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Journal of Community Health

, Volume 37, Issue 2, pp 513–519 | Cite as

Preventing Waterborne Diseases: Analysis of a Community Health Worker Program in Rural Tamil Nadu, India

  • Neal Gupta
  • Thingalraj Mutukkanu
  • Alexander Nadimuthu
  • Initha Thiyagaran
  • Eileen Sullivan-Marx
Original Paper

Abstract

Community health worker (CHW) programs have become popular tools in reducing the burden of childhood illnesses. However, the efficacy of CHWs in facilitating behavior change, as a means of preventing waterborne diseases, remains unclear. Using a household survey (n = 225),in rural Tamil Nadu, South India, we assessed the effects of a CHW program on knowledge, attitudes and practices related to diarrheal illness through comparison with a control population that was not enrolled in the program. The CHW program in the experimental village entailed behavior change aimed at preventing diarrheal illness through home visits, community events and health education. Correlates of four key variables on knowledge of drinking water contamination and behavior change were examined by using logistic regression models. We found that while the program was effective in raising awareness of drinking water contamination, it did not significantly increase hygiene and water sanitation practices in the village community in comparison to the control population. Furthermore, villagers enrolled in the CHW program were unable to recognize the connections between contaminated drinking water and disease. The results of our survey indicated the CHW program did not significantly affect behavior in the experimental village. Possible shortcomings in the program are discussed.

Keywords

Rural India Community health worker Diarrheal illness Behavior change Water treatment 

Notes

Acknowledgments

The University Scholars Program at the University of Pennsylvania supported the study financially. Dr. Sullivan-Marx is partially supported by a grant from ICTPH to the University of Pennsylvania School of Nursing. In addition, we thank the entire staff at ICTPH for facilitating this study and helping to organize the research team in the villages. The study would not have been possible without the support and cooperation of the families in the study villages.

References

  1. 1.
    Almroth, S., & Latham, M. (1995). Rational home management of diarrhea. Lancet, 345(8951), 709–711.PubMedCrossRefGoogle Scholar
  2. 2.
    Anand, S., & Barnighausen, T. (2004). Human resources and health outcomes. Lancet, 364(9445), 1603–1609.PubMedCrossRefGoogle Scholar
  3. 3.
    Ashok, S., Lamourelle, G., McNerney, K., Sutaria, J., & Ramamurthy, D. (2009). Nala oli volunteer handbook. Chennai: ICTPH.Google Scholar
  4. 4.
    Berman, P., Gawtkin, D., & Burger, S. (1987). Community based health workers: Head start or false start towards health for all? Social Science Medicine, 25(5), 443–459.PubMedCrossRefGoogle Scholar
  5. 5.
    Bhatnagar, S., Alam, S., & Gupta, P. (2010). Management of acute diarrhea: From evidence to policy. Indian Pediatrics, 47(3), 215–217.PubMedCrossRefGoogle Scholar
  6. 6.
    Bhutta, Z., Darmstadt, G., Hasan, B., & Haws, R. (2005). Community based interventions of perinatal health outcomes in developing countries: A review of the evidence. Pediatrics, 115(2 suppl), 519–617.PubMedGoogle Scholar
  7. 7.
    Black, R., Morris, S., & Byrce, J. (2003). Where and why are 10 million children dying every year? Lancet, 361(9376), 2226–2234.PubMedCrossRefGoogle Scholar
  8. 8.
    Bryant, C., Brown, K., McDermott, R., Debate, R., Alfonso, M., Baldwin, J., et al. (2009). Community based prevention marketing: A new framework for health promotion interventions. Emerging theories in health promotion practice and research (2nd ed., pp. 331–357). San Francisco, CA: Jossey-Bass.Google Scholar
  9. 9.
    Bryce, J., Victoria, C., Habicht, J., Black, R., & Scherpbier, R. (2005). Programmatic pathways to child survival: Results of a multi-country evaluation of integrated management of childhood illness. Health Policy Planning, 20(suppl. 1), i5–i17.CrossRefGoogle Scholar
  10. 10.
    Buckshee, K. (1997). Impact of roles of women on health in India. International Journal of Gynecology and Obstetrics, 58(1), 35–42.PubMedCrossRefGoogle Scholar
  11. 11.
    Clansen, T., Haller, L., Walker, D., Bartram, J., & Cairncross, S. (2006). Interventions to improve water quality for preventing diarrhea. Cochrane Database of Systematic Reviews, 1(3), 2–4.Google Scholar
  12. 12.
    Clasen, T. (2009). Scaling up household water treatment among low income populations. Geneva: World Health Organization.Google Scholar
  13. 13.
    De Zoysa, I., & Cole-King, S. (1983). Remuneration of the community health worker: What are the options? World Health Forum, 4, 125–130.Google Scholar
  14. 14.
    Fewtrell, L., Kauffman, R., Kay, D., Enanoria, W., Haller, L., & Colford, J., Jr. (2005). Water, sanitation and hygiene interventions to reduce diarrhea in less developed countries: A systematic review and meta-analysis. Lancet Infectious Disease, 5(1), 42–52.CrossRefGoogle Scholar
  15. 15.
    Healthcare Needs Assessment and Baseline Survey Report. (2008). Chennai: ICTPH. (Unpublished Data).Google Scholar
  16. 16.
    Jalan, J., & Ravallion, M. (2003). Does piped water reduce diarrhea for children in rural India? Journal of Econometrics, 112(1), 153–173.CrossRefGoogle Scholar
  17. 17.
    Luby, S., Agboatwalla, M., Painter, J., Atlaf, A., Billhimer, W., & Hoekstra, R. (2004). Effect of intensive hand washing promotion on the childhood diarrhea in high-risk communities in Pakistan. JAMA, 366(9481), 225–233.Google Scholar
  18. 18.
    Nath, K. (2003). Home hygiene and environmental sanitation: A country situation analysis for India. International Journal of Environmental Health Research, 13(1), S19–S28.PubMedCrossRefGoogle Scholar
  19. 19.
    Reller, M., Mendoza, C., Lopez, M., Alvarez, M., Hoekstra, R., Olson, C., et al. (2003). A randomized controlled trial of household-based flocculent-disinfectant drinking water treatment for diarrhea prevention in rural Guatemala. American Journal of Tropical Medicine and Hygiene, 69(4), 411–419.PubMedGoogle Scholar
  20. 20.
    Rowe, A., Savigny, D., Lanata, C., & Victoria, C. (2005). How can we achieve and maintain high quality performance among health workers and managers in low-resource settings. Lancet, 366, 1026–1035.PubMedCrossRefGoogle Scholar
  21. 21.
    Sazawal, S., & Black, R. (2003). Effect of pneumonia case management on mortality in neonates, infants and preschool children: A meta-analysis of community based trials. Lancet Infectious Disease, 3(9), 547–566.CrossRefGoogle Scholar
  22. 22.
    Sengupta, P., Mondal, S., Ghosh, S., Gupta, D., Sikder, S., & Sircar, B. (1994). Review on the development and community implementation of oral rehydration therapy. Indian Journal of Public Health, 38(2), 50–57.PubMedGoogle Scholar
  23. 23.
    Singh, R. Ministry of Home Affairs, Registrar General and Census Commissioner. (2001). Provisional Population Totals: Tamil Nadu, Series-34, Paper-1 of 2001. New Delhi: Census of India.Google Scholar
  24. 24.
    Swider, S. (2002). Outcome effectiveness of community health workers: An integrative literature review. Public Health Nursing, 19(1), 11–20.PubMedCrossRefGoogle Scholar
  25. 25.
    Taylor, C., & Greenough, W. (1989). Control of diarrheal diseases. Annual Review of Public Health, 10, 221–244.PubMedCrossRefGoogle Scholar
  26. 26.
    Viswanathan, M., Kraschnewski, J., Nishikawa, B., et al. (2009). Outcomes of community health worker interventions. In Evidence Report/Technology Assessment No. 181, AHRQ Publication No. 09-E014, RTI International–University of North Carolina Evidence-Based Practice Center. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
  27. 27.
    Walt, G., Perera, M., & Heggenhougen, K. (1989). Are large scale volunteer community health worker programs feasible? Social Science Medicine, 29(5), 599–608.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Neal Gupta
    • 1
  • Thingalraj Mutukkanu
    • 2
  • Alexander Nadimuthu
    • 2
  • Initha Thiyagaran
    • 2
  • Eileen Sullivan-Marx
    • 1
  1. 1.Department of Family and Community HealthUniversity of Pennsylvania School of NursingPhiladelphiaUSA
  2. 2.Sugha-Vazhvu Health Care Pvt. Ltd.ThanjavurIndia

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