Lay health workers in primary and community health care for maternal and child health: identification and treatment of wasting in children

Can lay health workers effectively identify and treat wasting in children?

The aim of this Cochrane Review was to find out whether lay health workers were more or less effective than health professionals at identifying and treating children with wasting.

Key messages

The results of this review suggest that children who receive care from lay health workers for severe wasting may have similar or slightly poorer results than children who receive care from health professionals.

What is wasting?

Childhood wasting refers to children being too thin for their height. Wasting happens when the child does not have enough food or enough healthy food, or because of disease. Children suffering from wasting are more often sick, can have developmental problems, and are more likely to die, particularly when the wasting is severe. Millions of children suffer from wasting, and most of them live in poor countries.

The best solution to this problem is to stop wasting occurring in the first place. When this is not possible, it is important to identify and treat children with wasting as soon as possible. However, treatment can take weeks or months, and it may be difficult or expensive for families to access care. As a result, many children are not getting the help they need.

What is a lay health worker?

One way of increasing children's access to care is to use lay health workers. A lay health worker is a member of the community who has received some training to carry out certain healthcare services but is not a healthcare professional. Research has shown that lay health workers are useful in some health interventions, such as increasing breastfeeding and childhood vaccination.

What did we want to find out?

In this review, we wanted to find whether lay health workers can effectively identify and treat moderate to severe wasting in children aged five years or younger. We looked for studies that evaluated the effect of using lay health workers in the community compared with health professionals working in health facilities.

What did we find?

We included seven studies in this review. Six studies were from African countries, and one study was from Pakistan. Six studies included children with severe wasting, and one included children with moderate wasting. In some studies, lay health workers identified children with wasting and then referred them to clinics for treatment. In the other studies, lay health workers also treated the children.

All studies compared lay health workers with health professionals. No studies included children younger than 6 months old.

Key results

Identification and referral of children with wasting by lay health professionals, compared with treatment by health professionals after self‐referral, may make little or no difference to the number of children who recover from moderate or severe wasting.

Identification and treatment of children with severe wasting by lay health workers, compared with treatment by health professionals after identification and referral by lay health workers:

• may slightly reduce response to treatment (60 fewer children per 1000 responding to treatment);
• may have little or no effect on the number of children who gain weight;
• probably has little or no effect on the amount of weight gained;
• probably has little or no effect on the number of children who relapse;
• probably has little or no effect on the number of children who are transferred to inpatient care;
• probably has little or no effect on the number of children who drop out of treatment; and
• may have little or no effect on the number of children who die.

How up‐to‐date is this evidence?

We searched for studies that had been published up to 24 September 2021.