The Effectiveness and Cost-Effectiveness of Community Health Workers in Delivering Antenatal Care and Immunization Services to Pregnant Mothers and Children Under 5 in Rural Africa: A Study Protocol for a Systematic Review and Meta-Analysis

Abstract Background: Maternal and child health care, particularly antenatal care (ANC) and immunization services, are essential to improving health outcomes in rural Africa. Despite global efforts, access to high-quality health care services remains limited in rural areas, contributing to high maternal and childhood mortality rates. Community Health Workers (CHWs) have been recognized as a promising solution for bridging this gap by providing essential services directly to underserved populations. This systematic review and meta-analysis aims to evaluate the effectiveness and cost-effectiveness of CHWs in delivering antenatal care and immunization services to pregnant mothers and children under 5 in rural Africa. Methods: This review will include randomized controlled trials (RCTs), cohort studies, case-control studies, and observational studies published from 2014 onward. The search strategy will be implemented across multiple databases, including Google Scholar, Academic Info, Cochrane, Refseek, PubMed, and MEDLINE. The primary outcomes will focus on clinical and economic measures, including maternal and child health outcomes and cost-effectiveness of CHW interventions. Data extraction and quality assessment will be conducted independently by two reviewers, with discrepancies resolved through discussion or the involvement of a third reviewer. Discussion: The findings from this review will contribute to the understanding of the role CHWs play in improving maternal and child health outcomes in rural Africa. The results will provide valuable insights for policymakers, health care providers, and stakeholders to inform future interventions and resource allocation strategies. Registration: This protocol is registered in PROSPERO Registration number CRD42024529963. Keywords: Community Health Workers, Antenatal Care, Immunization, Rural Africa, Maternal Health, Child Health, Cost-Effectiveness, Systematic Review, Meta-Analysis