PERFORMANCE OF COMMUNITY HEALTH VOLUNTEERS ON NUTRITION OUTCOMES OF HOUSEHOLDS WITH CHILDREN 6-59 MONTHS IN ALEGO USONGA, SIAYA COUNTY, KENYA

Abstract

The World Health Organization (WHO) recommends using Community Health Volunteers (CHVs) to deliver nutrition services, contributing to Universal Health Coverage (UHC), a broader goal that encompasses nutrition. Thus, various programs have been implemented worldwide utilizing CHVs. Nevertheless, poor nutrition outcomes persist in households under the care of CHVs, leading to high rates of malnutrition and mortality. Poor hygiene and sanitation practices also contribute to malnutrition and infections, worsening nutrition challenges. Using the Donabenian Model of Quality in Health Care, this study evaluated the performance of CHVs on the nutrition outcomes of households with children aged 6-59 months in Alego Usonga, Siaya County, Kenya, where nutrition and health outcomes are poor. A cross-sectional study design was employed, using purposive, multi-stage, and systematic sampling methods to gather data from 356 households and conduct 3 focus group discussions (FGDs). A structured questionnaire and FGD guide were utilized to collect quantitative and qualitative data. The study was carried out from February to May 2024. Statistical Package of Social Sciences (SPSS) Version 28 was used to analyze quantitative data, while NVivo 14 was used for qualitative data analysis. Fisher's Exact Tests and Multinomial Logistic Regression Analysis, at a 95% confidence level, were employed to establish the relationship between CHVs' service delivery and nutrition outcomes in households with children aged 6-59 months. The main economic activity was farming at 36.7%, with 78% of households earning less than USD 77 monthly. Key nutrition and health outcomes included: low Minimum Dietary Diversity (MDD) – 6.1%, low Minimum Acceptable Diet (MAD) – 2.7%, high bottle-feeding – 44.6%, high food insecurity – 60.4%, and low handwashing uptake – 15.7%. Despite these findings, a significant relationship was established between CHVs’ service delivery (household visitations, referrals, follow-ups, counseling services) and various nutrition outcomes. In conclusion, CHVs remain essential in nutrition service delivery, even though they visit only 71.9% of the targeted households every month. Therefore, to improve CHVs’ service delivery, the Government of Kenya should review CHVs’ policies and strengthen their capacity.