Relationship between role stressors, job tasks and job satisfaction among health surveillance assistants in Malawi: a cross-sectional study

ObjectivesThe objective of this study was to investigate the role stressors, sociodemographic characteristics and job tasks of health surveillance assistants (HSAs) and to explore major predictors of role stressors and job satisfaction of HSAs in Malawi.SettingData were collected from health centres and hospitals of three Malawi districts of Mangochi, Lilongwe and Mzimba.ParticipantsRespondents were 430 HSAs. 50.20% of them were male, while 49.8% were female.DesignA cross-sectional study of the observational correlational design was carried out.Main outcome measuresRespondents perceptions of job tasks, role stressors and job satisfaction.ResultsThe key findings of this study were role ambiguity and role overload were significantly negatively related to job satisfaction, while role conflict was insignificantly related to job satisfaction. Additionally, the clinical tasks of the HSAs and some of the sociodemographic variables were associated with the role stressors and job satisfaction of the HSAs in Malawi.ConclusionsSince the HSAs clinical tasks were significantly related to all role stressors, there is need by the government of Malawi to design strategies to control the role stressors to ensure increased job performance and job satisfaction among HSAs. Furthermore, studies may be required in the future to assist government to control role stressors among HSAs in Malawi.

Determinants of exclusive breastfeeding in infants of six months and below in Malawi: a cross sectional study

Background UNICEF and WHO recommend that all children should be exclusively breastfed for the first 6 months of life as breastmilk contains all the nutrients an infant needs during this period. In Malawi, exclusive breastfeeding has been declining from 72% (2009), 70.2% (2014) and 61% in the most recent survey (2015–16). We aimed to determine factors associated with exclusive breastfeeding in Malawi. Methods We used data from the Malawi Demographic and Health Survey (MDHS) 2015–2016. Survey records for 2059 mothers of children aged 6 months and below were identified and potential factors influencing infant feeding were examined. Logistic regression analysis was carried out to model determinants of exclusive breastfeeding (EBF). Results EBF declined in proportion to the age of the infant. Significant associations with continuing EBF were age of the mother, ethnicity of the mother, sex of infant and number of siblings. Members of the Tumbuka (OR = 1.71, CI. 1.13–2.59) and Ngoni (OR = 2.05, CI. 1.38–3.05) communities were more likely to practice EBF. In addition, mothers with female babies (OR = 1.35, CI. 1.08–1.70) and those with 3–4 children (OR = 1.47, CI. 1.04–2.08) were more likely to engage in EBF. Conclusion We identify important variations in EBF practices among population sub-groups in Malawi that need to be considered when framing health education messaging. Work is needed to assess the impact of more targeted messaging, whether delivered via ‘ten steps’ to successful breastfeeding under Baby Friendly Hospital Initiative (BFHI) programming or other health education and awareness campaigns to sensitize communities on implications of some cultural practices on the lives of babies. The potential role for mass media, targeted Health Surveillance Assistants’ (HSA) home visits and male involvement also require exploration.

Health Surveillance Assistants’ Practices of Postnatal Care in Lilongwe District, Malawi

Health surveillance assistants (HSAs) participate in the provision of postnatal care in Malawi, although their knowledge and skills in maternal and reproductive health are limited. This article presents the findings of a mixed-methods study that was conducted in three selected health centres to document the practices of HSAs in the provision of postnatal care to mothers and babies in Lilongwe district in Malawi. A random sample of 97 HSAs participated in the quantitative part of this study and 30 of these participated in the qualitative aspect of the study. Quantitative data were analysed using descriptive statistics while qualitative data were analysed using thematic analysis. This study found that many respondents (>60%) had limited capacity to provide adequate postnatal care and 85.3% of them never checked the vital signs of mothers and babies. They also lacked knowledge and skills in some aspects of postnatal care including danger signs. Almost all the respondents (96.8%) had never received any training in Basic Emergency Obstetric and Neonatal Care (BEmONC), or Emergency Obstetric and Neonatal Care (EmONC). Considering that HSAs have limited capacity to provide postnatal care to mothers and their babies, shifting tasks of nurses or midwives to HSAs should not be considered as an “outright solution” for increasing access to postnatal care in low-resource settings because it may compromise the quality of care.

"Prevalence of role stressors and associated factors among health surveillance assistants in Malawi? A cross-sectional study"

Background: Health Surveillance Assistants (HSAs) are community-based health workers in Malawi, responsible for health services delivery at the community level. The prevalence of high role stressors among health surveillance assistants (HSAs) is a very important issue to strengthen the delivery of the essential health package at the community level; however, data on the prevalence of these role stressors to help understand more about the role stressors among HSAs is unavailable. This study aimed to investigate the prevalence of role stressors and its associated factors among HSAs. Methods: A cross-sectional study design was used in this study to collect data from January 2017 to December 2017. Data were collected from 430 HSAs from the districts of Mangochi, Lilongwe and Mzimba using a self-administered structured questionnaire was hand delivered to a total of 455 HSAs (response rate of 94.5%). Role ambiguity and role conflict was measured using a 13-item Rizzo et al. role conflict and ambiguity (RCA) scale; role overload was measured using a 9-item Reilly role overload scale and the job tasks for HSAs were measured using Burgal et al. modified version of the task inventory scale. Factors for role stressors were analyzed using the principal component analysis (PCA) and multiple linear regression model. Results: Of the respondents 3% had high risk for RA, 51.20% RC and 49% RO. Role stressors are prevalent among HSAs in Malawi. HSAs who were resident in rural areas, female, and performing additional clinical roles experienced significant levels of role stressors. Interestingly, no statistically significant associations were found between role stressors and the years at service post, age and the district of work. Conclusion: This is the first study of occupational role stressors in Malawi. Role stressors are prevalent among HSAs. Interventions aimed at improving supervision, training and task regulation by an independent regulatory body may support to reduce role stressors among HSAs. Keywords : health surveillance assistants, role ambiguity, role conflict, role overload, role stressors

Is there any relationship between role stressors, job tasks, and job satisfaction among Health Surveillance Assistants in Malawi? A cross-sectional study

Background: Health Surveillance Assistants (HSAs) are community-based health workers in Malawi, responsible for health services delivery at the community level. They are reported to be overloaded in their work, and anecdotal evidence suggests they are stressed. The purpose of this study was to explore the role stressors among the HSAs with the view to identify factors for role stressors and suggest some measures for the effective management of the HSAs to alleviate the problem of role stressors. Methods: A descriptive cross-sectional study design and multistage stage sampling were used in this study. Data were collected from 430 HSAs from the districts of Mangochi, Lilongwe and Mzimba. A self-administered questionnaire was hand delivered to a total of 455 HSAs with a response rate of 94.5%. The data collected were analyzed with the aid of the computer software package Statistical Package for the Social Sciences (SPSS) version 23. Statistics used for the analysis included: Mean, Standard Deviation, correlations and principal component analysis (PCA). Results: The key findings of this study are that role ambiguity ( r = -.238, P< 0.001) and role overload ( r =-.159, P< 0.01) were significantly negatively related to job satisfaction, while role conflict ( r = -.004, P= 0.472) was insignificantly related to job satisfaction. Additionally, the HSAs curative role was negatively related to role ambiguity ( r = -.108, P= 0.013) and positively related to role conflict ( r = .118, P= 0.008) and role overload ( r = .105, P= 0.015) while the HSAs overall preventive task was positively related to role overload. Conclusion: Since the HSAs clinical tasks were significantly related to all role stressors there is need by the government of Malawi to design strategies to control the role stressors to ensure increased job performance and job satisfaction among HSAs. Keywords : Relationship, role ambiguity, role conflict, role overload, job satisfaction, role stressors

The role of information and communication technologies in the delivery of health services in rural communities: Experiences from Malawi

Background: In recent years, Africa has experienced a boom in information and communication technologies (ICTs). These ICTs have been hailed by the health sector as impetus for heath service delivery in rural areas. In this regard, stakeholders in the health sector have made attempts to reinforce frontline health workers with technological tools. Although there is much evidence that ICTs play a key role in the health sector, it remains unknown how the health sector in Malawi is exploiting ICTs in its delivery of day-to-day operations.Objectives: In this study, we investigate the role that ICTs play in rural health. This study will specifically determine the purposes that health surveillance assistants (HSAs) use ICTs for, assess the ICT skills and expertise of HSAs, analyse benefits of ICTs and study the problems faced by HSAs in the effective use of ICTs.Method: In this study, a quantitative research method approach was adopted to address the research objectives. Both research sites and respondents were selected using a convenient sampling method. We self-administered and collected the questionnaire from the respondents. The Statistical Package for the Social Sciences (SPSS) was used to analyse the data.Results: We find that HSAs have made headways in the adoption of various forms of ICTs such as mobile phones alongside their applications (Facebook, Twitter and WhatsApp). However, efforts to maximise the appropriation of ICTs by HSAs are punctuated by various hindrances including high cost of ICT gadgets, high cost of Internet bundles, inadequate training in ICTs and lack of support from senior management in the Ministry of Health.Conclusion: Use of ICTs in community health is slowly but surely possible. In a nutshell, the study has shown that, regardless of perceivable hindrances associated with use of ICTs, HSAs use some ICTs in their work and personal activities. It is evident that using mobile phones to improve performance is an important area and that there is little interest in evaluating such interventions.