ABSTRACT
Teenage pregnancy and child marriage are prevalent in Zambia and are complexly interrelated issues with common causes and effects. The aim of this study was to explore factors in the social and cultural environment shaping young people's sexual behaviour, with specific attention to teenage pregnancy and child marriage in Eastern Zambia. The study was conducted in selected wards in Petauke, Chadiza and Katete districts, using an exploratory mixed-method design including a household survey, focus group discussions and in-depth interviews. The participants included 1,434 young females and males aged 15 to 24, female and male parents and caregivers; grandmothers; traditional leaders; teachers; health and social workers; representatives from youth associations, community-based and non-governmental organizations; and district level policy makers. Qualitative data were analysed using thematic content analysis and NVivo was used to manage the data, while survey data were analysed using Stata. The study revealed a high prevalence rate of teenage pregnancy (48%) and child marriage (13%) among young women. The mean age at first pregnancy or fatherhood was lower among female (17) than male respondents (20). A clear interlinkage between teenage pregnancy and child marriage was found, the two issues were mutually reinforcing. While teenage pregnancy appeared both as a cause and consequence of child marriage, marriage was mostly a common response to pregnancy. Early sexual debut, limited knowledge and use of contraception, poverty and limited future perspectives as well as sexual and gender norms were identified as the main causative factors of teenage pregnancy and therefore, child marriage. Based on the findings, a conceptual model to explain the interrelationships between young people's sexual behaviour, teenage pregnancy and child marriage is discussed. To address teenage pregnancy and child marriage in Eastern Zambia, there is a need to look into the realities and needs of young people regarding sex and relationships.
Subject(s)
Marriage , Pregnancy in Adolescence/prevention & control , Adolescent , Female , Health Knowledge, Attitudes, Practice , Health Services Accessibility , Humans , Male , Models, Theoretical , Poverty , Pregnancy , Prevalence , Qualitative Research , Sexual Behavior , Social Norms , Young Adult , Zambia/epidemiologyABSTRACT
This study sought to synthesize and critically review evidence on costs and cost-effectiveness of community health worker (CHW) programmes in low- and middle-income countries (LMICs) to inform policy dialogue around their role in health systems.
Subject(s)
Humans , Community Health Workers/education , Community Health Workers/organization & administration , Environmental Health Surveillance , Costs and Cost Analysis/economicsABSTRACT
AIM: Improving community health worker's performance is vital for an effective health system in developing countries. In Malawi, hardly any research has been done on factors that motivate this cadre. This qualitative assessment was undertaken to identify factors that influence motivation and job satisfaction of health surveillance assistants (HSAs) in Mwanza district, Malawi, in order to inform development of strategies to influence staff motivation for better performance. METHODS: Seven key informant interviews, six focus group discussions with HSAs and one group discussion with HSAs supervisors were conducted in 2009. The focus was on HSAs motivation and job performance. Data were supplemented with results from a district wide survey involving 410 households, which included views of the community on HSAs performance. Qualitative data were analysed with a coding framework, and quantitative data with the Statistical Package for Social Sciences (SPSS). RESULTS: The main satisfiers identified were team spirit and coordination, the type of work to be performed by an HSA and the fact that an HSA works in the local environment. Dissatisfiers that were found were low salary and position, poor access to training, heavy workload and extensive job description, low recognition, lack of supervision, communication and transport. Managers and had a negative opinion of HSA perfomance, the community was much more positive: 72.9% of all respondents had a positive view on the performance of their HSA. CONCLUSION: Activities associated with worker appreciation, such as performance management were not optimally implemented. The district level can launch different measures to improve HSAs motivation, including human resource management and other measures relating to coordination of and support to the work of HSAs.
Subject(s)
Community Health Workers/psychology , Job Satisfaction , Motivation , Adult , Attitude of Health Personnel , Career Mobility , Community Health Workers/education , Female , Focus Groups , Humans , Malawi , Male , Middle Aged , Qualitative Research , Salaries and Fringe Benefits , Stress, PsychologicalABSTRACT
Aim: Improving community health worker's performance is vital for an effective health system in developing countries. In Malawi; hardly any research has been done on factors that motivate this cadre. This qualitative assessment was undertaken to identify factors that influence motivation and job satisfaction of health surveillance assistants (HSAs) in Mwanza district; Malawi; in order to inform development of strategies to influence staff motivation for better performance. Methods Seven key informant interviews; six focus group discussions with HSAs and one group discussion with HSAs supervisors were conducted in 2009. The focus was on HSAs motivation and job performance. Data were supplemented with results from a district wide survey involving 410 households; which included views of the community on HSAs performance. Qualitative data were analysed with a coding framework; and quantitative data with the Statistical Package for Social Sciences (SPSS).Results The main satisfiers identified were team spirit and coordination; the type of work to be performed by an HSA and the fact that an HSA works in the local environment. Dissatisfiers that were found were low salary and position; poor access to training; heavy workload and extensive job description; low recognition; lack of supervision; communication and transport. Managers and had a negative opinion of HSA perfomance; the community was much more positive: 72.9of all respondents had a positive view on the performance of their HSA. Conclusion Activities associated with worker appreciation; such as performance management were not optimally implemented. The district level can launch different measures to improve HSAs motivation; including human resource management and other measures relating to coordination of and support to the work of HSAs
