Work-related stress among Choma Kara counselling home-based care workers of AIDS patients

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Musheke, Maurice
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Infections caused by the human immunodeficiency virus (HIV) constitute the greatest global public health challenge today, particularly in sub-Saharan Africa (SSA), which has been worst hit by the pandemic. This has created pressure on the capacity for health care institutions and health workers to respond effectively to the challenges imposed by the disease. Consequently, home-based care (HBC) of people suffering from the Acquired Immune Deficiency Syndrome (AIDS) has emerged as another fundamental response to the AIDS pandemic. While extensive studies have been undertaken on stress in medical practice, not much is known about work-related stress among home-based care workers of AIDS patients.The aim of the study was to explore work-related stress among Choma Kara counselling home-based care workers of AIDS patients. A cross sectional study design was used. Simple random sampling was used to randomly select fourteen (14) zones from the existing thirty (30) zones. Personal interviews were conducted with one hundred and thirty-five (135) home-based caregivers. The self-reporting questionnaire (SRQ-20) was used to identify cases of stress. The cut-off point was set at 4. Additional information that was collected included socio-demographic information, home-based care tasks and coping mechanisms in home-based care for AIDS patients. Data was entered into, and analysed using, the statistical package for social sciences (SPSS version 13). Data analysis included descriptive statistics, Chi- square test and binary logistical regression to establish relationship between independent variables and the dependent variable. The level of statistical significance was set at the p=0.05 level. Cleaning the house and surrounding (81.5%); food preparation for, and feeding of, AIDS patients (48.9% and 43.0% respectively), drawing water and fetching firewood (48.1%), washing clothes and bed linen of AIDS patients (74.1%>), bathing and cleaning AIDS patients (78.5%), and health education (62.2%) were found to be the physical tasks conducted by caregivers. The psychosocial tasks performed were the counselling of AIDS patients (33.3%), counselling of families of AIDS patients (71.9%) and community members (18.5%), and the provision of spiritual and emotional support to AIDS patients and their families (75.6%). Hundred and twenty-three (123) caregivers (91.3%) were trained in home-based care, out of which forty-one (41) caregivers (33.3%) reported that the training was not adequate for them to effective perform their work. The prevalence of stress was found to be 35.6%. After adjusting for age and other socio-demographic characteristics, only stigma and discrimination of AIDS patients (OR, 4.38; 95% CI, 1.74-11.02); lack of/inadequate training in HBC (OR, 0.20; 95% CI, 0.49-0.83); and short duration of practice as caregiver (OR, 2.50; 95% CI, 1.05-6.00) were found to be independently associated with stress. To cope with stress, caregivers simply accepted the situation and continued life as normal (98%), took a bath and or rest (58.0 %), spent time with friends and family members (49.0 %), and engaged in household activities (30.0%). The least coping mechanisms adopted were reading the bible (11%) and taking painkillers (12%). The study found high levels of stress among home-based caregivers. Stigma and discrimination of AIDS patients; lack of/inadequate training in HBC; and low duration of practice as caregiver were independently associated with stress. Accepting the situation and taking a bath and/or resting were found to be the major coping strategies. Interventions to address stress among home-based caregivers should mainly focus on addressing stigma and discrimination of AIDS patients; and providing caregivers with on-going training in order to strengthen and reinforce their skills. Kara counselling should consider providing monetary incentives to caregivers not only to motivate them but also to compensate them for the opportunity cost of foregoing their own income generation activities.