Systematic review and metanalysis on community based interventions in tuberculosis care in developing countries.

BACKGROUND:

We aimed to evaluate the effectiveness of Lay Health Workers (LHW) in increasing case detection rate and treatment success outcome of Tuberculosis cases

METHODS:

PUBMED,; Google scholar, African Journal Online (AJOL) and other search engines were systematically searched, for literature from 2000 to 2012 for studies that are either: [randomized/cluster randomized/non randomized or prospective cohort study); assessing lay Health care worker participation in tuberculosis (TB) treatment, using the key words (LHW, TB and treatment). Studies were pooled using a random effect model. Of the thirteen studies that fulfilled the inclusion criteria for systemic review, only five were heterogeneous enough for a meta-analysis.

RESULTS:

There was a marginal effectiveness of LHW involvement in TB treatment success rate, RR 1.09 Confidence Interval. [0.98-1.21]. There was no publication bias; with {p = 0.135 for Eggar's weighed regression analysis}. Restrictive analysis showed a marginally higher summary relative risk in rural based studies RR 1.12, C.I. [1.01-1.24]; compared to urban studies RR 1.01, C.I. [0.91-1.13].

CONCLUSION:

The use of Lay Health care workers is associated with a marginal benefit in improving TB treatment success compared to standard facility based TB care. Larger studies are needed to properly prove its superiority.