LHW's role in the provision of nutrition services for under 5 children in peri-urban areas of Karachi - a qualitative study

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


Globally, one of the major risk factors for child morbidity and mortality is considered to be malnutrition. Malnutrition is attributable for nearly half of all deaths in children under 5 years of age and every year there is a loss of about 3 million lives unnecessary. The incidence of common infection with high frequency and severity results in malnutrition with delayed recovery in children or it can leads to death in children under 5 years of age. However, studies have shown that Lady Health Worker (LHW) plays an important role and can deliver nutrition services to underserved populations, despite the fact that working in a weak health system is a challenge for LHW to provide services. Study Objective: The study objective is to explore the extent of provision of nutritional services for children under 5 by LHWs according to their job description in peri urban areas of Karachi. Methodology: The exploratory qualitative research design was used for the research. This project was carried out in the peri-urban area of Karachi in Baldia Town. Our target populations were mothers, LHWs and the nutritional expert, behavior change communication expert (BCC), LHW program experts, field officer, and lady health supervisor. The data collection methods that were used for the study were focus group discussion (FGDs) and key informant interviews (KIIs). The FGDs were conducted with the mother of children under five to obtain their views on the services they are receiving from LEI Ws and with LHWs to find out their perceptions in regards to nutritional services. By using purposive sampling the participants from the peri-urban area of Karachi were invited for FGDs. Whereas the KI interviews were conducted with, LHWs and Nutrition support program managers, lady health supervisor, field officers, and behavior change communication experts. The study was carried out over a three month period. Transcriptions and the analysis of the data were carried out manually. Result: The analysis of this study reveals that LHWs are not skill-trained to address the nutritional component according to their mandates. The main associated factors from the health care provider perspective were found to be lack of intersectoral approach that is the integration of the LHW program with the other vertical program, low morale of LHWs, knowledge gap among the LHWs, lack of awareness among the community, beliefs of the community and excessive workload. From mothers perspective; inappropriate communication, unavailability of logistics are the factors that affect the performance of LHWs. Conclusion: It was concluded that training of the LHWs on the nutritional services is lacking. Thus, LHWs are unable to provide their services to the community. In this regards implementation and coordination among the stakeholders, continuous education and awareness for the community and LHWs, overcoming the logistic issue are the key solutions for improving the role of LHWs and quality of nutrition services.

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