Pakistan’s Community-based Lady Health Workers (LHWs): Change Agents for Child Health?

Zaidi, Shehla; Huda, Maryam; Ali, Ammarah; Gul, Xaher; Jabeen, Rawshan; Shah, Mashal Murad

doi:10.5539/gjhs.v12n11p177

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…Although, quality of services provided by LHW are questioned in earlier studies in Sindh [29], the interventions designed for this project had a specific component of training, monitoring and supportive supervision of LHWs [30]. This was to ensure implementation of intervention as intended, with identification of issues and timely feedback provided to the Lady health supervisors (LHS) for subsequent improvement in service quality [31], [32].…”

Section: Discussionmentioning

confidence: 99%

Impact of Integrating Family planning with Maternal and child health on uptake of contraception: A Quasi-Experimental Study in Rural Pakistan

Memon¹,

Ahmed²,

Lashari³

et al. 2023

Preprint

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Study aimed to evaluate the impact of integrating family planning with maternal, newborn, and child health (FP-MNCH) on uptake of modern contraceptive methods and related health outcomes in two districts of the province of Sindh, Pakistan. Impact of intervention was evaluated using a quasi-experimental control before-after study design. Intervention included capacity building of healthcare providers and outreach workers, ensuring sustained supplies of family planning commodities, data-driven decision-making, and community engagement activities. Data was collected through household surveys at baseline (December2020) and endline (December 2022). The sample size was estimated as 880 married women of reproductive age (MWRA) in each district. The Difference and Difference(DiD) analytical method was used to estimate the impact of intervention adjusted for potential confounding factors. There was statistically significant increase of 11.3% in the current use of MCM in the intervention group compared to the control group (p value <0.001), with increases observed in the uptake of injection , implants, and condoms. Additionally, there was an increase in the proportion of women who had ANC visits (DiD 10.5% p value 0.003), FP counselling during ANC (DiD 15.6% p value < 0.001), LHW visits during pregnancy (DiD 15.1% p value 0.021), PNC check-ups for mother (DiD 25.2% p value <0.001), LHW visits after delivery (DiD 20.4% p value <0.001), and LHW advised for family planning at PNC visit n (DiD 14.5% p value 0.030). This study provides strong evidence for the scaling-up of integrated interventions through existing health care platforms utilizing human resources deployed by the government. This FP-MNCH model has the potential to be adopted in other provinces and at federally administered areas for both health and population planning. This model should be considered for replication in other districts of Sindh to accelerate current level of integration already existing.

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Section: Discussionmentioning

confidence: 99%

Impact of Integrating Family planning with Maternal and child health on uptake of contraception: A Quasi-Experimental Study in Rural Pakistan

Memon¹,

Ahmed²,

Lashari³

et al. 2023

Preprint

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“…Another study from Sindh Pakistan depicted that LHWs are capable enough to identify SAM children without medical complications, while only 4% of the screened cases received appropriate counseling on medical and nutritional matters [17]. While examining the role of LHWs, particularly on immunization, nutrition, and early childhood illness, a study in two rural districts of Pakistan found that breastfeeding counseling by LHWs was received by 20% of mothers, and the majority of mothers did not know the correct use of ORS and early signs of pneumonia and other childhood diseases [18].…”

Section: Discussionmentioning

confidence: 99%

Distance to Healthcare Facility and Lady Health Workers’ Visits Reduce Malnutrition in under Five Children: A Case Study of a Disadvantaged Rural District in Pakistan

Shahid

Ameer

Malik

et al. 2022

IJERPH

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This study accesses the impact of lady health worker (LHWs) visits in the community and distance to a healthcare facility on the nutritional status of under-five children. Additionally, it explores the perceptions and attitudes of the community about the performance of LHWs. A self-administered instrument was applied to gather data on different parameters, such as children’s height, age, weight, and socioeconomic status from 384 rural households in a marginalized district of Punjab province with the help of a purposive random sampling technique. The binary logistic regression model was employed for the computation of the probability of malnutrition. The prevalences of stunting, underweight children, and wasting in the district were 34.8%, 46.1%, and 15.5%, respectively. The logistic results illustrate that those households in which LHW visits occur regularly within 15 days (OR = 0.28 with 95% CI: 0.09–0.82) have a lower probability of malnutrition prevalence among their children. The distance to the health facility shows that the odds of malnutrition were higher from 3–4 Kilometers (Km) (OR = 2.61, 95% CI: 0.85–8.14), and odds were also higher for the ≥5 km category (OR = 2.88, 95% CI: 0.94–8.82). Children from richer families had lower chances of being malnourished (OR = 0.28, 95% CI: 0.07–1.14). Furthermore, the respondents show a positive attitude towards LHWs. They have given the first rank to their performance being beneficial to mothers and childcare, especially on checkups and safe deliveries, while they have shown negative responses and given lower ranks to their performance due to irregular visits (6th rank) and poor community awareness (7th rank). We conclude that LHWs’ regular visits to targeted households and less distance to healthcare facilities reduce the malnutrition risk in under-five children.

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“…In addition, at least one FGD was conducted with lady health workers (LHWs) of the respective union council since they are advocates for breastfeeding in the community and are aware of the societal dynamics. LHWs are frontline community health workers responsible for visiting the community and counseling mothers to exclusively breastfeed up to six months and to continue breastfeeding with complementary foods until two years [20]. There were 8 -12 participants in each FGD.…”

Section: Study Design and Data Collectionmentioning

confidence: 99%

Barriers and facilitators to exclusive breastfeeding in rural Pakistan: a qualitative exploratory study

et al. 2022

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Background Exclusive breastfeeding (EBF) of children until six months of age is considered one of the most critical interventions in tackling childhood undernutrition. EBF rates are suboptimal in Pakistan, particularly in rural areas where child undernutrition is most prevalent. This study aimed to explore barriers to EBF in a rural context of Pakistan. Methods The study was conducted in the rural district Matiari of Sindh, Pakistan, during Jan-March 2020. We used a qualitative exploratory study design and conducted 36 focus group discussions (FGDs). Participants were purposively selected mothers who had not practiced EBF during their previous childbirth, their spouses and mothers-in-law, and lady health workers (LHWs) serving in the study catchment. FGDs were audio-recorded, transcribed, and translated into English from the local language and analysed using thematic content analysis. Results Barriers to EBF included low awareness and cultural practices of prelacteal feeds, insufficient breast milk production, undernutrition of mothers, mothers’ occupation as fieldworkers, less birth spacing, low awareness about the correct technique of breastfeeding, maternal and child ailments, abnormal breasts, and influence of in-laws to start top-up feeds. Several facilitators were identified: family support, appropriate maternal diet, maternal awareness, and support in the neighborhood. Conclusion Barriers to EBF are multifaceted in rural areas, and interventions aiming to improve adherence to EBFshould be multipronged. Awareness-raising alone might not be sufficient, and other interventions should be designed to address the barriers of maternal malnutrition, insufficient milk production, and socio-cultural practices. In addition, safe alternatives to breast milk may be necessary if breastfeeding is truly not feasible. Lack of breast milk substitutes is particularly challenging for poor rural women who cannot afford infant formula milk.

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Pakistan’s Community-based Lady Health Workers (LHWs): Change Agents for Child Health?

Cited by 7 publications

References 17 publications

Impact of Integrating Family planning with Maternal and child health on uptake of contraception: A Quasi-Experimental Study in Rural Pakistan

Impact of Integrating Family planning with Maternal and child health on uptake of contraception: A Quasi-Experimental Study in Rural Pakistan

Distance to Healthcare Facility and Lady Health Workers’ Visits Reduce Malnutrition in under Five Children: A Case Study of a Disadvantaged Rural District in Pakistan

Barriers and facilitators to exclusive breastfeeding in rural Pakistan: a qualitative exploratory study

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