Performance of volunteer community health workers in implementing home-fortification interventions in Bangladesh: A qualitative investigation

Sarma, Haribondhu; Jabeen, Ishrat; Luies, Sharmin Khan; Uddin, Md. Fakhar; Ahmed, Tahmeed; Bossert, Thomas; Banwell, Cathy

doi:10.1371/journal.pone.0230709

Cited by 23 publications

(44 citation statements)

References 35 publications

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“…A detailed description of BRAC home fortification is available in Paper 4 of this supplement (7) . The availability of BRAC community health workers and implementation facilities across sub-districts and districts in Bangladesh are key advantages for BRAC to scale up MNP intervention at the national level (21,22) .…”

Section: Identifying An 'Effective' Intervention and Brac Home Fortifmentioning

confidence: 99%

“…Home visits by BRAC community health workers was a key performance indicator for its home-fortification programme (21) . The qualitative analysis of BRAC homefortification programmes published elsewhere (22) identified a range of factors at the individual, community, programme and organisational levels, which influenced the performance of BRAC community health workers with respect to implementing the home-fortification programme (22) .…”

Section: Implementation Fidelity: Context and Process Of Brac Home Fomentioning

confidence: 99%

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Implementation science in nutrition: a summary and synthesis

Sarma

2021

Public Health Nutr.

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Objective: This paper aimed to summarise and critically synthesise the key findings of the articles included in the supplement entitled ‘Nutrition Implementation Science: The Experience of a Large-Scale Home Fortification in Bangladesh’. Design: Commentary, summary and synthesis. Settings: Low- and Middle-income country. Results: The supplement included six articles, including this summary paper. The second article presented an implementation science framework that facilitated conceptualising and evaluating the home-fortification programme in Bangladesh implemented by the Bangladesh Rural Advancement Committee (BRAC). The framework encompasses five components: identifying an ‘effective’ intervention; scaling-up and implementation fidelity; course corrections during implementation and assessing the implementation’s effectiveness; promoting sustainability of interventions; and consideration of a concurrent evaluation to identify ‘effective’ interventions and to assess the process and outcome indicators of implementation. The other four articles in this supplement addressed the different components of the framework. For example, the third article addressed the implementation fidelity of a home-fortification programme, and the fourth article described the use of concurrent evaluation to course correct the implementation plan that resulted in improved implementation fidelity. The fifth article explained the outcome of course correction in the programme coverage, and the sixth article described the cost-effectiveness of the BRAC home-fortification programme. Conclusions: Overall, the supplement provides a comprehensive understanding of nutrition implementation science, which is very new in the field. The lessons learned in this supplement may enhance the capacity of researchers, policymakers and key stakeholders in the nutrition field to scale up new nutrition interventions and sustain them until malnutrition is alleviated.

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Section: Identifying An 'Effective' Intervention and Brac Home Fortifmentioning

confidence: 99%

Section: Implementation Fidelity: Context and Process Of Brac Home Fomentioning

confidence: 99%

Implementation science in nutrition: a summary and synthesis

Sarma

2021

Public Health Nutr.

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“…In Ethiopia, females (and their husbands) expressed discomfort at seeking care for themselves or their children from male practitioners due to social norms around interactions between sexes and appropriate discourse with members of the opposite gender [ 18 ]. In contrast to medical providers, there are more female than male community health workers (CHWs) in many countries [ 19 – 21 ]. CHWs, particularly females, have been shown to play an important role in supporting households, in identifying and responding to child illnesses, and in negotiating with others in the household for advisory and financial support [ 19 , 20 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Gender-related influences on adherence to advice and treatment-seeking guidance for infants and young children post-hospital discharge in Bangladesh

Uddin

Molyneux

Muraya

et al. 2021

Int J Equity Health

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Background Post-hospital discharge mortality risk is high among young children in many low and middle-income countries (LMICs). The available literature suggests that child, caregiver and health care provider gender all play important roles in post-discharge adherence to medical advice, treatment-seeking and recovery for ill children in LMICs, including those with undernutrition. Methods A qualitative study was embedded within a larger multi-country multi-disciplinary observational cohort study involving children aged less than 2 years conducted by the Childhood Acute Illness and Nutrition (CHAIN) Network. Primary data were collected from family members of 22 purposively selected cohort children. Family members were interviewed several times in their homes over the 6 months following hospital discharge (total n = 78 visits to homes). These in-depth interviews were complemented by semi-structured individual interviews with 6 community representatives, 11 community health workers and 12 facility-based health workers, and three group discussions with a total of 24 community representatives. Data were analysed using NVivo11 software, using both narrative and thematic approaches. Results We identified gender-related influences at health service/system and household/community levels. These influences interplayed to family members’ adherence to medical advice and treatment-seeking after hospital discharge, with potentially important implications for children’s recovery. Health service/system level influences included: fewer female medical practitioners in healthcare facilities, which influenced mothers’ interest and ability to consult them promptly for their child’s illnesses; gender-related challenges for community health workers in supporting mothers with counselling and advice; and male caregivers’ being largely absent from the paediatric wards where information sessions to support post-discharge care are offered. Gendered household/community level influences included: women’s role as primary caretakers for children and available levels of support; male family members having a dominant role in decision-making related to food and treatment-seeking behaviour; and greater reluctance among parents to invest money and time in the treatment of female children, as compared to male children. Conclusions A complex web of gender related influences at health systems/services and household/community levels have important implications for young children’s recovery post-discharge. Immediate interventions with potential for positive impact include awareness-raising among all stakeholders – including male family members - on how gender influences child health and recovery, and how to reduce adverse consequences of gender-based discrimination. Specific interventions could include communication interventions in facilities and homes, and changes in routine practices such as who is present in facility interactions. To maximise and sustain the impact of immediate actions and interventions, the structural drivers of women’s position in society and gender inequity must also be tackled. This requires interventions to ensure equal equitable opportunities for men and women in all aspects of life, including access to education and income generation activities. Given patriarchal norms locally and globally, men will likely need special targeting and support in achieving these objectives.

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“…In Ethiopia, females (and their husbands) expressed discomfort at seeking care for themselves or their children from male practitioners due to social norms around interactions between sexes and appropriate discourse with members of the opposite gender [18]. In contrast to medical providers, there are more female than male community health workers (CHWs) in many countries [19][20][21]. CHWs, particularly females, have been shown to play an important role in supporting households, in identifying and responding to child illnesses, and in negotiating with others in the household for advisory and nancial support [19,20,22].…”

Section: Introductionmentioning

confidence: 99%

Gender-related influences on adherence to advice and treatment-seeking guidance for infants and young children post-hospital discharge in Bangladesh

Uddin

Molyneux

Muraya

et al. 2021

Preprint

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Background: Post-hospital discharge mortality risk is high among young children in many low and middle-income countries (LMICs). The available literature suggests that child, caregiver and health care provider gender all play important roles in post-discharge adherence to medical advice, treatment-seeking and recovery for ill children in LMICs, including those with undernutrition. Methods: A qualitative study was embedded within a larger multi-country multi-disciplinary observational cohort study involving children aged less than 2 years conducted by the Childhood Acute Illness and Nutrition (CHAIN) Network. Primary data were collected from family members of 22 purposively selected cohort children. Family members were interviewed several times in their homes over the 6 months following hospital discharge (total n=78 visits to homes). These in-depth interviews were complemented by semi-structured individual interviews with 6 community representatives, 11 community health workers and 12 facility-based health workers, and three group discussions with a total of 24 community representatives. Data were analysed using NVivo11 software, using both narrative and thematic approaches. Results: We identified gender-related influences at health service/system and household/community levels. These influences interplayed to family members’ adherence to medical advice and treatment-seeking after hospital discharge, with potentially important implications for children’s recovery. Health service/system level influences included: fewer female medical practitioners in healthcare facilities, which influenced mothers’ interest and ability to consult them promptly for their child’s illnesses; gender-related challenges for community health workers in supporting mothers with counselling and advice; and male caregivers’ being largely absent from the paediatric wards where information sessions to support post-discharge care are offered. Gendered household/community level influences included: women’s role as primary caretakers for children and available levels of support; male family members having a dominant role in decision-making related to food and treatment-seeking behaviour; and greater reluctance among parents to invest money and time in the treatment of female children, as compared to male children. Conclusions: A complex web of gender related influences at health systems/services and household/community levels have important implications for young children’s recovery post-discharge. Immediate interventions with potential for positive impact include awareness-raising among all stakeholders – including male family members - on how gender influences child health and recovery, and how to reduce adverse consequences of gender-based discrimination. Specific interventions could include communication interventions in facilities and homes, and changes in routine practices such as who is present in facility interactions. To maximise and sustain the impact of immediate actions and interventions, the structural drivers of women’s position in society and gender inequity must also be tackled. This requires interventions to ensure equal equitable opportunities for men and women in all aspects of life, including access to education and income generation activities. Given patriarchal norms locally and globally, men will likely need special targeting and support in achieving these objectives.

show abstract

Performance of volunteer community health workers in implementing home-fortification interventions in Bangladesh: A qualitative investigation

Cited by 23 publications

References 35 publications

Implementation science in nutrition: a summary and synthesis

Implementation science in nutrition: a summary and synthesis

Gender-related influences on adherence to advice and treatment-seeking guidance for infants and young children post-hospital discharge in Bangladesh

Gender-related influences on adherence to advice and treatment-seeking guidance for infants and young children post-hospital discharge in Bangladesh

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