Pan-African Research Journal Africa
Published October 22, 2026 | Version v1
Journal article Open

Medical Sociology of Community Health Worker Attrition and Chronic Disease Monitoring Coverage in Malawi: A Discrete-Time Survival Analysis of Dropout Exposure and Hypertension Follow-Up Loss

Authors/Creators

  • 1. University of Malawi

Description

Community health worker (CHW) attrition threatens the continuity of hypertension monitoring in Malawi's rural districts, yet the causal structure linking dropout exposure to follow-up loss remains poorly specified. Using a replication-based evaluation of an ordinary least squares estimator with 600 replications of N = 500 drawn from a declared data-generating process (intercept 12.0, exposure 0.42, group -3.1, severity 1.35, error SD 4.2), the study characterises estimator behaviour under conditions that mimic the clustered, unbalanced structure of CHW panel data. These results indicate that the estimator recovers the exposure parameter with negligible bias and near-nominal coverage, supporting the use of discrete-time survival specifications in CHW attrition research. Medical sociology must treat CHW attrition not as a background nuisance but as a structurally consequential exposure that reshapes the effective coverage of chronic disease monitoring. The contribution is a methodological and conceptual clarification of how dropout exposure can be modelled and interpreted within the sociology of health systems.

Notes

Published in African Medical Sociology, vol 27, issue 7, pp 57-70. DOI: 10.5281/zenodo.23550117. A Pan-African Research Journals (PARJ Africa) publication, https://parj.africa

Files

article.pdf

Files (611.1 kB)

Name Size
md5:bc8141059d98afd1284cd7e84b53094e
211.2 kB Download
md5:c64cdde46f9eb9f013991409b33bb677
399.9 kB Preview Download

Additional details

Related works

Is identical to
Journal article: https://parj.africa/ajsoa_medsoc/article/view/medical-sociology-of-community-health-worker-attrition-and (URL)

References

  • Allison, P. D. (1982). Discrete-time methods for the analysis of event histories. Sociological Methodology, 13, 61-98.
  • Campbell, C., Cornish, F., & McKenzie, K. (2003). Social capital and health: A systematic review. Health Education & Behavior, 30(6), 685-699.
  • Gilson, L. (2003). Trust and the development of health care as a social institution. Social Science & Medicine, 56(7), 1453-1468.
  • Haggerty, J. L., Reid, R. J., Freeman, G. K., Starfield, B. H., Adair, C. E., & McKendry, R. (2003). Continuity of care: A multidisciplinary review. BMJ, 327(7425), 1219-1221.
  • Kok, M. C., Dieleman, M., Taegtmeyer, M., Broerse, J. E. W., Kane, S. S., Ormel, H., Tijm, M. M., & de Koning, K. A. M. (2015). Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy and Planning, 30(9), 1207-1227.
  • Lehmann, U., & Sanders, D. (2007). Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. World Health Organization.
  • Nkonki, L., Cliff, J., & Sanders, D. (2011). Lay health worker attrition: Important but often ignored. Bulletin of the World Health Organization, 89(12), 919-923.
  • Schneider, H., Hlophe, H., & van Rensburg, D. (2008). Community health workers and the response to HIV/AIDS in South Africa: Tensions and prospects. Health Policy and Planning, 23(3), 179-187.
  • Singer, J. D., & Willett, J. B. (1993). It's about time: Using discrete-time survival analysis to study duration and the timing of events. Journal of Educational Statistics, 18(2), 155-195.
  • Starfield, B. (1998). Primary care: Balancing health needs, services, and technology. Oxford University Press.