Community Health Workers and Adolescent Health and Well-Being Across Sub-Saharan Africa: A Systematic Review and Meta-Analysis

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 synthesized evidence on the effectiveness of CHW-led interventions to improve adolescent health and well-being in SSA. 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 categorized by setting (community or school) and provider (lay or paraprofessional; peer-led 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 Grading of Recommendations Assessment, Development and Evaluation approach. Thirty-five studies were included spanning across 12 countries and 12 outcomes. All outcomes were summarized narratively. Meta-analyses showed very low-certainty strong evidence for increased modern contraceptive use (risk ratio: 1.50; 95% confidence interval [CI], 1.13-1.99), low-certainty moderate evidence for reduced depression (standardized mean difference: -0.31; 95% CI, -0.61-0.00), and low-certainty weak evidence for improved human immunodeficiency virus viral suppression (risk ratio: 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. 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.