Trial reportBMJ global health2021
A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi.
Trial report in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- A systematic review of the types, workload, and supervision mechanism of community health workers: lessons learned for Indonesia.BMC primary care · 2024Pooled it
- Lay health workers in primary and community health care for maternal and child health: identification and treatment of wasting in children.The Cochrane database of systematic reviews · 2023Pooled it
- Community case management to accelerate access to healthcare in Mali: a realist process evaluation nested within a cluster randomized trial.Health policy and planning · 2024Trial
- Trial
- Measuring community engagement and trust in community health workers in Haiti, Malawi, and Rwanda: a cross-sectional study.Journal of global health · 2026Article
- Strategies to integrate non-communicable disease interventions in HIV and tuberculosis care contexts in low- and middle-income countries: a scoping review.BMJ global health · 2026Article
- Multi-level determinants of tuberculosis treatment completion in rural Uganda: A cross-sectional study.PloS one · 2026Article
- The integration of communicable and non-communicable disease (CD-NCD) health services in Africa: A scoping review.PLOS global public health · 2026Article
- Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review.Frontiers in epidemiology · 2026Review
- A knowledge, attitude and practice-based integrative literature review of community health worker training on stroke and cardiovascular diseases in low-and middle-income countries.BMC primary care · 2025Review
- Advanced HIV disease management and patient outcomes in rural setting - Malawi: a retrospective cohort study.AIDS research and therapy · 2025Article
- Knowledge of local snakes, first-aid and prevention of snakebites among community health workers and community members in rural Malawi: A cross-sectional study.Tropical medicine & international health : TM & IH · 2025Article
- Task-sharing for non-communicable disease prevention and control in low- and middle-income countries in the context of health worker shortages: A systematic review.PLOS global public health · 2025Article
- The effectiveness of community-wide screening for pulmonary tuberculosis: a systematic review.EClinicalMedicine · 2025Review
- Impact of Mobile Health (mHealth) Use by Community Health Workers on the Utilization of Maternity Care in Rural Malawi: A Time Series Analysis.International journal of women's health · 2025Article
- Towards improving district health information system data consistency, report completeness and timeliness in Neno district, Malawi.BMC medical informatics and decision making · 2024Article
- Sustainability and impact of an intervention to improve initiation of tuberculosis preventive treatment: results from a follow-up study of the ACT4 randomized trial.EClinicalMedicine · 2024Article
- Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern.PLOS global public health · 2024Article
- Experiences and practices of traditional healers on snakebite treatment and prevention in rural Malawi.PLoS neglected tropical diseases · 2023Article
- A time-motion study of community health workers delivering community-based primary health care in Neno District, Malawi.Human resources for health · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors at 7 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCommunity health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).
methodsWe conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20-40 households for monthly (or more frequent) visits.
findingsThe intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (-0.8 percentage points (pp) (95% credible interval: -2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: -0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (-0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (-0.6 per 1000 (95% CI -2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges.
interpretationCHW programmes can be successfully expanded to more comprehensively address health needs in a population, although programmes should be carefully tailored to CHW and health system capacity.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.