, 95% CI 0.02 to 0.54). The mean of the proportion of PNVs received from a CHW per pregnant women was higher in remote (0.54 (SD 0.53)) compared with non-remote (0.36 (SD 0.25)) districts (AMD 0.19, 95% CI 0.02 to 0.36). The mean of the proportion of CHWs who reported that they had stocks of cotrimoxazole and oral contraceptives in the previous month per district was higher in remote compared with non-remote districts. Conclusions: In Afghanistan, the CHW programme appears to be effective and proportionate to need in remote regions. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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