The effect of community nurses and health volunteers on child mortality: the Navrongo Community Health and Family Planning Project

Scand J Public Health. 2007;35(6):599-608. doi: 10.1080/14034940701349225.

Abstract

Background: Despite effective treatments and preventive measures for the major causes of child illness and death in less wealthy nations, child mortality remains high in resource-poor settings due in part to ineffective health service delivery models.

Methods: The Navrongo Community Health and Family Planning Project is a longitudinal community trial of alternative organizational strategies for health service delivery in a rural, impoverished area of Ghana. In one area, nurses are placed in communities with doorstep visitation and service responsibilities. A second area includes training of a local health volunteer and community involvement in health delivery. A third area combines both strategies. Under-five mortality rates were calculated and Poisson regression was used to adjust for potential confounding characteristics.

Results: In areas with village-based community nurse services, under-five child mortality fell by 14% during five years of program implementation compared with before the intervention, with reductions in infant (5%), early child (18%), and late child (39%) mortality. The volunteer intervention was associated with a 14% increase in mortality, primarily driven by a 135% increase in early child mortality. Areas with both nurses and volunteers saw an 8% increase, with small increases in all age groups. Mortality in a comparison area with standard Ministry of Health services fell by 4% during the same time period.

Conclusions: These results suggest that convenient, accessible professional nursing care can reduce child mortality in impoverished African settings. However, they do not demonstrate a beneficial effect of community volunteers and suggest a possible negative impact on children's survival.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cause of Death
  • Child Mortality*
  • Child, Preschool
  • Community Health Nursing*
  • Developing Countries / statistics & numerical data
  • Family Planning Services*
  • Female
  • Ghana / epidemiology
  • Humans
  • Infant
  • Infant Mortality*
  • Male
  • Poverty
  • Rural Population
  • Socioeconomic Factors
  • Volunteers