Female Community Health Workers Research Articles

Development and evaluation of a training program on non-communicable diseases to empower community health workers in rural India

ObjectiveWe developed and evaluated a training program for Accredited Social Health Activists (ASHAs), female community health workers (CHWs) in India, on non-communicable diseases (NCDs). MethodsA 5-day training program, developed using government-approved manuals, was tested in a randomised controlled trial in the Tehri-Garhwal district. Quantitative comparisons were undertaken using Student's t-test and two-way ANOVA. ASHAs in the intervention group were asked questions about new skills learnt. ResultsThirty-six ASHAs (20 intervention, 16 controls) participated (response rate 75.0%). Mean pre-test knowledge score was 43.3/100 points (95% CI 36.7–49.9) for the intervention group and 44.4 (38.9–49.9) for controls. The mean post-test knowledge score increased more in the intervention group (48.5-point increase; P < 0.0001), than in controls (9.8-point increase, P = 0.016; ANOVA interaction term (time*allocation) P < 0.0001). ASHAs in the intervention group reported learning new skills for detecting NCDs. ConclusionThe training program increased knowledge of ASHAs on NCDs and improved their skills to detect NCDs. Our development and testing process for this training program, coupled with open-source resources, fosters innovation and collaboration in managing NCDs in LMICs. InnovationOur novel and adaptable training program incorporates interactive elements, case studies, and real-world scenarios to augment routine communication between ASHAs and community members for preventing NCDs.

Anthropometric knowledge and measurement evaluation among female volunteer community health workers in Depok

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: At the community level, assessment for children nutritional status is measured by female volunteer community health workers (FVCHW) through integrated health post (Posyandu). Based on initial observation, volunteers have sufficient knowledge of anthropometric measurement however, to put it into practice, common pitfalls remain found.Refreshment on basic knowledge and practical training on anthropometric assessment is needed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives&lt;/strong&gt;: As part of Kampung Caraka Project that attempts to empower locals to be deliberately aware of community health and well-being, this particular study aims to evaluate knowledge of FVCHW as well as their accuracy and precision on anthropometric assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: This study is a quasi-experimental study with pre-posttest with control group design. The sample was purposively selected and 54 overweight adolescents were divided into a control group and two intervention groups. Education using healthy snacks quartet was conducted for 21 days from September to October 2023 in Makassar City. Data analysis was performed using Wilcoxon singed ranks test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: Results showed women with good precision for MUAC, height, head circumferences and length measurement were 23.1%, 23.1%, 53.8% and 33.3%, respectively. In contrast, only 7.7% of women had good accuracy on MUAC measurement. There is a significant difference of knowledge score before and after the education given (p-value 0.02, CI 95%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: The cadre had good precision yet poor accuracy, implying the necessity of standardized procedure and regular equipment calibration prior to anthropometric measurement. There is a difference in mean scores before and after the education given, yet still denoted as low capacity. Further comprehensive education is highly required. &lt;/p&gt;

Exploring the motivations of female community health volunteers in primary healthcare provision in rural Nepal: A qualitative study.

Motivating Community Health Workers (CHWs)-many of whom are volunteers-is crucial for achieving Universal Healthcare Coverage (UHC) for Primary Healthcare (PHC) in resource-poor areas. In rural Nepal, PHC is mostly delivered by female CHWs, locally known as Female Community Health Volunteers (FCHVs), but little is known about them. This paper explores experiential factors influencing FCHVs' motivations, including how motivation intersects with women's livelihoods and consider what this means for achieving PHC in Nepal and globally. We conducted qualitative research in the hill and the Terai (flatland bordering India) areas of Nepal. Data were purposively collected through 31 semi-structured interviews (20 volunteers, 11 paid local health workers) and three focus group discussions with additional 15 volunteers. All interviews were audio-recorded, transcribed verbatim in Nepali and translated into English. Data were coded using NVivo10, analysed thematically at individual, organisational and community levels. FCHVs' motivations to volunteer was affected in several ways. At the individual level, participants wanted and were committed to voluntary work, yet the opportunity costs of volunteering, out-of-pocket expenditure and inadequate family support strained many of the women who were already overburdened. At the community level, perceived lack of appreciation of volunteer efforts by community members, who saw volunteers as paid health workers, undermined FCHVs motivation to volunteer. Finally, at the organizational level, a bureaucratic emphasis on recording and reporting, and lack of respect from local health workers undermined their motivation at work. Our paper illustrates how FCHVs from some of the poorest backgrounds can be highly motivated to volunteer, yet inadequate social and economic support across individual, organisational and community levels undermined this motivation, the security of their livelihoods, and thus wider efforts to achieve PHC. Financial investments are needed to compensate FCHVs, so that they remain motivated to deliver global health goals for PHC.

What a mix! Volatile organic compounds and worker exposure in small business beauty salons in Tucson, Arizona.

Small business beauty salons have volatile organic compounds (VOCs) in their workplace air. VOCs are present as ingredients in beauty or hair products. They may also form because of chemical reactions, where thermal-styling elements accelerate the volatilization of these compounds. Uncertainties remain about the relationship between air pollutant concentrations and the variety of beauty salon activities in a work shift. Investigating these associations can help determine high-risk services, associated products, and at-risk workers. In this exploratory study, female community health workers recruited beauty salons from target zip codes in predominately Latino neighborhoods, including primarily Spanish-speaking small businesses. We collected salon chemical inventories, business characteristics, and participant activity logs to understand how chemicals and activities influence the total and specific VOC concentrations. We sampled personal total VOCs and specific VOCs from the same shop during the participant work shift. We also measured personal total VOCs for four work shifts per shop. A linear mixed effects model of log VOCs on the fixed effect of activity and the random effects of salon and shift within the salon showed that the variance between salons explains over half (55%) of the total variance and is 4.1 times bigger than for shifts within salons. Summa canisters detected 31 specific VOCs, and hazard scores ranged between 0 and 4.3. 2-Propanol (isopropyl alcohol) was the only VOC detected in all shifts of all salons. In this study, differences in VOC measurements were primarily between salons. These differences may result from differences in ventilation, services rendered, and product lines applied.

Do Indian women know about and use the emergency contraceptive pill? An analysis of nationally representative data from 2005–06 and 2019–21

Abstract The emergency contraceptive pill (ECP) is a post-coital contraceptive method that prevents unintended pregnancy and is useful in specific circumstances. This study examined the awareness and use of the ECP in India, as there is scarce evidence in this area to guide policy development. This study used data from the 2005–06 (n = 124 385) and 2019–21 (n = 724 115) rounds of the National Family Health Survey of India. Bivariate analysis and multivariate logistic regression were applied to explore how demographic characteristics including age, education (none, primary, secondary, higher), wealth quintile, place of residence (urban, rural), marital status, parity, desire for children, whether current pregnancy was wanted, whether the women had had an abortion in the past 5 years, and whether current use of contraceptive methods affected the likelihood of knowledge and use of ECP. In the past 15 years, knowledge of ECP has increased by 37 percentage points but still remains relatively low at 48%. Less than 1% of the sample (0.55%) used ECP. Women aged 30–34 years, from wealthier and more educated backgrounds, living in urban areas, and currently using condoms had a higher likelihood of using ECP in comparison with women from age group 15–19 years, those from the poorest backgrounds, those with no education, those living in rural areas and those not using any contraceptive method, respectively. In comparison to married women, never-married women exhibited a higher awareness of ECP but lower use. More efforts must be made to improve awareness of the ECP, especially among adolescents, those with less education, poorer women and those in rural areas. The government is taking steps to improve access to ECP, and India’s female community health workers, the ASHAs, could be further supported to enhance awareness of ECP.

A scoping review of maternal and neonatal health services impacted during COVID-19 in Nepal

Background Coronavirus Disease 2019 (COVID-19), a global pandemic, has resulted in millions of deaths worldwide and severely impacted health service delivery systems. Developing countries, including Nepal, faced the risk of health system failure due to limited infrastructures. During the pandemic, Nepal experienced a decline in medical service utilization by pregnant women and a decrease in national child immunization rates. Maternity services and child immunization services had significant consequences, serving as a warning for future pandemics. This article examines the effects of pandemic-induced stay-at-home policies on maternal and child immunization in Nepal. Methods A comprehensive literature search was conducted to identify relevant articles on PubMed, Scopus, and Google Scholar. The search terms employed were “maternal mortality in Nepal during COVID-19”, “maternity service utilisation in Nepal during COVID-19”, and “child immunisation in Nepal during COVID-19”. The search was limited to articles published between 2019 and 2022, research conducted in Nepal, and that included maternal mortality, utilisation of maternity services, and child immunisation in the title of the full text. Results Factors such as the closure of public transportation and service centres and fear of contamination contributed to a decline in antenatal care visits. The disruption of programs aimed at reducing the Maternal Mortality Rate (MMR) and decreased activities of Female Community Health workers in most parts of the country led to an increase in the maternal mortality rate during the stay-at-home policies. Institutional delivery decreased by 52.4% during the stay-at-home policies compared to the period before. The neonatal mortality rate increased from 13 to 40 per 1000 live births during the pandemic stay-at-home policies. Immunization centres were also closed in Nepal during the early stages of stay-at-home policies, with 50% of centres ceasing services. Measles outbreaks were reported in some parts of the country during the pandemic. Conclusions To mitigate future damage, specific guidelines should be established based on regional factors and infrastructure development. Measures such as providing protective equipment and maintaining communication with pregnant women via telephone can help reduce the impact of future pandemics.

Breaking the silence on gendered harassment and assault of community health workers: an analysis of ethnographic studies

IntroductionAcross a variety of settings, women in tenuous financial circumstances are drawn to community health work as a way to advance themselves in the context of limited employment options. Female...

Motivation and job satisfaction of community health workers in Ethiopia: a mixed-methods approach

BackgroundEthiopia has been providing health care to its rural population since 2004 using female Community Health Workers called Health Extension Workers (HEWs). The HEWs are credited with several achievements in improving the country's health indicators. However, information about the HEWs' motivation and job satisfaction is limited. The aim of this study was to assess the HEWs' motivation and job satisfaction, as well as the factors that influence them.MethodsA mixed-methods study was nested within a national health extension program assessment conducted from March 01 to May 31, 2019. A structured questionnaire which looked at motivation and satisfaction with Likert type single-question and multiple-item measures was used to collect quantitative data from 584 HEWs. Focus group discussion and in-depth interviews were used to gather qualitative data. Means and percentages were used to descriptively summarize important variables. Linear regression was used to identify factors associated with job satisfaction. The qualitative data was analysed thematically.ResultsOverall, 48.6% of HEWs were satisfied with their job, with a mean score of 2.5 out of 4.0. The result showed a high level of satisfaction with autonomy (72%), relationships with co-workers (67%), and recognition (56%). Low level of satisfaction was linked to pay and benefits (13%), opportunities for promotion (29%), and education (34%). Regression analysis showed that HEWs in the age category of 30 years and older had lower satisfaction scores as compared to HEWs in the age category of 18–24 years (adjusted β = − 7.71, 95% CI: − 14.42, − 0.99). The qualitative result revealed that desire to help their community, recognition or respect gained from the community, and achievement were the major motivating factors. In contrast, inadequate pay and benefit, limited education and career advancement opportunities, workload, work environment, limited supportive supervision, and absence of opportunity to change workplace were the demotivating factors.ConclusionsThe overall job satisfaction of HEWs was low; extrinsic factors, such as inadequate pay, limited education and career advancement opportunities were the major sources of demotivation. Policy makers and human resource managers should revise their human resource policies and guidelines to address the main sources of low level of job satisfaction and demotivation.

“Helping Mentally Ill, a Reward Both in this Life and After”: A Qualitative Study Among Community Health Professionals in Somaliland

This study aimed to describe the experiences of community mental health workers, predominantly female, nurses and doctors providing community-based mental health services in Borama, Somaliland. A qualitative explorative study using focus group discussions was conducted. Data were collected from three focus group discussions with 22 female community health workers, two medical doctors, and two registered nurses and analyzed using content analysis with an inductive approach. Three main categories were identified from the analysis: (1) bridging the mental health gap in the community; (2) working in a constrained situation; and (3) being altruistic. Overall, the community mental health workers felt that their role was to bridge the mental health gap in the community. They described their work as a rewarding and motivated them to continue despite challenges and improving community healthcare workers’ work conditions and providing resources in mental health services will contribute to strengthening mental health services in Somaliland.

Sustaining Agriculture and Nutrition Interventions: Continued Engagement of Village Model Farmers in Nepal.

In homestead food production (HFP) programs, village model farmers (VMFs), after training, implement agriculture and nutrition activities to improve household knowledge and practices. Little evidence exists on what enables VMFs to remain actively engaged and for impacts to be sustained. To examine variables explaining active engagement of VMFs, at least 4 years post-training, in an HFP program in Nepal. We used cross-sectional data, collected from 2018 to 2019, among 4750 VMFs of Suaahara, a multisectoral nutrition program. We assessed whether respondents registered their HFP group with the local government, conducted regular group meetings, discussed vegetable growing and chicken rearing practices with group members, or engaged in saving and credit activities in their HFP group. Outcome variable was a count of these 4 activities in which the VMF engaged. Socioeconomic, demographic, and programmatic explanatory variables were identified a priori and by bivariate analysis and were adjusted in ordinal regression models accounting for clusters. On average, VMFs engaged in 1.4 activities. Having attended primary or secondary school (adjusted odds ratios [AOR] = 1.39), being a female community health volunteer (AOR = 1.27), being from an advantaged caste/ethnic group (AOR = 1.34), receiving additional trainings (AOR = 1.56) and inputs (AOR = 1.31) were associated with more active engagement of VMFs. Village model farmers receiving more training and inputs were more likely to remain actively engaged. Female community health workers, people from higher caste/ethnic groups, and those with primary or secondary education were more likely to remain active VMFs and could be targeted for this role in HFP programs leading to sustained impact.

How Gender Influenced the Experience of Using a mHealth Intervention in Rural Mozambique: Secondary Qualitative Analysis of Community Health Worker Survey Data

BackgroundThe mixed-gender community health worker (CHW) program in Mozambique is a window into the different experiences that male and female CHWs may face in their work. The objective of this study is to investigate how gender influenced the experiences of community health workers using the PIERS on the Move (POM) mHealth app in Mozambique.MethodsThis is a secondary analysis by gender of health care workers involved in the Mozambique Community Level Intervention for Pre-eclampsia (CLIP) cluster randomized trial (NCT01911494). A structured survey with 10 open-ended questions was used to elicit CHW experiences using the POM app. Data collection took place in 2017 after completion of the CLIP trial. This analysis examined emergent themes to consider how experiences may have been shaped by health worker gender.ResultsOf the 43 CHWs who used the POM app, there were 31 (72%) women and 12 (28%) men. Gender differences emerged in descriptions of how using POM increased their value and respect by pregnant women and community members. Fifty-eight percent of female CHWs (18/31) said that POM positively influenced their status in the community in comparison to 33% of their male counterparts (4/12). While the small sample sizes, particularly of male CHWs who used POM, preclude conclusions, these findings were supported by qualitative results. Female CHWs tended to elaborate more about community perceptions of their increased value and status as health care providers than male CHWs.ConclusionCHWs work within existing gender norms. While gender norms are perceived to support the comfort of women to speak to another woman about their maternal and child health issues, gender norms also work against female CHWs as their professionalism may be questioned more than for their male counterparts. CHW's narratives suggested that the mHealth intervention was valued beyond the technology itself because it also added symbolic clinical value and demonstrated a tangible investment in their professional capacities, which may have been especially appreciated by the female CHWs.

Reduced incidence of maternal health conditions associated with the home-based newborn care intervention package in Rural Gadchiroli, India: a 13 years before – after comparison

Background To evaluate the association between home-based neonatal care interventions and the incidence of maternal health conditions as well as to estimate the longitudinal trend of the incidence of maternal health conditions over 13 years in 39 villages of the field program area of the of home-based neonatal care from rural Gadchiroli, India. Methods This was a before-after comparative analysis of a program implemented in thirty-nine villages in Gadchiroli, India. The home-based newborn care interventions were incrementally introduced during the field trial (1995 – 1998) and continued as a service program until 2008. Over thirteen years (1995–2008), pregnant women were recruited and followed up from the seventh month of pregnancy to 28 days postpartum by trained female community health workers who made antenatal, natal and post-natal home visits, provided health education to mothers for behavior change, managed normal and sick neonates as well as encouraged seeking medical care when necessary. They recorded maternal symptoms and signs, which a physician supervisor verified. Based on these symptoms and signs, a computer algorithm diagnosed 20 different maternal health conditions. The incidence of these conditions in the first year (1995-96) was compared with the intervention’s last two years (2006 - 2008). Result The mean coverage of home-based newborn care, assessed on eight indicators, increased from 48.5% in 1995 – 96 to 87.1% in 2006 – 08. The proportion of women with any maternal health conditions during pregnancy reduced by 44.76% (P&lt;0.001), during labor by 44.59% (P &lt;0.001) and during the postpartum period by 77.82% (P&lt;0.001). The mean number of maternal conditions per 100 women reduced by 69% (P&lt;0.001). The need for emergency obstetric care was reduced by 78.83% (P&lt;0.001). The proportion of women free of any maternal health condition increased from 32.9 % to 64.6 %. Conclusions Home-based neonatal care interventions were associated with a significant reduction in the incidence of maternal health conditions. Developing a dedicated package of home-based maternal care in combination with neonatal care may further improve maternal health.

Mental health care delivery in poor settings through trained female community health workers: A five-year intervention program in Somaliland

Background: The situation of mental health globally is alarming particularly in developing countries. In Somaliland/Somalia, every third person may be suffering from some sort of mental illness according to the World Health Organization. Major barriers to improve mental health include stigma and lack of skilled human resources. Objectives: The aim was to explore the feasibility of organizing integrated community-based mental, epilepsy and mother and child health services delivered by trained female community health workers (FCHWs) in three urban sites (Borama, Baki and Dila) in the Awdal Region, Somaliland. Methods: After selection of the 3 project sites and recruitment and training of project staff, a baseline survey was carried out. First, the sites were properly mapped based on existing geographical administrative sectors and sub-sectors of the sites. Then a representative sample of 2,722 households was randomly selected from all the 3 sites. The female head of each of those households were then interviewed using a questionnaire containing 22 questions on the target groups. The questionnaire responses were coded, and data analysed using Statistical software program, SPSS. After the baseline survey, the FCHWs were deployed in the sites assigning a specified area to each female worker. The FCHWs worked 6 hours per day 6 days per week and were required to visit 6 families each day including follow-ups. Their activities included identification of patients with severe mental illness (SMI) or with epilepsy, counselling, distribution of medications, follow-up of patients already on medication, referral, stigma reduction and documentation of their daily activities in logbooks. Results: The baseline study showed that 12% of the households were taking care of at least one person with SMI each, while 7% had one person with epilepsy each. Of the patients with SMI, 18% were on chains. During the project period (2015-2019), the number of people with SMI or with epilepsy who benefited from the project was 2.225 and 738 respectively and their families empowered through increased mental health awareness. Among the patients with SMI, 237 were on chains before intervention and 85% of them were successfully released from their shackles. Conclusions: This project has shown that deployment of trained and supported FCHWs can be used to reduce the mental health care gap in Somaliland. It is suggested as a model project which could, hopefully, be replicated and tested in other similar settings.

Female Community Health Workers and Health System Navigation in a Conflict Zone: The Case of Afghanistan.

Afghanistan ranked 171st among 188 countries in the Gender Inequality Index of 2011 and has only 16% of its women participating in the labor force. The country has been mired in violence for decades which has resulted in the destruction of the social infrastructure including the health sector. Recently, Afghanistan has deployed community health workers (CHW) who make up majority of the health workforce in the remote areas of this country. This paper aims to bring the plight of the CHWs to the forefront of discussion and shed light on the challenges they face as they attempt to bring basic healthcare to people living in a conflict zone. The paper discusses the motivations of Afghani women to become CHWs, their status in the community and within the health system, the threatening situations under which they operate, and the challenges they face as working women in a deeply patriarchal society within a conflict zone. The paper argues that female CHWs should be provided proper accreditation for their work, should be allowed and encouraged to progress in their careers, and should be instilled at the heart of healthcare program planning because they have the field experience to make the most effective and community oriented programmatic decisions.

"Antibiotics Can Work as a Contraceptive:" Contraceptive Knowledge and Use Among University Students in Calabar, Nigeria.

Introduction: Many sexually active youths who wish to delay pregnancy are not using any form of modern contraceptives. In sub-Saharan Africa, less than 1 in 5 sexually active youth do not use contraceptives. In Nigeria, 48.4% of all sexually active unmarried women have an unmet need for contraception. Although the literature is replete with information on structural barriers to modern contraceptives, there is limited scholarship on contextual factors that may inhibit modern contraceptive use among Nigerian youth. This study uses a qualitative research approach to assess knowledge and use of natural, modern, and folkloric contraceptive methods among a sample of university students in Calabar, Nigeria.Methods: This study used data from focus group discussions among women and men in university halls of residence, all of whom were unmarried. Also, three male pharmacists and three female community health workers were interviewed. All focus group discussions and interviews took place in August 2017 and were conducted in Calabar Metropolis, Cross River State, Nigeria. The audio recordings were transcribed into detailed summaries of the interviews and focus group discussions. All data analysis was completed using Atlas.Ti (version 8).Results: University men and women have limited knowledge of and application of natural and modern contraception. Participants listed folkloric methods of contraceptives, including repurposing pharmaceuticals (e.g., antibiotics, quinine, and Andrews Livers Salt-a laxative) as contraceptive agents. Respondents also discussed the use of non-pharmaceuticals such as water, salt solution, and squatting after intercourse as contraceptives. Generally, university students defaulted to withdrawal, calendar method, and emergency contraceptives as preferred methods of contraception. Lastly, condoms were used among participants in causal sexual encounters. In dating relationships, however, both male and female students cited their partners' hesitancy to condom use as such act could indicate distrust.Conclusion: Awareness and use of modern contraceptives are limited among university students in Calabar, Nigeria. The use of folkloric contraceptives could lead to bodily harm and unintended pregnancy. Further research is needed to elucidate factors that promote use of folkloric methods of contraceptives. Integration of contraceptive awareness into health promotion services for young people may help to dispel myths about folkloric methods of contraceptives while promoting awareness and use of safe and effective contraception.

Community Capacity Building for HIV and Addiction Service Integration: An Intervention Trial in Vietnam

Scientific findings and policy guidelines recommend integrating HIV and drug addiction prevention and care into community-based settings. Systematic capacity-building efforts are warranted to provide technical support for community health workers and improve their confidence in the integrated service provision. An intervention trial was conducted between 2018 and 2019 with 120 community health workers (CHW) from 60 communes in Vietnam’s four provinces. The 60 intervention CHW received in-person training to enhance their HIV/addiction-related service knowledge and skills. Online support groups were established between trained CHW and local HIV and addiction specialists. The intervention outcomes were assessed using mixed-effects regression models with the data collected at baseline and every 3 months for 1 year. Adjusted analyses showed that intervention CHW reported a significant increase in the interaction with other treatment providers than the control group at 6 months and remained at the 12-month follow-up. The difference in the improvement of confidence in HIV/addiction-related service delivery between the intervention and control groups was significant at 6-month but became insignificant at the 12-month. Male CHW were more confident in providing services than female CHW at baseline, and gender differences in the changing patterns were observed over time. This capacity-building intervention demonstrated promising outcomes on CHW inter-agency collaborations and confidence in service delivery. Gender divides in healthcare professionals should be attended to in future studies.

Investigating violence against Accredited Social Health Activists (ASHAs): a mixed methods study from rural North Karnataka, India

# Background Accredited Social Health Activists (ASHAs) are female community health workers who primarily work to improve local reproductive, maternal, neonatal, and child health across India. As ASHAs often hail from patriarchal environments and are positioned at the bottom of the healthcare hierarchy, they are vulnerable to experiencing different forms of violence from the various individuals that they interact with. There is a gap in knowledge about the violence ASHAs experience. The purpose of this study was to assess the working condition of ASHAs, the extent and types of violence they experienced, and the corresponding perpetrators of this violence in two districts of Northern Karnataka. # Methods Using a mixed methods approach, we first surveyed 396 ASHAs to characterize their experiences of violence. We then conducted in-depth interviews with 16 ASHAs to elaborate on survey findings. Data was analyzed using quantitative prevalence statistics and qualitative thematic analysis. # Results The majority of ASHAs reported economic (88%) or emotional violence (73%), while many ASHAs reported sexual (32%) or physical violence (26%). ASHAs reported high levels of economic violence from their beneficiaries and their beneficiaries’ families (64%), emotional violence from their co-workers (44%), and physical and sexual violence from their husbands (17% and 12% respectively). Mixed methods findings revealed that violence was often rooted from their low positioning on the healthcare hierarchy, a lack of respect from community members, and limited autonomy at home. # Conclusions Evidence from this study suggests that violence perpetrated against ASHAs is highly prevalent, diverse in forms, and often arises from the ASHA’s immediate circles. Interventions aiming to decrease violence against ASHA workers requires multi-level approach, with collaborative components empowering ASHAs, sensitizing ASHA families and co-workers, implementing regulations at the health facility level, and increasing community-wide respect for ASHAs and their role in the health care.

Factors influencing the performance of accredited social health activists in district Sirmour, Himachal Pradesh

Background: Accredited Social Health Activist (ASHAs) is a female community health worker who provides care at grass-root level to her community people. The current study was conducted to assess the factors influencing the performance of ASHAs in district Sirmour, Himachal Pradesh with the objectives to assess the level of performance of ASHAs, to assess the individual factors influencing the performance of ASHAs and to assess the work environment factors influencing the performance of ASHAs.Methods: The researchers used non-experimental exploratory design and 228 ASHAs were selected from different blocks of district Sirmour through multistage sampling technique. Data was collected through structured interview and the tool used was structured interview schedule.Results: The study revealed that 61.4% ASHAs had average performance and 38.60% had good performance. The individual factors influencing the performance of ASHAs were family support, good relationship with family members, job satisfaction, increase in dignity etc. Work environment factors influencing the performance were supervisor’s guidance and support, in-service education, performance evaluation, flexibility in working hours, unavailability of resources, unequal work distribution, distance and transport, weather etc. Other factors influencing the performance were also explored through this study such as lack of safety, inadequate provision of incentives, irregular availability of resources and difficulty in motivating people.Conclusions: This study concluded that the level of performance was influenced by individual, work environment factors and many other factors. Hence, the study recommended that initiatives should be taken at administrative levels to improve the performance of ASHAs and the factors creating issues in their performance should be solved out.

Impact of Nutrition Education on the Nutrition Capacity of Caregivers and Nutrition Outcomes of Indigenous Mbororo Children in the West Region of Cameroon: Protocol for a Cluster Randomized Controlled Trial

BackgroundInadequate diets and life-threatening infections have profound adverse implications for child growth, development, and survival, particularly among indigenous peoples. Evidence of the effectiveness of community-based nutrition education interventions in improving child feeding and nutrition outcomes among indigenous Mbororo population in Cameroon is scarce.ObjectiveThis study aims to investigate the impact of culturally tailored community-based nutrition education intervention on caregivers’ knowledge, attitude, and practice regarding complementary feeding and on nutrition outcomes of indigenous Mbororo children (aged 3-59 months) in the Foumban and Galim health districts of the West Region of Cameroon.MethodsA two-arm cluster randomized controlled trial will be conducted in the Foumban Health District and Galim Health District. The intervention and control arms will each comprise 5 clusters with 121 child–caregiver pairs. Participants in the intervention arm will be organized into 5 caregivers’ peer-support platforms. A total of 12 educational sessions will be assigned to the intervention group by trained female Mbororo nutrition volunteers (n=6) and community health workers (n=6). The control arm will receive routine facility-based nutrition education. Data will be collected at 3-month and 6-month follow-up. Both descriptive statistics and multivariate logistic models will be used to estimate the effect of culturally tailored community-based nutrition education intervention (independent variable) on outcome variables (caregivers’ knowledge, attitude, and practice), child growth (weight, height/length, weight for age), and morbidity status (diarrhea, cough, and fever) between both arms. Data assessors will be blinded to the group allocation. Ethical approval (reference no. 2019/1002-07/UB/SG/IRB/FHS) was obtained from the Faculty of Health Sciences Institutional Review Board at the University of Buea.ResultsBaseline data were collected in September 2019. In February 2020, 10 Mbororo communities (clusters) with 242 child–caregiver pairs were selected and allocated to the experimental and control arm in a 1:1 ratio. Community nutrition volunteers (n=6) and community health workers (n=6) were selected and trained. Data collection and analysis are ongoing, and results are not available for this manuscript.ConclusionsThe findings of this study will provide evidence on the impact of culturally tailored and health belief model–based nutrition education on behavior change as a complementary strategy for strengthening health facility–based approaches in the reduction of malnutrition burden among the study populationInternational Registered Report Identifier (IRRID)DERR1-10.2196/23115

Intimate Labor at Biomedical Frontlines: Situated Knowledges of Female Community Health Workers in the Management of COVID-19 in India

Media reports of the COVID-19 pandemic in India have highlighted the important role that India’s female community health workers, the Accredited Social Health Activists (ASHAs), have played in managing COVID infections in India. This paper explores the epistemic basis of ASHA work to understand the significance of their role. Through a discourse analysis of textual media articles, we show that the ASHAs’ routine and COVID-related caregiving practices are a form of embodied, intimate labor rooted in their situated, community-oriented knowledge. This labor is devalued as emotional and feminized care work, which denies the ASHAs professional status in the public healthcare system of India and, in turn, reflects a hierarchy among health practitioners that stems from the status of objectivity/disembodiment in biomedicine. We find that, despite their low status in the public health system, ASHA workers develop a self-concept that enables them to self-identify as healthcare professionals, motivating them to continue providing essential healthcare services during the pandemic. We argue that an official recognition of the epistemic value of ASHA work would help to overcome the age-old nature/culture dichotomy that informs what counts as valuable, legitimate, formal medical knowledge. Furthermore, our analysis provides a critique of the gendered devaluation of care work within a political economy of health increasingly dictated by a neoliberal logic.