title: Factors related to retention of community health workers in a trial on community-based management of fever in children under 5 years in the Dangme West District of Ghana.
abstract: BACKGROUND
  In resource-constrained settings of developing countries, promotion of community-based health interventions through community health workers (CHWs) is an important strategy to improve child health. However, there are concerns about the sustainability of such programmes owing to the high rate of CHW attrition. This study examined factors influencing retention of volunteer CHWs in a cluster randomised trial on community management of under-5 fever in a rural Ghanaian district.
  
  
  METHODS
  Data were obtained from structured interviews (n=520) and focus group discussions (n=5) with CHWs. Factors influencing CHWs' decisions to remain or leave the programme were analysed using a probit model, and focus group discussion results were used to elucidate the findings.
  
  
  RESULTS
  The attrition rate among CHWs was 21.2%. Attrition was comparatively higher in younger age groups (25.9% in 15-25 years group, 18.2% in 26-45 years group and 16.5% in ≥46 years group). Approval of a CHW by the community (p<0.001) and the CHW's immediate family (p<0.05) were significant in influencing the probability of remaining in the programme. Motivation for retention was related to the desire to serve their communities as well as humanitarian and religious reasons.
  
  
  CONCLUSIONS
  The relatively moderate rate of attrition could be attributed to the high level of community involvement in the selection process as well as other aspects of the intervention leading to high community approval and support. Attention for these aspects could help improve CHW retention in community-based health interventions in Ghana, and the lessons could be applied to countries within similar settings.
authors.affiliation: Research and Development Division, Ghana Health Service, PM Bag 190, Accra, Ghana mercy.abbey@yahoo.com mercy.abbey@ghsmail.org.
authors.forename: Mercy
authors.initials: M
authors.lastname: Abbey
authors.affiliation: School of Public Health, University of Texas Health Science Centre, 1200 Herman Pressler Street, Suite W238, Houston, TX 77030, USA.
authors.forename: L Kay
authors.initials: LK
authors.lastname: Bartholomew
authors.affiliation: School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana.
authors.forename: Justice
authors.initials: J
authors.lastname: Nonvignon
authors.affiliation: Research and Development Division, Ghana Health Service, PM Bag 190, Accra, Ghana.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Chinbuah
authors.affiliation: School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana.
authors.forename: Matilda
authors.initials: M
authors.lastname: Pappoe
authors.affiliation: Dodowa Health Research Centre, Ghana Health Service, P.O. Box 1, Dangme West District, Ghana.
authors.forename: Margaret
authors.initials: M
authors.lastname: Gyapong
authors.affiliation: Research and Development Division, Ghana Health Service, PM Bag 190, Accra, Ghana.
authors.forename: John O
authors.initials: JO
authors.lastname: Gyapong
authors.affiliation: National Malaria Control Programme, Ghana Health Service, P.O. Box KB 493, Korle-Bu, Accra, Ghana.
authors.forename: Constance
authors.initials: C
authors.lastname: Bart-Plange
authors.affiliation: Department of Health Promotion, University of Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: van den Borne
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002675:Child, Preschool; D003150:Community Health Workers / Q000523:psychology / Q000600:supply & distribution*; D019468:Disease Management; D005260:Female; D005334:Fever / Q000628:therapy*; D017144:Focus Groups; D005869:Ghana; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010563:Personnel Turnover; D019035:Rural Health Services / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014838:Volunteers; D055815:Young Adult
keywords: Attrition; Community health workers; Community management; Fevers; Ghana; Retention