Effectiveness of Interventions Utilizing Community Health Worker Model on Reducing Stunting in Low- and Middle-Income Countries: A Systematic Review
Abstract
Background: This study aimed to assess the effectiveness of interventions delivered by CHWs and their strategies for reducing stunting in LMICs.
Methods: We undertook a systematic review following PRISMA guidelines. The articles were selected from major electronic databases, reference lists and grey literature from 2016 and 2023.
Results: Seventeen articles were included in the final analysis from the initial 2,899 search results. CHW-led interventions significantly reduce stunting. Training and refresher courses enhanced outcomes, while challenges included inconsistent implementation and resource constraints. The variability in results underscores the need for multisectoral collaboration to maximize impact.
Conclusion: Our findings highlighted the significant role of CHW-led interventions in reducing stunting, emphasizing their potential as accessible and reliable resources for local communities.
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2. Stewart CP, Iannotti L, Dewey KG, et (2013). Contextualising complementary feeding in a broader framework for stunting prevention. Matern Child Nutr, 9 (Suppl 2):27-45.
3. Gardner JM, Grantham-McGregor SM, Himes J, et al (1999). Behaviour and development of stunted and nonstunted Jamaican children. J Child Psychol Psychiatry, 40 (5):819-27.
4. Aryastami NK, Shankar A, Kusumawardani N, et al (2017). Low birth weight was the most dominant predictor associated with stunting among children aged 12–23 months in Indonesia. BMC Nutrition, 3 (1):1-6.
5. Goudet SM, Kimani-Murage EW, Wekesah F, et al (2017). How does poverty affect children’s nutritional status in Nairobi slums? A qualitative study of the root causes of undernutrition. Public Health Nutr, 20 (4):608-619.
6. Fenske N, Burns J, Hothorn T, et al (2013). Understanding child stunting in India: a comprehensive analysis of socio-economic, nutritional and environmental determinants using additive quantile regression. PloS One, 8 (11):e78692.
7. Black RE, Victora CG, Walker SP, et al (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet, 382 (9890):427-451.
8. Horton S, Shekar M, McDonald C, et al (2009). Scaling up nutrition: What will it cost? World Bank Publications, WORLD.
9. Westerbotn M, Monfors F, Reusser J, et al (2023). Promoting health and preventing malnutrition among children in rural Bangladesh: A qualitative study. Nurs Open, 10 (8):5693-5700.
10. Darzi A, Evans T (2016). The global shortage of health workers-an opportunity to transform care. Lancet, 388 (10060):2576-2577.
11. Love MB, Gardner K, Legion V (1997). Community health workers: who they are and what they do. Health Educ Behav, 24 (4):510-22.
12. Perry HB, Zulliger R, Rogers MM (2014). Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health, 35:399-421.
13. Chen L, Evans T, Anand S, et al (2004). Human resources for health: overcoming the crisis. Lancet, 364 (9449):1984-90.
14. Phuka J, Maleta K, Thomas M, et al (2014). A job analysis of community health workers in the context of integrated nutrition and early child development. Ann N Y Acad Sci, 1308 (1):183-191.
15. Kemenkes R (2012). Buku Saku Posyandu. Pusat Promosi Kesehatan, KEMENKES Indonesia.
16. Yousafzai AK, Rasheed MA, Rizvi A, et al (2014). Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: a cluster-randomised factorial effectiveness trial. Lancet, 384 (9950):1282-93.
17. Cosgrove S, Moore-Monroy M, Jenkins C, et al (2014). Community health workers as an integral strategy in the REACH U.S. program to eliminate health inequities. Health Promot Pract, 15 (6):795-802.
18. Organization WH (2018). WHO guideline on health policy and system support to optimize community health worker programmes. ed. World Health Organization.
19. Martin MA, Perry-Bell K, Minier M, et al (2019). A Real-World Community Health Worker Care Coordination Model for High-Risk Children. Health Promot Pract, 20 (3):409-418.
20. Mørkve ÅW, Sitienei J, Van den Bergh G (2024). “We Are Just Supposed to Be an NGO Helping”: A Qualitative Case Study of Health Workers’ and Volunteers’ Perceptions of the Government and Civil Society’s Role in Fighting Jiggers in Bungoma County, Kenya. Societies, 14 (2):28.
21. Venditti EM, Zgibor JC, Vander Bilt J, et al (2018). Mobility and Vitality Lifestyle Program (MOVE UP): A Community Health Worker Intervention for Older Adults With Obesity to Improve Weight, Health, and Physical Function. Innov Aging, 2 (2):igy012.
22. Khairunnisa C, Siagian A, Siregar FA, et al (2021). Social Medicine Approach in the Management of Lung Tuberculosis (TB) in North Aceh Regency: Role of Government and Non-Governmental Organization. Journal of Health, Medicine and Nursing,DOI: 10.7176/JHMN/95-07.
23. Bridge R, Lin TK (2024). Evidence on the impact of community health workers in the prevention, identification, and management of undernutrition amongst children under the age of five in conflict-affected or fragile settings: a systematic literature review. Confl Health, 18 (1):16.
24. Pallas SW, Minhas D, Pérez-Escamilla R, et al (2013). Community health workers in low- and middle-income countries: what do we know about scaling up and sustainability? Am J Public Health, 103 (7):e74-82.
25. JBI (2019) Critical Appraisal Tools. Joana Briggs Institute.
26. Melo G, Dutra KL, Rodrigues Filho R, et al (2018). Association between psychotropic medications and presence of sleep bruxism: A systematic review. J Oral Rehabil, 45 (7):545-554.
27. McHugh ML (2012). Interrater reliability: the kappa statistic. Biochem Med (Zagreb), 22 (3):276-82.
28. Locks LM, Dahal P, Pokharel R, et al (2019). Changes in growth, anaemia, and iron deficiency among children aged 6–23 months in two districts in Nepal that were part of the post‐pilot scale‐up of an integrated infant and young child feeding and micronutrient powder intervention. Matern Child Nutr, 15 (2):e12693.
29. Yadav D, Gupta N, Shrestha N, et al (2014). Community Based Nutrition Education for Promoting Nutritional Status of Children under Three Years of Age in Rural Areas of Mahottari District of Nepal. Journal of Nepal Paediatric Society, 34(3):181-187.
30. Aboud FE, Singla DR, Nahil MI, et al (2013). Effectiveness of a parenting program in Bangladesh to address early childhood health, growth and development. Soc Sci Med, 97:250-8.
31. Menon P, Nguyen PH, Saha KK, et al (2016). Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: results of a cluster-randomized program evaluation in Bangladesh. J Nutr, 146 (10):2075-2084.
32. Mistry SK, Hossain MB, Arora A (2019). Maternal nutrition counselling is associated with reduced stunting prevalence and improved feeding practices in early childhood: a post-program comparison study. Nutr J, 18(1):47.
33. Khan GN, Ariff S, Kureishy S, et al (2021). Effectiveness of wheat soya blend supplementation during pregnancy and lactation on pregnancy outcomes and nutritional status of their infants at 6 months of age in Thatta and Sujawal districts of Sindh, Pakistan: a cluster randomized-controlled trial. Eur J Nutr, 60(2):781-789.
34. Khan A, Ul-Haq Z, Fatima S, et al (2023). Long-Term Impact of Multiple Micronutrient Supplementation on Micronutrient Status, Hemoglobin Level, and Growth in Children 24 to 59 Months of Age: A Non-Randomized Community-Based Trial from Pakistan. Nutrients, 15 (7):1690.
35. Nair N, Tripathy P, Sachdev H, et al (2017). Effect of participatory women's groups and counselling through home visits on children's linear growth in rural eastern India (CARING trial): a cluster-randomised controlled trial. Lancet Glob Health, 5 (10):e1004-e1016.
36. Effendy DS, Prangthip P, Soonthornworasiri N, et al (2020). Nutrition education in Southeast Sulawesi Province, Indonesia: A cluster randomized controlled study. Matern Child Nutr, 16 (4):e13030.
37. Argaw A, de Kok B, Toe LC, et al (2023). Fortified balanced energy–protein supplementation during pregnancy and lactation and infant growth in rural Burkina Faso: A 2 × 2 factorial individually randomized controlled trial. PLoS Med, 20 (2):e1004186.
38. Sudfeld CR, Bliznashka L, Ashery G, et al (2021). Effect of a home-based health, nutrition and responsive stimulation intervention and conditional cash transfers on child development and growth: a cluster-randomised controlled trial in Tanzania. BMJ Global Health, 6(4):e005086.
39. Rockers PC, Fink G, Zanolini A, et al (2016). Impact of a community-based package of interventions on child development in Zambia: a cluster-randomised controlled trial. BMJ Global Health, 1(3):e000104.
40. Nyamasege CK, Kimani-Murage EW, Wanjohi M, et al (2021). Effect of maternal nutritional education and counselling on children's stunting prevalence in urban informal settlements in Nairobi, Kenya. Public Health Nutr, 24 (12):3740-3752.
41. Tomlinson M, Rotheram-Borus MJ, le Roux IM, et al (2016). Thirty-Six-Month Outcomes of a Generalist Paraprofessional Perinatal Home Visiting Intervention in South Africa on Maternal Health and Child Health and Development. Prev Sci, 17 (8):937-948.
42. Rockers PC, Leppänen JM, Tarullo A, et al (2023). Evaluation of a community health worker home visit intervention to improve child development in South Africa: A cluster-randomized controlled trial. PLoS Med, 20 (4):e1004222.
43. Galasso E, Weber AM, Stewart CP, et al (2019). Effects of nutritional supplementation and home visiting on growth and development in young children in Madagascar: a cluster-randomised controlled trial. Lancet Global Health, 7 (9):e1257-e1268.
44. Engebretsen IMS, Jackson D, Fadnes LT, et al (2014). Growth effects of exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa: the cluster-randomised PROMISE EBF trial. BMC Public Health, 14:633.
45. Lewin S, Munabi-Babigumira S, Glenton C, et al (2010). Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev, 2010(3):CD004015.
46. Purwanti D, Pajeriaty P, Rasyid A (2014). Faktor yang berhubungan dengan status gizi balita di wilayah kerja Puskesmas Madello Kabupaten Barru. Jurnal Ilmiah Kesehatan Diagnosis, 5 (1):8-13.
47. Tanner JC, Candland T, Odden WS (2016) Later impacts of early childhood interventions: a systematic review. Washington: Independent Evaluation Group, World Bank Group, World Bank Group, USA
48. Aboud FE, Moore AC, Akhter S (2008). Effectiveness of a community-based responsive feeding programme in rural Bangladesh: a cluster randomized field trial. Matern Child Nutr, 4 (4):275-86.
49. Sunguya BF, Poudel KC, Mlunde LB, et al (2013). Effectiveness of nutrition training of health workers toward improving caregivers' feeding practices for children aged six months to two years: a systematic review. Nutr J, 12:66.
50. O’Donovan J, O’Donovan C, Kuhn I, et al (2018). Ongoing training of community health workers in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Open, 8 (4):e021467.
51. Ayele F, Desta A, Larson C (1993). The functional status of community health agents: atrial of refresher courses and regular supervision. Health Policy and Planning, 8 (4):379-384.
52. Shi L, Zhang J (2011). Recent evidence of the effectiveness of educational interventions for improving complementary feeding practices in developing countries. J Trop Pediatr, 57 (2):91-8.
53. Albelbeisi A, Shariff ZM, Mun CY, et al (2020). Multiple micronutrient supplementation improves growth and reduces the risk of anemia among infants in Gaza Strip, Palestine: a prospective randomized community trial. Nutr J, 19 (1):133.
54. Adu-Afarwuah S, Lartey A, Brown KH, et al (2007). Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. Am J Clin Nutr, 86 (2):412-20.
55. Miranda AV, Sirmareza T, Nugraha RR, et al (2023). Towards stunting eradication in Indonesia: Time to invest in community health workers. Public Health Chall, 2 (3):e108.
2. Stewart CP, Iannotti L, Dewey KG, et (2013). Contextualising complementary feeding in a broader framework for stunting prevention. Matern Child Nutr, 9 (Suppl 2):27-45.
3. Gardner JM, Grantham-McGregor SM, Himes J, et al (1999). Behaviour and development of stunted and nonstunted Jamaican children. J Child Psychol Psychiatry, 40 (5):819-27.
4. Aryastami NK, Shankar A, Kusumawardani N, et al (2017). Low birth weight was the most dominant predictor associated with stunting among children aged 12–23 months in Indonesia. BMC Nutrition, 3 (1):1-6.
5. Goudet SM, Kimani-Murage EW, Wekesah F, et al (2017). How does poverty affect children’s nutritional status in Nairobi slums? A qualitative study of the root causes of undernutrition. Public Health Nutr, 20 (4):608-619.
6. Fenske N, Burns J, Hothorn T, et al (2013). Understanding child stunting in India: a comprehensive analysis of socio-economic, nutritional and environmental determinants using additive quantile regression. PloS One, 8 (11):e78692.
7. Black RE, Victora CG, Walker SP, et al (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet, 382 (9890):427-451.
8. Horton S, Shekar M, McDonald C, et al (2009). Scaling up nutrition: What will it cost? World Bank Publications, WORLD.
9. Westerbotn M, Monfors F, Reusser J, et al (2023). Promoting health and preventing malnutrition among children in rural Bangladesh: A qualitative study. Nurs Open, 10 (8):5693-5700.
10. Darzi A, Evans T (2016). The global shortage of health workers-an opportunity to transform care. Lancet, 388 (10060):2576-2577.
11. Love MB, Gardner K, Legion V (1997). Community health workers: who they are and what they do. Health Educ Behav, 24 (4):510-22.
12. Perry HB, Zulliger R, Rogers MM (2014). Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health, 35:399-421.
13. Chen L, Evans T, Anand S, et al (2004). Human resources for health: overcoming the crisis. Lancet, 364 (9449):1984-90.
14. Phuka J, Maleta K, Thomas M, et al (2014). A job analysis of community health workers in the context of integrated nutrition and early child development. Ann N Y Acad Sci, 1308 (1):183-191.
15. Kemenkes R (2012). Buku Saku Posyandu. Pusat Promosi Kesehatan, KEMENKES Indonesia.
16. Yousafzai AK, Rasheed MA, Rizvi A, et al (2014). Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: a cluster-randomised factorial effectiveness trial. Lancet, 384 (9950):1282-93.
17. Cosgrove S, Moore-Monroy M, Jenkins C, et al (2014). Community health workers as an integral strategy in the REACH U.S. program to eliminate health inequities. Health Promot Pract, 15 (6):795-802.
18. Organization WH (2018). WHO guideline on health policy and system support to optimize community health worker programmes. ed. World Health Organization.
19. Martin MA, Perry-Bell K, Minier M, et al (2019). A Real-World Community Health Worker Care Coordination Model for High-Risk Children. Health Promot Pract, 20 (3):409-418.
20. Mørkve ÅW, Sitienei J, Van den Bergh G (2024). “We Are Just Supposed to Be an NGO Helping”: A Qualitative Case Study of Health Workers’ and Volunteers’ Perceptions of the Government and Civil Society’s Role in Fighting Jiggers in Bungoma County, Kenya. Societies, 14 (2):28.
21. Venditti EM, Zgibor JC, Vander Bilt J, et al (2018). Mobility and Vitality Lifestyle Program (MOVE UP): A Community Health Worker Intervention for Older Adults With Obesity to Improve Weight, Health, and Physical Function. Innov Aging, 2 (2):igy012.
22. Khairunnisa C, Siagian A, Siregar FA, et al (2021). Social Medicine Approach in the Management of Lung Tuberculosis (TB) in North Aceh Regency: Role of Government and Non-Governmental Organization. Journal of Health, Medicine and Nursing,DOI: 10.7176/JHMN/95-07.
23. Bridge R, Lin TK (2024). Evidence on the impact of community health workers in the prevention, identification, and management of undernutrition amongst children under the age of five in conflict-affected or fragile settings: a systematic literature review. Confl Health, 18 (1):16.
24. Pallas SW, Minhas D, Pérez-Escamilla R, et al (2013). Community health workers in low- and middle-income countries: what do we know about scaling up and sustainability? Am J Public Health, 103 (7):e74-82.
25. JBI (2019) Critical Appraisal Tools. Joana Briggs Institute.
26. Melo G, Dutra KL, Rodrigues Filho R, et al (2018). Association between psychotropic medications and presence of sleep bruxism: A systematic review. J Oral Rehabil, 45 (7):545-554.
27. McHugh ML (2012). Interrater reliability: the kappa statistic. Biochem Med (Zagreb), 22 (3):276-82.
28. Locks LM, Dahal P, Pokharel R, et al (2019). Changes in growth, anaemia, and iron deficiency among children aged 6–23 months in two districts in Nepal that were part of the post‐pilot scale‐up of an integrated infant and young child feeding and micronutrient powder intervention. Matern Child Nutr, 15 (2):e12693.
29. Yadav D, Gupta N, Shrestha N, et al (2014). Community Based Nutrition Education for Promoting Nutritional Status of Children under Three Years of Age in Rural Areas of Mahottari District of Nepal. Journal of Nepal Paediatric Society, 34(3):181-187.
30. Aboud FE, Singla DR, Nahil MI, et al (2013). Effectiveness of a parenting program in Bangladesh to address early childhood health, growth and development. Soc Sci Med, 97:250-8.
31. Menon P, Nguyen PH, Saha KK, et al (2016). Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: results of a cluster-randomized program evaluation in Bangladesh. J Nutr, 146 (10):2075-2084.
32. Mistry SK, Hossain MB, Arora A (2019). Maternal nutrition counselling is associated with reduced stunting prevalence and improved feeding practices in early childhood: a post-program comparison study. Nutr J, 18(1):47.
33. Khan GN, Ariff S, Kureishy S, et al (2021). Effectiveness of wheat soya blend supplementation during pregnancy and lactation on pregnancy outcomes and nutritional status of their infants at 6 months of age in Thatta and Sujawal districts of Sindh, Pakistan: a cluster randomized-controlled trial. Eur J Nutr, 60(2):781-789.
34. Khan A, Ul-Haq Z, Fatima S, et al (2023). Long-Term Impact of Multiple Micronutrient Supplementation on Micronutrient Status, Hemoglobin Level, and Growth in Children 24 to 59 Months of Age: A Non-Randomized Community-Based Trial from Pakistan. Nutrients, 15 (7):1690.
35. Nair N, Tripathy P, Sachdev H, et al (2017). Effect of participatory women's groups and counselling through home visits on children's linear growth in rural eastern India (CARING trial): a cluster-randomised controlled trial. Lancet Glob Health, 5 (10):e1004-e1016.
36. Effendy DS, Prangthip P, Soonthornworasiri N, et al (2020). Nutrition education in Southeast Sulawesi Province, Indonesia: A cluster randomized controlled study. Matern Child Nutr, 16 (4):e13030.
37. Argaw A, de Kok B, Toe LC, et al (2023). Fortified balanced energy–protein supplementation during pregnancy and lactation and infant growth in rural Burkina Faso: A 2 × 2 factorial individually randomized controlled trial. PLoS Med, 20 (2):e1004186.
38. Sudfeld CR, Bliznashka L, Ashery G, et al (2021). Effect of a home-based health, nutrition and responsive stimulation intervention and conditional cash transfers on child development and growth: a cluster-randomised controlled trial in Tanzania. BMJ Global Health, 6(4):e005086.
39. Rockers PC, Fink G, Zanolini A, et al (2016). Impact of a community-based package of interventions on child development in Zambia: a cluster-randomised controlled trial. BMJ Global Health, 1(3):e000104.
40. Nyamasege CK, Kimani-Murage EW, Wanjohi M, et al (2021). Effect of maternal nutritional education and counselling on children's stunting prevalence in urban informal settlements in Nairobi, Kenya. Public Health Nutr, 24 (12):3740-3752.
41. Tomlinson M, Rotheram-Borus MJ, le Roux IM, et al (2016). Thirty-Six-Month Outcomes of a Generalist Paraprofessional Perinatal Home Visiting Intervention in South Africa on Maternal Health and Child Health and Development. Prev Sci, 17 (8):937-948.
42. Rockers PC, Leppänen JM, Tarullo A, et al (2023). Evaluation of a community health worker home visit intervention to improve child development in South Africa: A cluster-randomized controlled trial. PLoS Med, 20 (4):e1004222.
43. Galasso E, Weber AM, Stewart CP, et al (2019). Effects of nutritional supplementation and home visiting on growth and development in young children in Madagascar: a cluster-randomised controlled trial. Lancet Global Health, 7 (9):e1257-e1268.
44. Engebretsen IMS, Jackson D, Fadnes LT, et al (2014). Growth effects of exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa: the cluster-randomised PROMISE EBF trial. BMC Public Health, 14:633.
45. Lewin S, Munabi-Babigumira S, Glenton C, et al (2010). Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev, 2010(3):CD004015.
46. Purwanti D, Pajeriaty P, Rasyid A (2014). Faktor yang berhubungan dengan status gizi balita di wilayah kerja Puskesmas Madello Kabupaten Barru. Jurnal Ilmiah Kesehatan Diagnosis, 5 (1):8-13.
47. Tanner JC, Candland T, Odden WS (2016) Later impacts of early childhood interventions: a systematic review. Washington: Independent Evaluation Group, World Bank Group, World Bank Group, USA
48. Aboud FE, Moore AC, Akhter S (2008). Effectiveness of a community-based responsive feeding programme in rural Bangladesh: a cluster randomized field trial. Matern Child Nutr, 4 (4):275-86.
49. Sunguya BF, Poudel KC, Mlunde LB, et al (2013). Effectiveness of nutrition training of health workers toward improving caregivers' feeding practices for children aged six months to two years: a systematic review. Nutr J, 12:66.
50. O’Donovan J, O’Donovan C, Kuhn I, et al (2018). Ongoing training of community health workers in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Open, 8 (4):e021467.
51. Ayele F, Desta A, Larson C (1993). The functional status of community health agents: atrial of refresher courses and regular supervision. Health Policy and Planning, 8 (4):379-384.
52. Shi L, Zhang J (2011). Recent evidence of the effectiveness of educational interventions for improving complementary feeding practices in developing countries. J Trop Pediatr, 57 (2):91-8.
53. Albelbeisi A, Shariff ZM, Mun CY, et al (2020). Multiple micronutrient supplementation improves growth and reduces the risk of anemia among infants in Gaza Strip, Palestine: a prospective randomized community trial. Nutr J, 19 (1):133.
54. Adu-Afarwuah S, Lartey A, Brown KH, et al (2007). Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. Am J Clin Nutr, 86 (2):412-20.
55. Miranda AV, Sirmareza T, Nugraha RR, et al (2023). Towards stunting eradication in Indonesia: Time to invest in community health workers. Public Health Chall, 2 (3):e108.
| Files | ||
| Issue | Vol 54 No 11 (2025) | |
| Section | Review Article(s) | |
| Keywords | ||
| CHWs Stunting LMICs Nutrition interventions Health education Food supplementation | ||
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How to Cite
1.
Pranata M, Saddiq F, Wang JY, Yeh YL. Effectiveness of Interventions Utilizing Community Health Worker Model on Reducing Stunting in Low- and Middle-Income Countries: A Systematic Review. Iran J Public Health. 2025;54(11):2342-2355.
