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

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Abstract Introduction Adolescence represents a pivotal stage of development. Community health workers (CHWs) may offer 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 14 databases and 17 grey literature sources for studies published between January 2014 and October 2024. The protocol was registered in PROSPERO (CRD42024618546). Interventions were categorised by setting (community or school) and provider (lay or paraprofessional; peer- or adult-led). Vote-counting and meta-analyses were conducted, alongside risk of bias using Joanna Briggs Institute tools and evidence quality assessments using the GRADE approach. Results Thirty-five studies were included spanning across 12 countries and 12 outcomes. All outcomes were summarised narratively. Meta-analyses showed very low-certainty strong evidence for increased modern contraceptive use (RR: 1.50, 95% confidence interval [CI] 1.13-1.99), low-certainty moderate evidence for reduced depression (SMD: −0.31, 95% CI −0.61-0.00), and low-certainty weak evidence for improved human immunodeficiency virus viral suppression (RR: 1.16, 95% CI 0.99-1.36). No clear effects were observed for sexual health knowledge, unmet need for contraception, or adolescent pregnancy, all with very-low certainty. Discussion CHW-led interventions show promise for improving adolescent contraceptive use and mental health in SSA. However, substantial heterogeneity warrants cautious interpretation, and more rigorous evidence is needed across all health domains. Implications and Contribution Drawing on 35 studies, this systematic review consolidates evidence on community health workers’ role in supporting adolescent health across Africa. It shows potential to improve modern contraceptive use, mental health, and HIV viral load suppression, while exposing evidence gaps in other domains and setting priorities for future investment and research.

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