Abstract
Background: Despite 60% coverage by Lady Health Worker (LHW) Program, 30% of child deaths in Pakistan are still due to diarrhea and pneumonia. Caregivers are an important stakeholder yet there is little information on their case management practices and utilization of LHW Program. This study explored caregivers’ knowledge and practices about childhood diarrhea and pneumonia and utility of LHW services before and after a supportive supervision intervention. Methods: Cross sectional surveys were conducted with caregivers’ (mothers) pre and post intervention in project NIGRAAN. The intervention aimed to improve LHSs clinical and supervisory skills of lady health supervisors in order to improve LHW performance and ultimately impact caregiver practices. 4250 households were surveyed. Questionnaire was adapted from PDHS 2012-13. Differences between intervention and control groups were assessed using chi square test. P-value of <0.05 was considered significant. Results: Comparing baseline to end line, there were significant overall improvements in caregivers’knowledge of loose motion (62 to 84%) and dehydration (12 to 18%) as signs and symptoms of childhood diarrhea. There was also a significant overall increase in caregivers’ knowledge of presenting features of pneumonia- i.e. fever (58 to 86%), cough (51 to 61%) and breathing problems (25 to 57%). The proportion of caregivers seeking advice for diarrhea from public sector significantly improved in intervention arm from 20% to 29%. Private sector however remained overall preferred choice for care seeking. There was significant overall improvement in awareness about LHWs functioning (93 to 99%) and household visits (91 to 98%). Actual care seeking from LHWs however stayed low (≤ 0.3%) Conclusion: In order to improve utility and expand coverage of LHW Program interventions aimed at providing supportive supervision have the potential to improve caregiver practices and utilization of available services and decrease childhood deaths due to preventable illnesses.
Highlights
Despite 60% coverage by Lady Health Worker (LHW) Program, 30% of child deaths in Pakistan are still due to diarrhea and pneumonia
This study explores if there was any improvement brought in caregivers’ knowledge and practices about childhood diarrhea and pneumonia as well as their perceptions and utility of the Lady Health Worker Program (LHW-P) before and after a supportive supervision intervention
The study found that comparing baseline to end line survey there were some improvements in the knowledge of caregivers about childhood diarrhea and pneumonia as well as their perceptions about the lady health worker’s program
Summary
Despite 60% coverage by Lady Health Worker (LHW) Program, 30% of child deaths in Pakistan are still due to diarrhea and pneumonia. Pakistan showed a slow progress and under achieved its millennium development goal (MDG-4) targets as the under-five morality fell from 117 deaths in 1990 to 86 deaths per 1,000 live births in 2013 with a gain of only 31 points, lagging behind some of the better performing neighbors like Sri Lanka, Nepal and India [2]. Much of this mortality can be prevented with proven lifesaving interventions for which the global coverage continues to remain low. Pakistan Demographic Health Survey (PDHS) of 2012-13 reports that only 42% of acute respiratory infections (ARI)
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