Table 3.
Risk factors for retention of a cohort of 542 volunteer community health workers, Dhaka urban slums, 2009 a
| Independent variables |
Model 1: Sociodemographic characteristics |
Model 2: Addition of motivational factors |
Model 3: Addition of organizational inputs |
Model 4: Addition of competitive factors |
Model 5: Final model |
|---|---|---|---|---|---|
|
Partially adjusted RR (95% CI) |
Partially adjusted RR (95% CI) |
Partially adjusted RR (95% CI) |
Partially adjusted RR (95% CI) |
Adjusted RR (95% CI) |
|
| (1) | (2) | (3) | (4) | (5) | |
|
Sociodemographic characteristics |
|
|
|
|
|
| Age |
|
|
|
|
|
| >25 yr of age |
1.00 |
1.00 |
1.00 |
1.00 |
|
| 25-45 yr of age |
1.08 (0.92 to 1.27) |
1.08 (0.93 to 1.27) |
1.09 (0.93 to 1.28) |
1.06 (0.91 to 1.25) |
|
| >45 yr of age |
1.06 (0.85 to 1.32) |
1.06 (0.84 to 1.32) |
1.05 (0.84 to 1.31) |
1.04 (0.83 to 1.30) |
|
| Marital status |
|
|
|
|
|
| Unmarried |
0.74 (0.42 to 1.30) |
0.80 (0.46 to 1.38) |
0.88 (0.54 to 1.43) |
0.85 (0.52 to 1.40) |
|
| Married |
1.00 |
1.00 |
1.00 |
1.00 |
|
| Widow, divorced, or separated |
1.02 (0.89 to 1.16) |
1.02 (0.89 to 1.18) |
1.02 (0.88 to 1.18) |
1.02 (0.88 to 1.18) |
|
| Primary education complete or above |
0.97 (0.87 to 1.07) |
0.97 (0.87 to 1.08) |
0.96 (0.87 to 1.07) |
0.96 (0.86 to 1.07) |
|
| Household size |
1.02 (0.99 to 1.04) |
1.01 (0.99 to 1.04) |
1.01 (0.99 to 1.04) |
1.02 (0.99 to 1.04) |
|
| Duration of stay in the slum |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
| <10 yr |
1.11c (0.98 to 1.25) |
1.10 (0.98 to 1.24) |
1.08 (0.96 to 1.22) |
1.07 (0.95 to 1.20) |
1.08 (0.96 to 1.21) |
| 10-20 yr |
1.12c (0.98 to 1.26) |
1.11c (0.98 to 1.25) |
1.10 (0.97 to 1.24) |
1.09 (0.96 to 1.23) |
1.11c (0.99 to 1.25) |
| >20 yr |
|
|
|
|
|
| Household asset quintiles |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
| Poorest |
1.16b (1.01 to 1.33) |
1.14c (0.99 to 1.31) |
1.15b (1.00 to 1.32) |
1.13c (0.98 to 1.29) |
1.13c (0.99 to 1.29) |
| Lower middle |
1.05 (0.90 to 1.23) |
1.06 (0.91 to 1.23) |
1.07 (0.92 to 1.25) |
1.07 (0.92 to 1.24) |
1.05 (0.91 to 1.22) |
| Middle |
1.08 (0.92 to 1.26) |
1.06 (0.90 to 1.25) |
1.06 (0.91 to 1.25) |
1.05 (0.90 to 1.23) |
1.04 (0.89 to 1.22) |
| Upper middle |
1.12 (0.97 to 1.31) |
1.10 (0.94 to 1.28) |
1.12 (0.96 to 1.29) |
1.12 (0.97 to 1.30) |
1.12c (0.98 to 1.28) |
| Richest |
|
|
|
|
|
| Household loan status |
1.04 (0.95 to 1.13) |
1.01 (0.93 to 1.10) |
1.00 (0.92 to 1.09) |
0.95 (0.86 to 1.04) |
|
|
Motivational factors |
|
|
|
|
|
| Family disapproval |
|
1.10c (1.00 to 1.22) |
1.10c (0.99 to 1.21) |
1.12b (1.01 to 1.25) |
1.12b (1.01 to 1.24) |
| Positive family attitude |
|
0.98 (0.87 to 1.11) |
0.99 (0.87 to 1.12) |
0.99 (0.87 to 1.11) |
|
| Monthly CHW income |
|
|
|
|
|
| <US$ 5.92 |
|
1.00 |
1.00 |
1.00 |
|
| US$ 5.92 to US$ 7.64 |
|
1.03 (0.90 to 1.17) |
1.02 (0.89 to 1.16) |
1.01 (0.88 to 1.15) |
|
| >US$ 7.64 |
|
1.09c (0.99 to 1.20) |
1.07 (0.97 to 1.18) |
1.06 (0.96 to 1.17) |
|
| Joined with expectation of income |
|
1.02 (0.93 to 1.12) |
1.02 (0.93 to 1.12) |
1.02 (0.93 to 1.12) |
1.04 (0.95 to 1.14) |
| Change in social prestige |
|
0.90c (0.80 to 1.02) |
0.91 (0.80 to 1.02) |
0.90c (0.80 to 1.02) |
1.0 |
| Less than before |
|
1.00 |
1.00 |
1.00 |
0.91c (0.81 to 1.02) |
| No change |
|
0.95 (0.86 to 1.05) |
0.93 (0.84 to 1.03) |
0.94 (0.85 to 1.04) |
0.95 (0.86 to 1.05) |
| More than before |
|
|
|
|
|
| Joined with expectation of social recognition |
|
0.92 (0.82 to 1.02) |
0.92 (0.82 to 1.03) |
0.93 (0.83 to 1.03) |
0.94 (0.85 to 1.04) |
| Harassed while working in the community |
|
1.12c (1.00 to 1.26) |
1.11c (0.98 to 1.24) |
1.08 (0.96 to 1.21) |
|
| Community approval |
|
1.02 (0.91 to 1.15) |
1.02 (0.91 to 1.14) |
1.01 (0.90 to 1.14) |
1.00 (0.89 to 1.11) |
| Positive community appraisal |
|
1.39b (1.05 to 1.84) |
1.39b (1.06 to 1.83) |
1.42b (1.08 to 1.87) |
1.45b (1.10 to 1.91) |
| Effect of CHW role on other income sources |
|
0.88 (0.73 to 1.05) |
0.91 (0.76 to 1.08) |
0.85c (0.70 to 1.02) |
0.85c (0.71 to 1.03) |
| Difficult to run family without CHW income |
|
0.97 (0.88 to 1.07) |
0.98 (0.89 to 1.08) |
1.01 (0.91 to 1.12) |
|
|
Organizational inputs |
|
|
|
|
|
| Village organization membership |
|
|
1.00 (0.91 to 1.10) |
0.95 (0.86 to 1.05) |
|
| Attending refresher training regularly |
|
|
2.13b (1.03 to 4.39) |
2.17b (1.04 to 4.52) |
2.25b (1.08 to 4.71) |
|
Competitive factors |
|
|
|
|
|
| Conflict with household responsibilities |
|
|
|
0.98 (0.85 to 1.12) |
0.98 (0.86 to 1.13) |
| Competition with other providers |
|
|
|
1.01 (0.87 to 1.18) |
1.01 (0.88 to 1.16) |
| Competition with other employment |
|
|
|
1.09c (1.00 to 1.20) |
1.08c (0.99 to 1.18) |
| Involvement with other NGOs |
|
|
|
1.15b (1.03 to 1.28) |
1.13b (1.04 to 1.23) |
| Working for other health program | 0.80c (0.63 to 1.01) | 0.81c (0.64 to 1.02) |
aCHW, Community health worker; CI, Confidence interval; NGO, Non-governmental organization; RR, Relative risk. bSignificant at the 5%** level. cSignificant at the 10%* level. US$ 1.00 = 67.52 Bangladeshi Taka (on 1 July 2008).