Line Health Workers Research Articles

Tribal eligible couple and care providers' perspective on family planning: A qualitative study in Keonjhar district, Odisha, India

IntroductionCultural belief and individual's perception play an important role in acceptance of modern family planning method, more so among tribal communities. It is important to understand the prevailing beliefs and practices among tribal as well as their felt and unmet needs to address existing gaps and improve family planning services for them. MethodsTotal 32 in-depth interviews and eight focus group discussions were conducted among service providers and the tribal eligible couples respectively from April to June 2017 in six villages of Anandpur block in Keonjhar district, Odisha to explore about tribals' beliefs and cultural practice on marriage and childbirth, barriers and challenges in adopting family planning methods and their practices to address unwanted pregnancies. Data were analysed thematically using content analysis method. ResultsThe most prevalent barriers for accepting permanent family planning method were their cultural practice to ban woman acceptor from worshiping God, fear of unable to provide sexual satisfaction to their partner that may cause remarriage of their spouse. Non availability of contraceptives with front line health workers was an important factor for its non adherence. Low affordability and lack of easy access to public health facilities during any reproductive health related complications make tribal consult local traditional healers. ConclusionsRound the clock availability of contraceptives with front-line health providers along with continuous behavioural change communication involving male partners and local influential persons will improve family planning service among tribal.

Time Utilisation Pattern of Front Line Health Workers in India – A Case Study from Mangalore District

Sustainable development goal 3: Ensure healthy lives and promote well-being for all at all ages reports that most of populations are living healthier than before but there are many suffering from many disease and its prevalence and targets to achieve all them. Health workers are the core of the health care service system to deliver the care to the community. World Health Organization section of Nurse and Midwifery states that they comprised of more than 50% of the total health workforce, and there is a global shortage but the largest need based shortage in the Africa and South East Asia regions (https://www.who.int/news-room/fact-sheets/detail/nursing-andmidwifery). WHO statistics consists of Auxiliary nurses midwife (ANM, two years of training), registered nurses and midwifes (it varies from 3 -4 years of education).

An investigation into mistreatment of women during labour and childbirth in maternity care facilities in Uttar Pradesh, India: a mixed methods study

ObjectivesTo investigate the nature and context of mistreatment during labour and childbirth at public and private sector maternity facilities in Uttar Pradesh, India.MethodsThis study analyses mixed-methods data obtained through systematic clinical observations and open-ended comments recorded by the observers to describe care provision for 275 mothers and their newborns at 26 hospitals in three districts of Uttar Pradesh from 26 May to 8 July 2015. We conducted a bivariate descriptive analysis of the quantitative data and used a thematic approach to analyse qualitative data.FindingsAll women in the study encountered at least one indicator of mistreatment. There was a high prevalence of not offering birthing position choice (92%) and routine manual exploration of the uterus (80%) in facilities in both sectors. Private sector facilities performed worse than the public sector for not allowing birth companions (p = 0.02) and for perineal shaving (p = < 0.001), whereas the public sector performed worse for not ensuring adequate privacy (p = < 0.001), not informing women prior to a vaginal examination (p = 0.01) and for physical violence (p = 0.04). Prepared comments by observers provide further contextual insights into the quantitative data, and additional themes of mistreatment, such as deficiencies in infection prevention, lack of analgesia for episiotomy, informal payments and poor hygiene standards at maternity facilities were identified.ConclusionsMistreatment of women frequently occurs in both private and public sector facilities. This paper contributes to the literature on mistreatment of women during labour and childbirth at maternity facilities in India by articulating new constructs of overtreatment and under-treatment. There are five key implications of this study. First, a systematic and context-specific effort to measure mistreatment in public and private sector facilities in high burden states in India is required. Second, a training initiative to orient all maternity care personnel to the principles of respectful maternity care would be useful. Third, innovative mechanisms to improve accountability towards respectful maternity care are required. Fourth, participatory community and health system interventions to support respectful maternity care would be useful. Lastly, we note that there needs to be a long-term, sustained investment in health systems so that supportive and enabling work-environments are available to front- line health workers.

Addressing Malnutrition among Children – An Assessment of Dastak Abhiyan in Madhya Pradesh

Background: The Dastak Abhiyan is considered a pioneer program of Government of Madhya Pradesh and was pilot tested in the month of November 2016. The program offers a basket of services (10 core activities) focused on the reduction of Under 5 mortality Objectives: In this study, we monitored the functioning and the implementation of 10 core activities of the Abhiyan in 4 districts of Madhya Pradesh viz. Jhabua, Sheopur, Raisen, and Bhopal. Methods: The study takes into account modified World Health Organization(WHO)’s 30x7 cluster sampling where 7 households were selected from 30 villages of 4 districts of Madhya Pradesh including 2 tribal and 1 high priority district. Results: We have observed that majority of the Front Line Health Workers (FLWs) were working as per the micro plan. We identified few gaps, such as FLWs missed on carrying out some of the activities viz. Blood Test, Mid Upper Arm Circumference measurement, demonstration of Oral Rehydration Solution preparation, and Handwashing. Conclusion: We found the need to strengthen inter-communication, to customize micro plan in consultation with the Auxiliary Nurse Midwife of that village. Our study also highlighted the need for supportive supervision, post-training assessment for FLWs to assess the knowledge gained by them during the training session.

A Study on Knowledge, Attitude and Practices among Front Line Health Workers Regarding Tuberculosis and DOTS

A Study on Knowledge, Attitude and Practices among Front Line Health Workers Regarding Tuberculosis and DOTS

Prevalence of Anemia among Adolescent Girls in Uttar Pradesh and Sharing Field Experience of Community-based Anemia Management Program

Introduction: The anemia management program for adolescent girls (15–19 years) was part of Eastern Uttar Pradesh Health Initiative implemented by Tata Trusts in 9 districts and 19 blocks in partnership with block level community-based organizations. Objective of the Health Initiative was to build community-based platform (In the form of Village Health and Nutrition Day – VHND) to provide primary healthcare services for basic maternal, child and adolescent health. The anemia management component in the program was based on the National Iron Plus Initiative guideline. Objectives: To ascertain prevalence of anemia in adolescent girls registered in the program; to demonstrate a community-based model for anemia management with the help of adolescent collectivization facilitated by trained front line health workers. Materials and Methods: Total 26,982 girls were screened in first phase of the program from April 2014; followed by second and third screenings with average duration of 3–6 months between each screening. Total 18,428 girls participated in second screening and total 13,979 girls were part of all three screenings till September 2015. WHO recommended Hemoglobin (Hb) Color Scale Method was used as a screening tool, implemented by auxiliary nurse midwives and lab technicians. Girls’ collectivization was facilitated by the trained frontline health workers to spread awareness, mobilize girls for screening and conduct health education sessions. Data is from the project MIS and was analyzed with the help of Microsoft Excel and SPSS. Results: Project implementation level data across 19 sites for 3 checkups with mean interval between each checkup as 3–6 months, shows prevalence of anemia in adolescent girls was 86.80%. Mean rise of hemoglobin from checkup 1 to checkup 3 is 0.6 gm. Drastic reduction in severe anemia from 5.66% to less than 1% is seen in the program. In case of non-school-going girls, reduction in severe anemia was from 17% to 1.5%. Conclusion: Overall burden of anemia in adolescent girls (15–19 years) is very high in girls in late adolescence stage. As age increases, prevalence increases, non-school-going girls are worst affected with severe anemia. It is promising to implement anemia management program through a platform led by a trained frontline health worker facilitated adolescent girls’ collectivization. Community-based strategies and individual follow up is significant to reduce burden of severe anemia.

Food taboos among pregnant and lactating mothers in Tumkur: a qualitative study

Background: Maternal nutrition has a huge impact on the health of the mother and the fetus. Pregnancy imposes the need for considerable extra calorie and nutrient requirements. A food taboo is a prohibition against consuming certain foods. The restrictions imposed on people forces them to abstain from certain food and drinking items as these things are embedded into the cultural and religious threads. Methods: A qualitative study was conducted between July 2014 and September 2014. Study was conducted in urban and rural field practice area of Sri Siddhartha medical college, Tumkur, Karnataka. Study involved three groups Mother –in- laws Anganwadi workers, Pregnant and lactating women. Six Focus group discussions were conducted and four themes were used. Quantitative data was tabulated and analyzed using SPSS version 16. Results: All most all women under the study followed some form of restrictive diet. Many nutritive and locally available foods were avoided which includes fruits, vegetables, pulses and green leafy vegetables. Special foods rich in energy were consumed during post-partum period. Concept of hot and cold food is prevailing high and there was no scientific reasoning given for the taboo. Anganwadi workers who are front line health workers were believed in the many of the food taboos. Conclusions: Food taboos in this community are deep rooted. Avoidance of nutritive food was common in both the religion. Many misconceptions are prevalent which do not have scientific basis. Maternal nutrition needs to be prioritized at community level among family members and front line workers. Anganwadi workers need to be sensitized regarding different beliefs about food consumption during pregnancy and lactation.

The role of context in the co-evolution of work and tools

Purpose This paper presents a work-centred study of how information systems practices and tools become shaped by their context. The purpose of this paper is to increase the understanding of how practices and tools co-evolve, with a specific focus on the role of context, and based on this to offer relevant design implications. The empirical motivation comes from attempts to utilize information and communication technologies (ICT) in resource-constrained settings. Design/methodology/approach Empirical work was conducted in primary healthcare facilities in Tanzania that offer Prevention of Mother-To-Child Transmission services. Four health facilities with different organizational and socio-economic characteristics were studied using ethnographic methods (participant observation, interviews and document analysis). The authors have employed activity theory as the theoretical framework, since it explicitly places human activity within a cultural, social and temporal (developmental) context. Specifically, the concept of mediation breakdown was used for data analysis at activity, action and operation levels. Findings By focussing analytically on situations of mediation breakdown in the situation of use, at both an activity, action and operation level, the authors have achieved an understanding of how information tools are being adapted to both their contextual conditions and the information needs of the community of users. Research limitations/implications The study illustrates the decisive role that context may play in shaping the actual usage of information technology. While the detailed findings were specific to the concrete domain, time and place, in general, an increased awareness of the role of context may lead to more robust approaches to the introduction of ICT solutions. Originality/value While activity theory literature offers insight on how to analyse context, the discussion is limited to the understanding of how context can be modelled into artefacts. The paper suggests that the contradiction concept is useful for studying the role of context and its impact in co-evolution of work and information tools. The study also contributes to the discourse in health information systems in developing countries by emphasizing the crucial role of the front line health workers’ own problem solving, invention and adaptation of information tools.

Development and Internal Validation of a Predictive Model Including Pulse Oximetry for Hospitalization of Under-Five Children in Bangladesh.

BackgroundThe reduction in the deaths of millions of children who die from infectious diseases requires early initiation of treatment and improved access to care available in health facilities. A major challenge is the lack of objective evidence to guide front line health workers in the community to recognize critical illness in children earlier in their course.MethodsWe undertook a prospective observational study of children less than 5 years of age presenting at the outpatient or emergency department of a rural tertiary care hospital between October 2012 and April 2013. Study physicians collected clinical signs and symptoms from the facility records, and with a mobile application performed recordings of oxygen saturation, heart rate and respiratory rate. Facility physicians decided the need for hospital admission without knowledge of the oxygen saturation. Multiple logistic predictive models were tested.FindingsTwenty-five percent of the 3374 assessed children, with a median (interquartile range) age of 1.02 (0.42–2.24), were admitted to hospital. We were unable to contact 20% of subjects after their visit. A logistic regression model using continuous oxygen saturation, respiratory rate, temperature and age combined with dichotomous signs of chest indrawing, lethargy, irritability and symptoms of cough, diarrhea and fast or difficult breathing predicted admission to hospital with an area under the receiver operating characteristic curve of 0.89 (95% confidence interval -CI: 0.87 to 0.90). At a risk threshold of 25% for admission, the sensitivity was 77% (95% CI: 74% to 80%), specificity was 87% (95% CI: 86% to 88%), positive predictive value was 70% (95% CI: 67% to 73%) and negative predictive value was 91% (95% CI: 90% to 92%).ConclusionA model using oxygen saturation, respiratory rate and temperature in combination with readily obtained clinical signs and symptoms predicted the need for hospitalization of critically ill children. External validation of this model in a community setting will be required before adoption into clinical practice.

Probable Post Traumatic Stress Disorder in Kenya and Its Associated Risk Factors: A Cross-Sectional Household Survey.

This study aimed to assess the prevalence of probable post-traumatic stress disorder (PTSD), and its associated risk factors in a general household population in Kenya. Data were drawn from a cross-sectional household survey of mental disorders and their associated risk factors. The participants received a structured epidemiological assessment of common mental disorders, and symptoms of PTSD, accompanied by additional sections on socio-demographic data, life events, social networks, social supports, disability/activities of daily living, quality of life, use of health services, and service use. The study found that 48% had experienced a severe trauma, and an overall prevalence rate of 10.6% of probable PTSD, defined as a score of six or more on the trauma screening questionnaire (TSQ). The conditional probability of PTSD was 0.26. Risk factors include being female, single, self-employed, having experienced recent life events, having a common mental disorder (CMD)and living in an institution before age 16. The study indicates that probable PTSD is prevalent in this rural area of Kenya. The findings are relevant for the training of front line health workers, their support and supervision, for health management information systems, and for mental health promotion in state boarding schools.

Tedium vitae, death wishes, suicidal ideation and attempts in Kenya-prevalence and risk factors.

BackgroundThere has been no previous household population study of suicidal ideation and attempts in Kenya. Therefore this study aimed to establish the prevalence of suicidal ideation and attempts in a rural population in Kenya, and to assess risk factors.MethodsAn epidemiological survey of a household population, using standardised structured interviews. We examined the prevalence of suicidal ideation and suicide attempts and the predictors of suicidal thoughts and attempts, using STATA to calculate unadjusted and adjusted odds ratios.ResultsA quarter of the sample (24.1 %) had thought that life was not worth living (tedium vitae) at some point in their lives, while a fifth had experienced death wishes at some stage. About 7.9 % reported suicidal thoughts and 1.9 % had made actual suicide attempts at some point in their lives. It can be seen that the prevalence of suicidal thoughts was 0.7 %, 4.2 %, 3.7 % and 7.9 % for last week, last year, at some other time, and lifetime respectively, while the prevalence of suicidal attempts was 0.5 %, 1.2 %, 0.7 and 1.9 % respectively.In the adjusted analysis of factors associated with suicidal thoughts, being female (OR 1.8, p = 0.017), having CMD (OR 2.7, p = 0.001), having a number of recent life events (OR 2.3, p = 0.001 for 2–3 life events and OR 2.6, p = 0.004 for 4 or more life events), and having a large social group size (OR 7.7, p = 0.006 for social group size of 4–8 and OR 9.1, p = 0.003 for social group size of 9 or more) were all associated with increased rates of life time suicidal thoughts, but psychotic symptoms were no longer significant after adjustment for the other variables. In the adjusted analysis of suicide attempts, having any psychotic symptoms (OR 5.1, p = 0.001) was the only factor associated with suicide attempts after adjustment for other factors significant at the bivariate level.ConclusionSuicidal ideation and attempts pose a significant public health burden in this poor rural area of Kenya. The findings are relevant for mental health promotion and prevention programmes, public education and professional training programmes in relevant sectors, especially in front line health workers and social workers.

Descriptive characterization of the 2010 cholera outbreak in Nigeria.

BackgroundIn 2010, 18 States of Nigeria reported cholera outbreaks with a total of 41,787 cases including 1,716 deaths (case-fatality rate [CFR]: 4.1%). This exceeded the mean overall CFR of 2.4% reported in Africa from 2000–2005 and the WHO acceptable rate of 1%. We conducted a descriptive analysis of the 2010 cholera outbreak to determine its epidemiological and spatio-temporal characteristics.MethodsWe conducted retrospective analysis of line lists obtained from 10 of the 18 states that submitted line lists to the Federal Ministry of Health (FMOH). We described the outbreak by time, place and person and calculated the attack rates by state as well as the age- and sex-specific CFR from cholera cases for whom information on age, sex, place of residence, onset of symptoms and outcome were available.ResultsA total of 21,111 cases were reported with an overall attack rate and CFR of 47.8 cases /100,000 population and 5.1%, respectively. The CFR ranged in the states between 3.8% and 8.9%. The age-specific CFR was highest among individuals 65 years and above (14.6%). The epidemiological curve showed three peaks with increasing number of weekly reported cases. A geographical clustering of LGAs reporting cholera cases could be seen in all ten states. During the third peak which coincided with flooding in five states the majority of newly affected LGAs were situated next to LGAs with previously reported cholera cases, only few isolated outbreaks were seen.ConclusionOur study showed a cholera outbreak that grew in magnitude and spread to involve the whole northern part of the country. It also highlights challenges of suboptimal surveillance and response in developing countries as well as potential endemicity of cholera in the northern part of Nigeria. There is the need for a harmonized, coordinated approach to cholera outbreaks through effective surveillance and response with emphasis on training and motivating front line health workers towards timely detection, reporting and response. Findings from the report should be interpreted with caution due to the high number of cases with incomplete information, and lack of data from eight states.

The Effectiveness of a Meaning-Centred Intervention in Protecting the Well-Being HIV/AIDS Health Educators

This study investigated whether teaching HIV/AIDS Health Educators about Viktor Frankl’s theory of finding meaning in life, results in a significant improvement in their psychological well-being. The participants were 24 volunteers from the Information, Education and Communication (IEC) cluster of a Non-Governmental Organization (NGO) in South Africa (age range = 20–39 years, females = 67 %, majority ethnicity = 58 % Sotho speaking). The study was both quantitative and qualitative. Quantitative data was collected using Purpose in Life Test (PIL) and Beck Depression Inventory (BDI-IA). In addition, qualitative data was collected on the participants’ subjective experience of development in creative potential. A one group pretest–posttest design was employed. The quantitative data was analysed using a non-parametric test procedure for small sample size designs. The qualitative data was analysed by means of themes. The researcher discovered that a sense of meaning intervention seems to result in significant improvement in levels of meaning, and a decrease in depressive symptoms among participants. Consequently, the findings indicate that it is possible to support front line health workers in their search for meaning by means of a meaning-centred intervention, and that this helps to alleviate depressive symptoms. Similarly, meaning-centred intervention seems to be a promising intervention for instilling resilience amongst front line health workers, who provide a valuable voluntary service in the community. Participants indicated they could apply the theory to their personal lives. More importantly, they would use the skills they have acquired in their duties.

Infant feeding counselling of HIV-infected women in two areas in Kenya in 2008

While WHO no longer recommends individual infant feeding counselling to HIV-positive women, it may still be practised in some settings and for specific cases. In any case, lessons can be learned by examining how well front line health workers are able to take on counselling tasks. This qualitative study was designed to assess how counsellors deal with challenges they face in two Kenyan provinces. It consisted of brief post-counselling exit interviews with 80 mothers, observations of 21 counselling sessions and 11 key informant interviews. Much infant feeding counselling was of reasonable quality, better than often reported elsewhere. However, nutrition and infant feeding were given low priority, counsellors' training was inadequate, individual postnatal counselling as well as growth monitoring and promotion were rarely done and complementary feeding was inadequately covered. Acceptable, feasible, affordable, sustainable and safe (AFASS) assessments were not of satisfactory quality. Breast milk expression was mentioned only to a minority and the possibility of heat treatment during the transition to cessation was not mentioned. Counsellors were often biased in discussing risks of breastfeeding and replacement feeding. Implementing the new WHO guidance will reduce the need for AFASS assessments, greatly simplifying both the government's and counsellors' tasks.

A rapid assessment and response approach to review and enhance advocacy, communication and social mobilisation for tuberculosis control in Odisha state, India.

BackgroundTuberculosis remains a major public health problem in India with the country accounting for 1 in 5 of all TB cases reported globally. An advocacy, communication and social mobilisation project for Tuberculosis control was implemented and evaluated in Odisha state of India. The purpose of the study was to identify the impact of project interventions including the use of 'Interface NGOs' and involvement of community groups such as women's self-help groups, local government bodies, village health sanitation committees, and general health staff in promoting TB control efforts.MethodsThe study utilized a rapid assessment and response (RAR) methodology. The approach combined both qualitative field work approaches, including semi-structured interviews and focus group discussions with empirical data collection and desk research.ResultsResults revealed that a combination of factors including the involvement of Interface NGOs, coupled with increased training and engagement of front line health workers and community groups, and dissemination of community based resources, contributed to improved awareness and knowledge about TB in the targeted districts. Project activities also contributed towards improving health worker and community effectiveness to raise the TB agenda, and improved TB literacy and treatment adherence. Engagement of successfully treated patients also assisted in reducing community stigma and discrimination.ConclusionThe expanded use of advocacy, communication and social mobilisation activities in TB control has resulted in a number of benefits. These include bridging pre-existing gaps between the health system and the community through support and coordination of general health services stakeholders, NGOs and the community. The strategic use of 'tailored messages' to address specific TB problems in low performing areas also led to more positive behavioural outcomes and improved efficiencies in service delivery. Implications for future studies are that a comprehensive and well planned range of ACSM activities can enhance TB knowledge, attitudes and behaviours while also mobilising specific community groups to build community efficacy to combat TB. The use of rapid assessments combined with other complementary evaluation approaches can be effective when reviewing the impact of TB advocacy, communication and social mobilisation activities.

Developing and introducing evidence based clinical practice guidelines for serious illness in Kenya

The under-5 mortality rate in most developing countries remains high yet many deaths could be averted if available knowledge was put into practice. For seriously ill children in hospital investigations...

Health Worker Perceptions of the Integration of Leprosy Control Services at the Primary Health Care Level in Ibadan, Nigeria

A goal of both the World Health Organization and the Nigerian National Tuberculosis and Leprosy Control (TBL) Program is to integrate leprosy control services into the front line primary health care service system. Traditionally, leprosy services had been handled by one local government officer with little involvement of other health staff, and this limited access and timeliness of services for leprosy patients. Even after the national TBL program was implemented, integration has not been achieved, and this study of 203 front line health workers in the five local government areas that comprise the Ibadan metropolitan area of Oyo State, Nigeria sought to determine the role of health worker knowledge, attitudes, and self-efficacy in fostering or inhibiting leprosy service integration. Leprosy knowledge scores were positively associated with years in service, having lectures on leprosy during basic training, and having attended in-service training (IST) on leprosy. Among the cadres interviewed, Environmental Health Officers (EHOs), who had traditionally managed leprosy services prior to the move for integrated services, had the highest scores. EHOs and those who had leprosy lectures during basic training also had better attitudes toward leprosy than their counterparts. Male health staff and those who had leprosy lectures during basic training also had higher attitude scores concerning integrating leprosy control services with primary care. Finally, the only factor associated with perceived self-efficacy to perform leprosy control services was cadre. Ironically, Community Health Extension workers, who have had little in the way of experience with and training in leprosy control, believed they could handle these responsibilities better than other cadres. The influence of basic and in-service training on enhancing leprosy control knowledge and attitudes is recognized and enhancement of curricula for all cadres on leprosy issues is recommended.

Practical Techniques for Front Line Health Workers for the Detection, Treatment and Prevention of Nutritional Disorders*

Practical Techniques for Front Line Health Workers for the Detection, Treatment and Prevention of Nutritional Disorders*