Community health workers and adolescent health and well-being across sub-Saharan Africa: A systematic review

Introduction. Adolescence represents a pivotal stage of development. Community health workers (CHWs) may constitute a valuable approach to addressing adolescent health challenges in sub-Saharan Africa (SSA). This review systematically synthesised evidence on the effectiveness of CHW-led interventions to improve adolescent health and well-being in SSA. Methods. We searched 12 databases and 19 grey literature sources for relevant studies published between January 2014 and October 2024. Interventions were classified by settings (community or school) and by delivery (lay or paraprofessional, peer- or adult-led). Vote-counting and meta-analyses were conducted, alongside risk of bias and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessments. Results. Fifty studies were included spanning across 11 countries and 21 outcomes. All outcomes were summarised narratively. Meta-analyses showed moderate-certainty evidence for reducing post-traumatic stress (PTS), low-certainty evidence for reducing depression and improving human immunodeficiency virus (HIV) viral suppression, and very low-certainty evidence for increasing modern contraceptive use. No clear effects were observed for HIV and sexual health knowledge or adolescent pregnancy, all with very low certainty. Conclusion. CHW-led programmes show promise for improving adolescent mental health and HIV suppression outcomes and may support contraceptive use in SSA. However, future research is needed on other adolescent health domains.