ABSTRACT
Introduction: Community Health Workers (CHWs) are vital resources in delivering community-based primary health care, especially in low-and-middle-income countries (LMIC). However, few studies have investigated detailed time and task assessments of CHW's work. We conducted a time-motion study to evaluate CHWs' time on health conditions and specific tasks in Neno District, Malawi. Methods: We conducted a descriptive quantitative study utilizing a time observation tracker to capture time spent by CHWs on focused health conditions and tasks performed during household visits. We observed 64 CHWs between 29 June and 20 August 2020. We computed counts and median to describe CHW distribution, visit type, and time spent per health condition and task. We utilized Mood’s Median Test to compare the median time spent at a household during monthly visits with the program design standard time. We used Pairwise Median Test to test differences in median time duration for health conditions and assigned tasks. Results: We observed 660 CHW visits from 64 CHWs, with 95.2% (n= 628) of the visits as monthly household visits. The median time for a monthly household visit was 34 minutes, statistically less than the program design time of 60 minutes (p<0.001). While the CHW program focused on eight disease areas, pretesting with the observation tool showed that CHWs were engaged in additional health areas like COVID-19. Of the 3043 health area touches by CHWs observed, COVID-19, tuberculosis, and non-communicable diseases (NCDs) had the highest touches (19.3%, 17.6%, and 16.6%, respectively). The median time spent on sexually transmitted infections (STIs) and NCDs was statistically higher than in other health areas (p<0.05). Of 3813 tasks completed by CHWs, 1640 (43%) were on health education and promotion. A significant difference was observed in the median time spent on health education, promotion, and screening compared to other tasks (p<0.05). Conclusion: This study demonstrates that CHWs spend the most time on health education, promotion, and screening per programmatic objectives but, overall, less time than program design. CHWs deliver care for a broader range of health conditions than the programmatic design indicates. Future studies should examine associations between time spent and quality of care delivery.
Subject(s)
COVID-19 , Tuberculosis , Communication DisordersABSTRACT
Objective: To assess changes over time in COVID-19 knowledge, risks, symptoms, testing, and infection prevention practices among patients with complex non-communicable disease (NCD) receiving care at Neno District and Lisungwi Community Hospitals, Malawi. Design and participants: We conducted a prospective open cohort study using telephone-based data collection among patients enrolled in NCD clinics. We conducted four rounds of data collection between November 2020 and October 2021. Setting: Rural southwestern Malawi in Neno District which has a population of 150, 211 persons. Primary and secondary outcome measures: We used descriptive statistics to characterize the population and assess COVID-19-related knowledge and behaviors. Linear and logistic regression models were used to assess significant changes over time. Results: Across four rounds of data collection, the most commonly reported COVID-19-related risks among patients included visiting health facilities (range: 35-49%), attending mass gatherings (range: 33-36%), and travelling outside the district (range: 14-19%). Patients reporting having ever experienced COVID-like symptoms increased from 30% in December 2020 to 41% in October 2021, however, as of the end of study period, only 13% of patients had ever received a COVID-19 test. Overall, respondents answered about two thirds (range: 67-70%) of the COVID-19 knowledge questions correctly with no significant changes over time. Hand washing, wearing of face masks and maintaining safe distance were the most frequently reported strategies used to prevent spreading of COVID-19. Wearing of facemask significantly improved from 63% to 96% over time (p<0.001). Conclusions: Households of advanced chronic disease patients reported accurate knowledge about COVID-19 and improved adherence to wearing of face masks over time. However, patients commonly visit locations where they could be exposed to COVID-19 and often experience COVID-like symptoms but are rarely tested for COVID-19. We urge the government and other stakeholders to increase COVID-19 testing accessibility to primary facility and community levels.