***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objectives : To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives . Design : R and omised controlled trial with six month follow up . Setting : Recruitment in a university teaching hospital and care provided in women 's homes . Participants : 623 postnatal women allocated at r and om to intervention ( 311 ) or control ( 312 ) group . Intervention : Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker . Main outcome measure : General health status as measured by the SF-36 and risk of postnatal depression . Breast feeding rates , satisfaction with care , use of services , and personal costs . Results : At six weeks there was no significant improvement in health status among the women in the intervention group . At six weeks the mean total NHS costs were £ 635 for the intervention group and £ 456 for the control group ( P=0.001 ) . At six months figures were £ 815 and £ 639 ( P=0.001 ) . There were no differences between the groups in use of social services or personal costs . The women in the intervention group were very satisfied with the support worker visits . Conclusions : There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36 . There were no savings to the NHS over six months after the introduction of the community postnatal support worker service A home visit intervention program for adolescents throughout their pregnancy and during the early stages of motherhood was evaluated . The participants ( N = 90 ) were part of a larger group of adolescents treated in two health centers in a poor neighborhood in Santiago , Chile . The program was carried out by volunteer community health monitors and evaluated through an experimental , r and omized , controlled clinical trial . Cost-effectiveness was examined in comparison with st and ard health care . Results show higher scores for the intervention group on the mothers ’ mental health and nutritional state , as well as on the children ’s levels of linguistic development OBJECTIVE To describe the costs of providing support to breastfeeding low-income women and compares costs to cost offsets of the intervention . DESIGN Secondary analysis of data from a r and omized controlled trial of an intervention to promote breastfeeding  among low-income women with full-term infants . SETTING A university hospital and a community hospital in Baltimore , Maryl and . PARTICIPANTS Special Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) eligible breastfeeding women ( N = 328 ) were r and omized to usual care or the community health nurse/peer counselor intervention . METHODS The research ers collected and described personnel and mileage costs over the entire duration of the intervention ( 24 weeks ) . Research ers also compared ( using t tests ) change in re sources associated with breastfeeding including the number of clinic visits , hospital nights , emergency room visits , prescriptions , and formula feedings per day up to 12 weeks . RESULTS The cost of the personnel and travel required for the intervention was $ 296 per woman . The use of medical care and number of formula feedings per day were similar for the intervention and usual care groups . When differences in use of medical care and formula feeding were statistically significant , the intervention group used fewer re sources . CONCLUSION Support for breastfeeding by community health nurses and peer counselors is partially offset by reducing medical care utilization and formula feeding costs We did a cost-effectiveness analysis alongside a cluster-r and omised controlled trial of a participatory intervention with women 's groups  to improve birth outcomes in rural Nepal . The average provider cost of the women 's group intervention was US0.75 dollars per person per year ( 0.90 dollars with health-service strengthening ) in a population of 86,704 . The incremental cost per life-year saved ( LYS ) was 211 dollars ( 251 dollars ) , and expansion could rationalise on start-up costs and technical assistance , reducing the cost per LYS to 138 dollars ( 179 dollars ) . Sensitivity analysis showed a variation from 83 dollars to 263 dollars per LYS for most variables . This intervention could provide a cost-effective way of reducing neonatal deaths BACKGROUND Breastfeeding can ameliorate some of the complex health issues faced by low-income families . Women who breastfeed and their infants have lower health care costs compared with those who formula feed . Increasing the duration of breastfeeding is recognized as a national priority , particularly for low-income women . This community-based r and omized clinical trial involving low-income mothers compared usual care with an intervention comprising hospital and home visits , and telephone support by a community health nurse/peer counselor team for 6 months after delivery . METHODS Forty-one women were recruited after delivery of a full-term singleton infant and r and omly assigned to intervention or usual care groups . RESULTS Women receiving the community health intervention  breastfed longer than the women receiving usual care . The infants in the intervention group had fewer sick visits and reported use of fewer medications than infants in the usual care group . The intervention cost ( $ 301/mother ) was partially offset by cost savings on formula and health care . CONCLUSIONS Community health nurse and peer counselor support can increase breastfeeding duration in low-income women , and has the potential to reduce total costs including the cost of support Background Intermittent preventive treatment for malaria in children ( IPTc ) involves the administration of a full course of an anti-malarial treatment to children under 5 years old at specified time points regardless of whether or not they are known to be infected , in areas where malaria transmission is seasonal . It is important to determine the costs associated with IPTc delivery via community based volunteers and also the potential savings to health care providers and caretakers due to malaria episodes averted as a consequence of IPTc . Methods Two thous and four hundred and fifty-one children aged 3–59 months were r and omly allocated to four groups to receive : three days of artesunate plus amodiaquine ( AS+AQ ) monthly , three days of AS+AQ bimonthly , one dose of sulphadoxine-pyrimethamine ( SP ) bi-monthly or placebo . This paper focuses on incremental cost effectiveness ratios ( ICERs ) of the three IPTc drug regimens as delivered by community based volunteers ( CBV ) in Hohoe , Ghana compared to current practice , i.e. case management in the absence of IPTc . Financial and economic costs from the publicly funded health system perspective are presented . Treatment costs borne by patients and their caretakers are also estimated to present societal costs . The costs and effects of IPTc during the intervention period were considered with and without a one year follow up . Probabilistic sensitivity analysis was undertaken to account for uncertainty . Results Economic costs per child receiving at least the first dose of each course of IPTc show SP bimonthly , at US$ 8.19 , is the cheapest to deliver , followed by AS+AQ bimonthly at US$ 10.67 and then by AS+AQ monthly at US$ 14.79 . Training , drug delivery and supervision accounted for approximately 20–30 % each of total unit costs . During the intervention period AS & AQ monthly was the most cost effective IPTc  drug regimen at US$ 67.77 ( 61.71–74.75 , CI 95 % ) per malaria case averted based on intervention costs only , US$ 64.93 ( 58.92–71.92 , CI 95 % ) per malaria case averted once the provider cost savings are included and US$ 61.00 ( 54.98 , 67.99 , CI 95 % ) when direct household cost savings are also taken into account . SP bimonthly was US$ 105.35 ( 75.01–157.31 , CI 95 % ) and AS & AQ bimonthly US$ 211.80 ( 127.05–399.14 , CI 95 % ) per malaria case averted based on intervention costs only . The incidence of malaria in the post intervention period was higher in children who were < 1 year old when they received AS+AQ monthly compared to the placebo group leading to higher cost effectiveness ratios when one year follow up is included . The cost per child enrolled fell considerably when modelled to district level as compared to those encountered under trial conditions . Conclusions We demonstrate how cost-effective IPTc  is using three different drug regimens and the possibilities for reducing costs further if the intervention was to be scaled up to the district level . The need for effective training , drug delivery channels and supervision to support a strong network of community based volunteers is emphasised OBJECTIVES This study aim ed to measure the effect and the total cost per woman of providing postnatal support at home , based on a Dutch model . The research hypothesis was furnished by some existing evidence that postnatal support could reduce the risk of postnatal depression and encourage breastfeeding . DESIGN The r and omised controlled trial aim ed to measure differences in health status in a group of women who were offered postnatal support from a community midwifery support worker ( SW ) compared with a  control group of women who were not offered this support .  Women were followed-up by postal question naire at 6 weeks and 6 months postnatally . SETTING AND SUBJECTS All women who delivered a baby at the recruiting hospital were eligible to take part in the trial if they lived within the study area , were aged 17 years or over , and could underst and English . INTERVENTION The intervention consisted of the SW offering practical and emotional support and to help women rest and recover after childbirth . The SW offered ten visits in the first 28 days postnatally , for up to 3 hours per day . The SW 's activities included housework , talking with the mother , and care for the baby or other siblings . The service was provided in addition to routine visits by the community midwife . MAIN OUTCOME MEASURES The primary outcome was the general health perception domain of the Short Form-36 at 6 weeks . Secondary outcomes were mean Edinburgh Postnatal Depression Scale ( EPDS ) , Duke Functional Social Support ( DUFSS ) scores and breastfeeding rates . RESULTS The 623 r and omised women were well-matched by group with a good response to follow-up . At 6 weeks there was no evidence of a significant difference between the two groups for the primary outcome . There was a non-significant trend for the control group to have better mean DUFSS and EPDS scores at 6 weeks . Breastfeeding rates were not significantly different at follow-up . At 6 months , both groups had similar health status . Satisfaction with the service was higher than for all other services received . The incremental cost of introducing the service comprised setting up and running the service . There were no differences between the groups in other re source use ( general practitioner contacts , hospital services , prescriptions or medicines bought for mothers and babies ) to 6-month follow-up . The total mean NHS cost to 6-month follow-up for the intervention group was pound180 per woman greater than for the control group ( confidence interval , pound79.60 , pound272.40 ) . CONCLUSIONS Although women valued the service , there was no evidence of any health benefit at the 6-week or 6-month follow-up , no difference in use of NHS services , and the additional cost of the service provision would be around pound 180 per woman OBJECTIVE To assess the cost-effectiveness of two strategies of home management of under-five fevers in Ghana - treatment using antimalarials only ( artesunate-amodiaquine - AAQ ) and combined treatment using antimalarials and antibiotics ( artesunate-amodiaquine plus amoxicillin - AAQ + AMX ) . METHODS We assessed the costs and cost-effectiveness of AAQ and AAQ + AMX compared with a control receiving st and ard care . Data were collected as part of a cluster r and omised controlled trial with a step-wedged design . Approximately , 12,000 children aged 2 - 59 months in Dangme West District in southern Ghana were covered . Community health workers delivered the interventions . Costs were analysed from societal perspective , using anaemia cases averted , under-five deaths averted and disability-adjusted life years ( DALYs ) averted as effectiveness measures . RESULTS Total economic costs for the interventions were US$ 204,394.72 ( AAQ ) and US$ 260,931.49 ( AAQ + AMX ) . Recurrent costs constituted 89 % and 90 % of the total direct costs of AAQ and AAQ + AMX , respectively . Deaths averted were 79.1 ( AAQ ) and 79.9 ( AAQ + AMX ) , with DALYs averted being 2264.79 ( AAQ ) and 2284.57 ( AAQ + AMX ) . The results show that cost per anaemia case averted were US$ 150.18 ( AAQ ) and US$ 227.49 ( AAQ + AMX ) and cost per death averted was US$ 2585.58 for AAQ and US$ 3272.20 for AAQ + AMX . Cost per DALY averted were US$ 90.25 ( AAQ ) and US$ 114.21 ( AAQ + AMX ) . CONCLUSION Both AAQ and AAQ + AMX approaches were cost-effective , each averting one DALY at less than the st and ard US$ 150 threshold recommended by the World Health Organisation . However , AAQ was more cost-effective . Home management of under-five fevers in rural setting s is cost-effective in reducing under-five mortality Early childhood programs are heralded as a way to improve children 's health and educational outcomes . However , few studies in developing countries calculate the effectiveness of quality early childhood interventions . Even fewer estimate the associated costs of such interventions . The study here looks at the costs and effectiveness of a cluster-r and omized effect 
    Output:
    
We found evidence of cost-effectiveness of community health worker ( CHW ) interventions in reducing malaria and asthma , decreasing mortality of neonates and children , improving maternal health , increasing exclusive breastfeeding and improving malnutrition , and positively impacting physical health and psychomotor development amongst children .
Outcomes included disease- or condition -specific outcomes , morbidity , mortality , and generic measures ( e.g. disability-adjusted life years ( DALYs ) ) .
This is the first systematic review to assess the cost-effectiveness of community health workers in delivering child health interventions