a realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries一个现实主义者的合成涉及使用社区卫生工作者的随机控制试验提供儿童健康干预措施在低收入和中等收入国家.pdfVIP

Kane et al. BMC Health Services Research 2010, 10:286 /1472-6963/10/286 RESEARCH ARTICLE Open Access A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries 1* 1 2 3 1 Sumit S Kane , Barend Gerretsen , Robert Scherpbier , Mario Dal Poz , Marjolein Dieleman Abstract Background: A key constraint to saturating coverage of interventions for reducing the burden of childhood illnesses in Low and Middle Income Countries (LMIC) is the lack of human resources. Community health workers (CHW) are potentially important actors in bridging this gap. Evidence exists on effectiveness of CHW in management of some childhood illnesses (IMCI). However, we need to know how and when this comes to be. We examine evidence from randomized control trials (RCT) on CHW interventions in IMCI in LMIC from a realist perspective with the aim to see if they can yield insight into the working of the interventions, when examined from a different perspective. Methods: The realist approach involves educing the mechanisms through which an intervention produced an outcome in a particular context. ‘Mechanisms’ are reactions, triggered by the interaction of the intervention and a certain context, which lead to change. These are often only implicit and are actually hypothesized by the reviewer. This review is limited to unravelling these from the RCTs; it is thus a hypothesis generating exercise. Results: Interventions to improve CHW performance included ‘Skills based training of CHW’, ‘Supervision and referral support from public health services’, ‘Positioning of CHW in the community’. When interventions were applied in context of CHW program