Distance to Healthcare Facility and Lady Health Workers' Visits Reduce Malnutrition in under Five Children: A Case Study of a Disadvantaged Rural District in Pakistan.

This study accesses the impact of lady health worker (LHWs) visits in the community and distance to a healthcare facility on the nutritional status of under-five children. Additionally, it explores the perceptions and attitudes of the community about the performance of LHWs. A self-administered instrument was applied to gather data on different parameters, such as children's height, age, weight, and socioeconomic status from 384 rural households in a marginalized district of Punjab province with the help of a purposive random sampling technique. The binary logistic regression model was employed for the computation of the probability of malnutrition. The prevalences of stunting, underweight children, and wasting in the district were 34.8%, 46.1%, and 15.5%, respectively. The logistic results illustrate that those households in which LHW visits occur regularly within 15 days (OR = 0.28 with 95% CI: 0.09-0.82) have a lower probability of malnutrition prevalence among their children. The distance to the health facility shows that the odds of malnutrition were higher from 3-4 Kilometers (Km) (OR = 2.61, 95% CI: 0.85-8.14), and odds were also higher for the ≥5 km category (OR = 2.88, 95% CI: 0.94-8.82). Children from richer families had lower chances of being malnourished (OR = 0.28, 95% CI: 0.07-1.14). Furthermore, the respondents show a positive attitude towards LHWs. They have given the first rank to their performance being beneficial to mothers and childcare, especially on checkups and safe deliveries, while they have shown negative responses and given lower ranks to their performance due to irregular visits (6th rank) and poor community awareness (7th rank). We conclude that LHWs' regular visits to targeted households and less distance to healthcare facilities reduce the malnutrition risk in under-five children.