Influence of age on community health worker’s knowledge and service provision for maternal, newborn, and child health in Morogoro region, Tanzania

Abstract

Background: Developing countries with increasing service needs and shortage of skilled health workers, governments are investing in community health worker (CHW) programs to address rural health needs. With current renewed interest in CHWs in Tanzania, questions have arisen surrounding the age group composition of this health worker cadre. This study investigated age differences in characteristics, knowledge, and service delivery among CHWs working on maternal, newborn, and child health (MNCH) in rural Tanzania.

Methods: A quantitative survey was administered to all CHWs that received training from December 2012 to July 2013 in five administrative districts of Morogoro Region, Tanzania where the community integrated MNCH program is being implemented. Program monitoring and evaluation forms provided detailed records of service delivery during CHW home visits. Data on CHW socio-demographic characteristics, knowledge, and service delivery was analyzed through bi- and multivariate analyses. Composite scores were generated across ten knowledge domains: pregnancy, postpartum, newborn, and child care, family planning, injury and infection prevention, malaria, nutrition, and HIV. Ordered logit models were used to estimate relationships between knowledge scores and predictor variables.

Results: Among ninety seven percent of the eligible 238 Community Health Workers interviewed, the highest percentage (37%) was in the age group above 35 years. A variation in gender was not significant among different age groups. However there was a statistically significant difference (p<0.05) in marital status, education levels, use of English language, number of dependants, and income from agriculture among CHWs of different age groups. No Significant differences by age group in MNCH knowledge were observed even after controlling for education, gender, date of training, income, and socio-economic status. There was no significant difference in most CHW service provision across different age groups except for ability to working with other CHW programs and duration of working as CHW, of which both proportion and mean respectively were increasing as the age increases (p<0.05).

Conclusions: This study showed that apart from some slight differences, there was no statistical difference in CHW knowledge retention, and service provision for MNCH across different age groups. However there was a significant difference in their demographic characteristics that may affect guidelines defining CHWs recruitment and retentions criteria in Tanzania. Besides other criteria for CHW recruitment in rural areas age factor should also be considered to ensure retention of this carder. Further analysis on other social determinants and comparison with qualitative research is indicated to better understand the implications of the social profile of CHWs on the effectiveness and sustainability of the program.

Keywords: Age, Community Health Workers, Maternal Newborn and Child Health, Tanzania