Assessing Community Health Workers Compliance to who Best Practices for Safe Injection of Contraceptive in a Rural Community Setting of Tanzania
objective of this study was to assess Community health workers (CHW) compliance
to WHO guideline of safe injection steps in community settings. The cross sectional
descriptive study design using structured observation checklist was adopted to collect
injection safety steps data. The CHWs trained to provide injectable contraceptive were direct observed by
reproductive health nurse while administering intramuscular injection to women in need of injectable contraceptiveas
part of family planning program in Kilombero district, Tanzania. About 1704 women received injection
from 35 trained CHW. In this study we assessed if intramuscular injection and infection prevention
steps taken complied to WHO based best
practices for safe injections when CHW interacted with client.
Majority of CHW complied to WHO best practice for safe injection: Over 89 % steps
for infection prevention measures and over 91% steps for intramuscular injection
technical performance complied to WHO safe injection guideline. The result also
shows that CHW are likely to comply to WHO safety when they conduct injection at
their own homes compared to other locations; infection prevention at CHW’s home
-90.7%, health centre -80%, client home - 77% and 59.4% in other settings, while
intramuscular injection steps; CHW’s home -89.6%, health centre- 83.1%, patient’s
home -84% and other places -81%. Young CHW aged 18-25 years are highly likely to
comply to the guideline for infection prevention steps by 79.3% compared to 77.2%
CHWs aged 25 years and above, while for safe intramuscular steps -91.7% for CHW
aged 17-24, and 82.4% for CHW aged over 25 years.
Keywords: WHO Compliance, Safe
injection procedures, community health workers, Blood borne infection, intramuscular
injection technical performance, infection prevention.
Auma Olawo, Issak Bashir, Marsden Solomon, John Stanback, Baker Maggwa Ndugga, Isaac
Malonza. 2013. A cup of tea with our CBD agent … ’’: community provision of injectable
contraceptives in Kenya is safe and feasible. Global Health: Science and Practice
2013 | Volume 1 | Number 3.
. Brunie A, Hoke TH, Razafindravony B.
(2011). Community-based distribution of injectable contraceptives in an African setting: community trial in Madagascar. Sante.2011 Jan-Mar; 21(1):21-6. doi: 10.1684/san.2011.0232.
. Coffey PS1, Sharma J, Gargi KC, Neupane
D, Dawson P, Pradhan YV. (2012) Feasibility and acceptability
of gentamicin in the Uniject prefilled injection system for community-based treatment
of possible neonatalsepsis: the experience of female
community health volunteers in Nepal. J Perinatol. 2012 Dec; 32(12):959-65. doi: 10.1038/jp.2012.20.
. Gyawali S1, Rathore DS, Shankar PR, Kumar
KV. (2013). Strategies and challenges
for safe injection practice in developing countries. J Pharmacol Pharmacother. 2013 Jan; 4(1):8-12. doi: 10.4103/0976-500X.107634.
Ramsey1,2*, Ahmed Hingora2, Malick Kante1,2, Elizabeth
Jackson1, Amon Exavery2, Senga Pemba3, Fatuma Manzi2,
Colin Baynes1,2, Stephane Helleringer, James F Phillips (2013). The Tanzania
Connect Project: a cluster randomized trial of the child survival impact of adding
paid community health workers to an existing facility-focused health system. BMC
Health Serv Res. 2013;13 Suppl 2:S6. doi: 10.1186/1472-6963-13-S2-S6.
J, Andrea B. Pembe, Miriam Urasa, and Elisabeth Darj (2013). Safe injections and waste management among healthcare
workers at a regional hospital in northern Tanzania. Tanzania Journal of Health Research Doi:
http://dx.doi.org/10.4314/thrb.v15i1.8 Volume 15, Number 1, January 2013.
. Perez F, Ba H, Dastagire SG, Altmann
M. (2009). The role of community
health workers in improving child health programmes in Mali. BMC Int Health
Hum Rights. (2009) Nov 10;9:28. doi:
. Prüss-Üstün A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. American Journal of Industrial Medicine, 2005, 48(6):482–490. Retrieved from
(2004) National Infection Prevention and
Control Guidelines for Health Care Services in Tanzania. Ministry
of Health and Social welfare, The United Republic of Tanzania, Dar es Salaam.
. World Health Organization, 2010. WHO Best Practices for Injections and Related Procedures Toolkit Geneva: 2010 Mar. ISBN-13: 978-92-4-159925-2. Retrieved from
World Health Organization, 2015. WHO Guideline on the Use of Safety-Engineered Syringes for Intramuscular, Intradermal and Subcutaneous Injections in Health-Care Settings. Geneva: Retrieved from