Factors associated with home visits by volunteer community health workers to implement a home-fortification intervention in Bangladesh: a multilevel analysis

Objective: BRAC, an international development organization based in Bangladesh, engages community health workers called Shasthya Shebikas (SS) to implement home fortification of foods with micronutrient powders (MNP). We identified factors associated with home visits by SS, at different levels of the BRAC programme-delivery hierarchy, to implement home-fortification interventions. Design: We conducted a cross-sectional survey, semi-structured interviews, and collected programme-related data from sub-districts included in the caregiver survey of BRAC's home-fortification programme and performed multilevel logistic regression modelling to investigate factors associated with home visits by SS. Settings: Sixty-eight sub-districts in Bangladesh. Participants: Caregivers of children aged 6-59 months (n 1408) and BRAC's SS (n 201). Results: Households with older children (0 center dot 55; 0 center dot 42, 0 center dot 72; P < 0 center dot 001) and located >300 m from the SS's house (0 center dot 67; 0 center dot 50, 0 center dot 89; P = 0 center dot 006) were less likely to have been visited by the SS, whereas those with caregivers who had >= 5 years of schooling (1 center dot 53; 1 center dot 10, 2 center dot 12; P = 0 center dot 011) were more likely to have been visited by the SS (adjusted OR; 95 % CI). Households in the catchment area of older SS aged >50 years (0 center dot 44; 0 center dot 21, 0 center dot 90; P = 0 center dot 025) were less likely to have been visited by the SS, whereas those with SS who received incentives of >800 BDT (3 center dot 00; 1 center dot 58, 5 center dot 58; P = 0 center dot 001) were more likely to have been visited by the SS (adjusted OR; 95 % CI). Conclusions: The number of home visits is a function of the characteristics of SS, factors that characterize the households they serve and characteristics of their organizational context, particularly to implement home fortification of foods with MNP.

Automated summary

The study identified factors associated with home visits by community health workers in a home-fortification program in Bangladesh, including characteristics of the households they serve, education level of caregivers, age of the workers, and incentives received. This emphasizes the importance of understanding various factors that influence the implementation of health programs in communities.