Motivating and demotivating factors for community health workers engaged in maternal, newborn and child health programs in low and middle-income countries: a systematic review

This systematic review aimed to synthesize primary research on motivating factors of community health workers [CHWs] for maternal, neonatal, and child health [MNCH] in low and middle-income countries [LMICs]. Peer-reviewed literatures were systematically searched in five databases. Identified studies were then screened and selected for inclusion. The eligibility criteria were reported primary qualitative, quantitative, or mixed methods research, with participants being CHWs in LMICs who address MNCH, which investigated motivation or related concepts of retention, attrition, and performance. A thematic synthesis process was used to analyze findings of motivating factors, reported by included studies. Seventeen qualitative, quantitative, or mixed methods studies met inclusion criteria. Two overarching themes were developed: Levels of motivation [i.e. individual, community, and health system] and stages of motivation [i.e. recruitment, retention, and attrition]. Nine sub-themes were further developed at the intersection of each level and stage of motivation. Each subtheme comprises the motivating factors that are influential to community health workers at each stage and level. These themes and sub-themes are presented in a Community Health Worker Motivation Model. The motivation model can be used to identify what motivating factors are relevant to community health workers motivation and the stakeholders necessary to address each motivating factor. Recruitment of community health workers for maternal, neonatal, and child health relies largely on individual level of motivation. At retention, individual level motivating factors remain influential; and community and health system begin to influence motivation positively. But, overall health systems in low and middleincome countries are demotivating the health workers rather than motivating them

Vaccine effectiveness and risk factors associated with measles among children presenting to the hospitals of Karachi, Pakistan

To determine the risk factors regarding guardian's practices associated with development of Measles and also find out effectiveness of Measles vaccine among children less than 12 years of age presenting to the hospitals of Karachi. Matched case control study. Multicenter surveillance was conducted in 11 public and private sector hospitals of Karachi from January 2011 to September 2012 in consultation with World Health Organization Measles Surveillance Cell. Cases were children aged less than 12 years with Measles presenting to the hospitals. Controls for cases were enrolled from the same hospitals without Measles, matched for age and gender. Studied variables were analyzed by multivariate conditional logistic regression analysis adjusted for age and gender. Measles cases were more likely to have mothers with 'lower education' [adjusted matched Odds Ratio or mOR: 3.2 [95% CI: 1.2 - 7.6], for < 5 years of schooling adjusted mOR: 2.2 [95% CI: 1.0 - 5.7] for 6 - 10 years of schooling]. Children with Measles were also more likely to be not given breast milk in initial 2 years of life [adjusted mOR: 2.6, 95% CI 1.0 - 7.0]. Cases were also more likely to have never received vaccination [adjusted mOR: 10.1, 95% CI 4.5 - 22.5] and having no other children vaccinated at home [adjusted mOR: 3, 95% CI 1.5 - 5.3]. Vaccine effectiveness for single dose was found to be 87.4 [95% CI: 76.1 - 93.4], while for two doses it was approximately 93% [95% CI: 86.2 - 96.6]. For Measles elimination, mother's education on breast feeding and appropriate weaning practices is required

An overview of the predictors of depression among adult pakistani women

Diseases of women that are due to their gender specific roles and responsibilities result from cultural and social factors prevalent in the environs. World Health Organization has put special emphasis on research need regarding gender related factors for diseases disproportionately affecting women in developing countries. The objective of this write up was to determine the prevalence of depression and the associated risk factors among adult women in Pakistan. PubMed was searched using key words depression, risk factors, women and Pakistan. Out of 20 initially retrieved articles, 12 were directly related to depression and its risk factors among Pakistani women within Pakistani geographical context. Women in Pakistan are vulnerable to poor mental health due to marriage related issues, domestic violence, verbal or physical abuse by in-laws, stressful life and poor social conditions. Women in their perinatal period are more at risk of depression due to pregnancy related concerns