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Analysis of Indonesia’s community health volunteers (kader) as maternal health promoters in the community integrated health service (Posyandu) following health promotion training.
International Journal of Community Medicine and Public Health. 2018 Mar; 5(3):856-863.Background: Maternal health promotion is a task allocated to the kader (community health volunteers) in the community integrated health services called Posyandu. Yet, they are inadequately trained to perform this task. We present an analysis of the kader as maternal health promoters after their health promotion training with use of counselling card. Methods: Between March-April 2015, 14 participatory workshops were conducted and 188 kader in four villages in Ciranjang sub-district were trained. Data were collected through in-depth interviews and focus group discussions from community members, health care providers and policy makers in the four villages. A total of 44 interviews were conducted prior to health promotion training and 48 interviews post- training. In 46 Posyandu, kader were observed during their practice of health promotion within 3 consecutive months of post training. Data was transcribed and analysed in NVivo 10. Results: Most kader acknowledged that health promotion training improved their knowledge of maternal health and counselling skills and changed their attitude towards pregnant women at the Posyandu. They could confidently negotiate health messages and importance of health facility delivery with antenatal women. The kader also found the counselling cards helped pregnant women understand the health messages more clearly. The participatory training method involving role play and direct discussions boost kader confidence to deliver health promotion. As a result, the kader gained community appreciation which enhanced their motivation about their job. Conclusions: Appropriate health promotion training, provided the kader with adequate knowledge and skills to become resourceful maternal health promoters in the community.
Anthropometric profile of children attending anganwadi centers under integrated child development services scheme.
International Journal of Community Medicine and Public Health. 2018 Apr; 5(4):1613-1616.Background: The first six years of a child’s life are most crucial as the foundations for cognitive, social, emotional, physical, motor and psychological development are laid at this stage. The present study was conducted to assess the nutritional status of children availing the services under Integrated Child Development Service Scheme. Methods: The study was done with house to house survey with the help of a prepared scheduled proforma by personal interview and taking necessary anthropometric measurements and clinical examination. In the present study the following age independent criteria's are taken into account for the assessment of the nutritional status of the (3-5 years) age group of children in both the I.C.D.S and non I.C.D.S area separately: Mid upper arm circumference; Kanwati’s index; Rao’s index; Bangle screening method. Results: The association of nutritional status and MUAC measurement is statistically significant (p<0.05). The association of nutritional status and Kanawati ratios is statistically significant (p<0.05). The association of the nutritional status and Rao’s index is statistically significant (p<0.05). The number of children in I.C.D.S area with passing of the bangle above the elbow are only 28 and in non – I.C.D.S area, it is 42. In I.C.D.S area the immunisation status is better. Conclusions: I.C.D.S scheme is encouraging and there is no doubt regarding the positive achievements and prospective of I.C.D.S. Still there is much to be done to improve its performance by giving much emphasis on the supplementary nutrition, to the beneficiaries.
A cross sectional survey to analyze infant and young child feeding practices among mothers of Chottanikkara Panchayat.
International Journal of Community Medicine and Public Health. 2018 Aug; 5(8):3377-3382.Background: This study was carried out to assess the practices of young mothers related to Infant and Young Child Feeding Practices (IYCF) in Chottanikkara Grama Panchayat. Methods: All mothers of infants and children upto 5 years in Chottanikkara Grama Panchayat who were registered under the Integrated Child development Services (ICDS) program for services were interviewed based on self-prepared questionnaire based on National guidelines for IYCF by Indian Academy of Pediatrics (IAP). Results: 277 ladies were interviewed. Of this 50% of ladies had undergone caesarean delivery. 60.7% of children had received prelacteals. Only less than 30% of infants had been given breast milk within one hour after delivery. 50% of the ladies exclusively breast fed their babies only below a period of four months. Around 50% of ladies started complementary feeding of child on 6th month of age, whereas around 30% started complementary feeding before 6 months and 20% started complementary feeding only after 6 months of age. 78.6% of ladies continued breast feeding till 2 years after delivery. Conclusions: The studied population was a small population who had used services of the anganwadi and ASHA workers. But there are many who are not properly utilizing these services. In both rural and urban areas more efforts are needed to encourage exclusive breast feeding, to avoid premature complementation and, in the urban areas to protect extended breast feeding.
Ethiopian Journal of Health Sciences. 2017 Jul; 27(4):314.Add to my documents.
Geneva, Switzerland, WHO, 2018. 32 p. (WHO/CDS/TB/2018.22)The 2018 United Nations General Assembly High-Level Meeting (HLM) on Tuberculosis and the current revision of the Roadmap for childhood tuberculosis together present an important moment to consolidate and advance advocacy, commitment, resource mobilization and joint efforts by all stakeholders to provide health care and address the burden of TB among children The first Roadmap, published five years ago, helped to draw the childhood TB epidemic into the global spotlight after decades of neglect. Today, we are closer to a generation of children free from TB. Armed with new knowledge about how 10% of all TB affects and manifests in children under 15 years of age, we have a clearer vision of what is needed, how to deliver it -and the priority actions and enhanced investments that are urgently required. The 2018 Roadmap incorporates an additional critical population: adolescents. Despite making up 1 in 6 of the world’s people, adolescents have been largely overlooked as global momentum to address TB has grown. Spanning the ages of 10-19 years, adolescents are both at risk of TB and represent an important population for TB control. They often present with infectious TB and frequently have multiple contacts in congregate settings, such as schools and other educational institutions. Nevertheless, few countries capture TB data in suitably age-disaggregated ways to allow full understanding of its impact in this group and even fewer provide the adolescent-friendly services our young people need to access diagnosis and care.
Factors affecting implementation of integrated community case management of childhood illnesses in South West Shoa Zone, Central Ethiopia.
Journal of Public Health and Epidemiology. 2018 May; 10(5):132-138.Ethiopia, this proven strategy is being implemented in selected districts of the regions but there are no sufficient evidences to decision-makers for improvement interventions. Cross-sectional study was conducted by including all functional health posts and HEWs from four randomly selected districts. Pre-tested structured questionnaires and observation checklist were used to collect data. Data was entered into Epi data version.3.1 and transported to SPSS v.21.0 for analysis. Bivariate and multiple binary logistic regression analysis were used to identify the determinants. 60 (60.6%) of the Health post were in good implementation category. 24 (15.3%) had only one HEW each, 26.8% had recommended three HEWs and 16 (16.2%) had no. HEWs mentored quarterly had three times better implementation (AOR) 3.14, 95% CI [1.65-6.52]). The services were less likely implemented in kebelles lacking any CHAs (AOR 0.47, 95% CI [0.19-0.83]). Health posts which were serving community for greater than eight hours per day had five times better implementation (AOR 5.33, 95% CI [2.58-9.33]). The study revealed that there is still a long way to go for better implementation of the program. Improving the program implementation needs a coordinated effort of all stakeholders at different levels. Nationally, preparing a system-wide approach towards resolving multifaceted challenges facing the programs will help attain the sectorial mission of reducing child mortality.
What research is needed to address the co-epidemics of HIV and cardiometabolic disease in sub-Saharan Africa?
Lancet. Diabetes and Endocrinology. 2018 Jan; 6(1):7-9.Add to my documents.
Lancet. HIV. 2018 Mar; 5(3):e107.Add to my documents.
Benchmark assessment of orphaned and vulnerable children in areas of the Zambia Family (ZAMFAM) Project.
Washington, D.C., Population Council, Project SOAR, 2018 Jan. 139 p. (Project SOAR Final Report; USAID Agreement No. AID-OAA-A-14-00060)This benchmark assessment was a cross-sectional survey of 2,034 ZAMFAM beneficiary OVC households in project target communities conducted in the Lusaka and Copperbelt Provinces between May and July of 2016 (about a year after roll-out) and in the Central and Southern Provinces between September and October of 2016 (around the time of program initiation). Interviews were conducted with caregivers about themselves and any OVC in the household between the ages of zero and nine years. OVC in the household between the ages of 10 and 17 years were interviewed directly by the survey team. The study instrument was based on MEASURE Evaluation’s “Child, Caregiver & Household Well-being Survey Tools for Orphans & Vulnerable Children Programs,” and captured PEPFAR Core OVC Indicators. The analysis is descriptive, reviewing the PEPFAR essential and additional core OVC indicators. The study findings were disaggregated by province, age, sex, and residential status where appropriate.The findings provide a deeper understanding of the needs of OVC families and the gaps in service provision, as well as suggestions for strengthening care and support strategies for OVC in Zambia.
Chapel Hill, North Carolina, University of North Carolina, MEASURE Evaluation, 2018 Aug. 4 p. (USAID Cooperative Agreement AID-OAA-L-14-00004)The Partnership for HIV-Free Survival (PHFS) was a six-country initiative implemented between 2012–2016. It was designed to reduce mother-to-child transmission of HIV and increase child survival. This document focuses on seven components of PHFS in Mozambique highlighted by a legacy evaluation of partnership activities. The findings are based largely on a rapid assessment conducted by MEASURE Evaluation in Mozambique in January 2018. The core components follow: 1) Harmonized quality improvement; 2) Patient records; 3) Mother-baby pairs; 4) Breastfeeding practices; 5) Integration of services; 6) Community-patient links; and 7) Coaching.
Chapel Hill, North Carolina, University of North Carolina, MEASURE Evaluation, 2018 Sep. 164 p. (USAID Cooperative Agreement AID-OAA-L-14-00004)Conservation projects to protect the environment came to realize that improvements in the health and nutrition of people were also necessary to advance conservation agendas. These programs evolved into what are now called population, health, and environment (PHE) projects that deliver family planning, basic health services, environmental management or conservation information, and service interventions to rural communities in a coordinated or integrated fashion. PHE projects vary, based on local dynamics, human health problems, and pertinent threats to local environmental conditions. But what all PHE projects have in common is the hypothesis that human populations can be a major threat to the environment, that human health is inextricably linked to the environment, and that working across the human health and environment sectors is more effective than pursuing interventions in isolation. Many projects have also experienced the added benefits of integrating across the PHE sectors--including more women in natural resources management activities; engaging men on reproductive health and family planning decisions; and reaching underserved communities in remote, but often biologically diverse, areas. The effective management and execution of these or any projects depend on the ability to define and measure success at several levels. A well-thought-out and implemented monitoring and evaluation (M&E) system provides the information for measuring success.The Guide is a comprehensive reference for practitioners and provides not only a list of potential indicators but also advice on setting up M&E systems; the addition of livelihoods indicators; and a new section on evaluating complex programs. The guide further includes several new indicators cross-referenced to the United Nations Sustainable Development Goals (SDGs).
Making ward-based outreach teams an effective component of human immunodeficiency virus programmes in South Africa.
Southern African Journal of HIV Medicine. 2018; 19(1): p.The implementation of ward-based outreach teams (WBOTs), comprised of community health workers (CHWs), is one of the three interventions of the South African National Department of Health’s (NDoH) Primary Health Care (PHC) Re-engineering strategy for improving health outcomes. CHWs provide a necessary structure to contribute to successful implementation of the human immunodeficiency virus (HIV) programme in four ways: (1) prevention of HIV infection by health education, (2) linkage to care by health education and referrals, (3) adherence support and (4) identification of individuals who are failing treatment. However, CHW programme and HIV programme-specific barriers exist that need to be resolved in order to achieve maximum impact. These include a lack of stakeholder and community support for WBOTs, challenging work and operational environments, a lack of in-depth knowledge and skills, and socio-cultural barriers such as HIV-related stigma. Considering its promising structure, documentation of the WBOT contribution to healthcare overall, and the HIV programme in particular, is urgently warranted to successfully and sustainably incorporate it into the South African healthcare system.
An evaluation of nutritional status of children in Anganwadi Centre of Hyderabad district of Andhra Pradesh stateusing WHO z- score technique.
Global Journal of Medicine and Public Health. 2013; 2(6):6 p.BACKGROUND: In India the nationwide Integrated Child Development Services (ICDS) uses the I.A.P criteria to grade under nutrition. The current WHO recommendation is to use Z score or the standard deviation system to grade under nutrition. Although widely recommended the z scores have not been widely used in India, especially in community based studies. AIMS & OBJECTIVES: 1. To assess the socio-demographic profile of 0-72 months age group of children. 2. To find out the nutritional status of children using WHO z- score technique. METHODOLOGY: A cross sectional, community-based was done in ICDS Anganwadi centers among the 400 ICDS children (0-6 years). RESULTS: There are (47.5%) undernourished and (16.5%) severely malnourished children according to WHO z score technique. Males (49.5%) are comparatively more under nourished than females (45.5%). Female infants (31.2%) are less undernourished when compared to male infants (50%). Literacy of mother had significance over the nutritional status of their children (p 0.05). CONCLUSION: The present study shows that there are still many children who are undernourished and severely malnourished in our country, even after 36 years of ICDS services. There is need to use WHO standards at the grass route levels to correctly identify the burden of under nutrition. Z score technique is simple to use, reliable and easy to understand at grass route level by health workers.
Investing in sexual and reproductive health and rights of women and girls to reach HIV and UHC goals.
Lancet. Global Health. 2018 Oct; 6(10):e1058-e1059.Add to my documents.
Designing and Implementing an Early Childhood Health and Development Program in Rural, Southwest Guatemala: Lessons Learned and Future Directions.
Advances in Pediatrics. 2017 Aug; 64(1):381-401.Add to my documents.
Provider understandings of and attitudes towards integration: Implementing an HIV and sexual and reproductive health service integration model, South Africa.
African Journal of AIDS Research. 2018 Jul; 17(2):183-192.In South Africa, a lack of integration between sexual and reproductive health (SRH) and HIV services has led to lost opportunities in the treatment cascade. In a context of high HIV, tuberculosis (TB) and unplanned pregnancies, a model for integrating SRH and HIV services was implemented in a hospital and six feeder clinics in KwaZulu-Natal, South Africa. Changes in healthcare provider knowledge, attitudes and understandings were explored following model implementation. Baseline data were collected via focus group discussions (FGDs) and a cross-sectional survey, and were used to inform the development of a model for integrating SRH and HIV services. Following the implementation of the model, an endline survey was conducted to explore any changes. Four FGDs were conducted with healthcare providers at study facilities. A total of 46 providers participated in the baseline survey, and 44 in the endline survey. Qualitative data were thematically analysed using NVivo 11, and quantitative data were descriptively analysed using SPSS 24. The understanding of integration improved by endline. Integration of services was considered important for reducing stigma and increasing access to and improving quality of care. Concerns raised were that integration would increase workload and time per client. Physical structure of facilities was not always conducive to referral or integration. Perceived benefits of integration and actual integration of services improved between baseline and endline. Enhanced understanding of integration and increased levels of reported integration over time imply that providers are more aware, suggesting that the model was effective. Provider perspectives and understandings are important for the successful integration of services. This integration model is relevant and useful to inform training and mentoring of providers, as well as to provide recommendations for policy implementation.
African Journal of Primary Health Care and Family Medicine. 2018 Jun 21; 10(1):e1-e6.BACKGROUND: Integrated care through community-oriented primary care (COPC) deployed through municipal teams of community health workers (CHWs) has been part of health reform in South Africa since 2011. The role of COPC and integration of information and communication technology (ICT) information to improve patient health and access to care, require a better understanding of patient social behaviour. Aim: The study sought to understand how COPC with CHWs visiting households offering health education can support antenatal follow-up and what the barriers for access to care would be. Method: A mixed methodological approach was followed. Quantitative patient data were recorded on an electronic health record-keeping system. Qualitative data collection was performed through interviews of the COPC teams at seven health posts in Mamelodi and telephonic patient interviews. Interviews were analysed according to themes and summarised as barriers to access care from a social and community perspective. Results: An integrated COPC approach increased the number of traceable pregnant women followed up at home from 2016 - 2017. Wrong addresses or personal identification were given at the clinic because of fear of being denied care. Allocating patients correctly to a ward-based outreach team (WBOT) proved to be a challenge as many patients did not know their street address. Conclusion: Patient health data available to a health worker on a smartphone as part of COPC improve patient traceability and follow-up at home making timely referral possible. Health system developments that support patient care on community level could strengthen patient health access and overall health.
Integration of antenatal care services with health programmes in low- and middle-income countries: systematic review.
Journal of Global Health. 2016 Jun; 6(1):010403.BACKGROUND: Antenatal care (ANC) presents a potentially valuable platform for integrated delivery of additional health services for pregnant women-services that are vital to reduce the persistently high rates of maternal and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited evidence on the impact of integrating health services with ANC to guide policy. This review assesses the impact of integration of postnatal and other health services with ANC on health services uptake and utilisation, health outcomes and user experience of care in LMICs. METHODS: Cochrane Library, MEDLINE, Embase, CINAHL Plus, POPLINE and Global Health were searched for studies that compared integrated models for delivery of postnatal and other health services with ANC to non-integrated models. Risk of bias of included studies was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC) criteria and the Newcastle-Ottawa Scale, depending on the study design. Due to high heterogeneity no meta-analysis could be conducted. Results are presented narratively. FINDINGS: 12 studies were included in the review. Limited evidence, with moderate- to high-risk of bias, suggests that integrated service delivery results in improved uptake of essential health services for women, earlier initiation of treatment, and better health outcomes. Women also reported improved satisfaction with integrated services. CONCLUSIONS: The reported evidence is largely based on non-randomised studies with poor generalizability, and therefore offers very limited policy guidance. More rigorously conducted and geographically diverse studies are needed to better ascertain and quantify the health and economic benefits of integrating health services with ANC.
Patients at a London integrated sexual health clinic are concerned at redirection of contraceptive prescriptions.
BMJ Sexual and Reproductive Health. 2018 Apr; 44(2):146-147.Add to my documents.
Scaling up integrated community case management for childhood illness in the Democratic Republic of the Congo.
[Washington, D.C.], MCSP, 2018 May. 6 p. (USAID Cooperative Agreement No. AID-OAA-A-14-00028)The leading causes of childhood deaths in the the Democratic Republic of the Congo are attributable to neonatal complications and illnesses -- mainly diarrhea, pneumonia and malaria. This brief highlights the benefits of getting services closer to remote communities, and larger efforts to scale up integrated community case management for childhood illness to reduce the country’s child deaths.
Effectiveness of a package of postpartum family planning interventions on the uptake of contraceptive methods until twelve months postpartum in Burkina Faso and the Democratic Republic of Congo: the YAM DAABO study protocol.
BMC Health Services Research. 2018 Jun 11; 18(1):12 p.BACKGROUND: Postpartum family planning (PPFP) information and services can prevent maternal and child morbidity and mortality in low-resource countries, where high unmet need for PPFP remains despite opportunities offered by routine postnatal care visits. This study aims to identify a package of PPFP interventions and determine its effectiveness on the uptake of contraceptive methods during the first year postpartum. We hypothesize that implementing a PPFP intervention package that is designed to strengthen existing antenatal and postnatal care services will result in an increase in contraceptive use. METHODS: This is an operational research project using a complex intervention design with three interacting phases. The pre-formative phase aims to map study sites to establish a sampling frame. The formative phase employs a participatory approach using qualitative methodology to identify barriers and catalysts to PPFP uptake to inform the design of a PPFP intervention package. The intervention phase applies a cluster randomized-controlled trial design based at the primary healthcare level, with the experimental group implementing the PPFP package, and the control group implementing usual care. The primary outcome is modern contraceptive method uptake at twelve months postpartum. Qualitative research is embedded in the intervention phase to understand the operational reasons for success or failure of PPFP services. DISCUSSION: Designing, testing, and scaling-up effective, affordable, and sustainable health interventions in low-resource countries is critical to address the high unmet need for PPFP. Due to socio-cultural complexities surrounding contraceptive use, this research assumes that this is more effectively accomplished by engaging key stakeholders, including adolescents, women, men, key community members, service providers, and policy-makers. At the individual level, knowledge, attitudes, and behaviors of women and couples toward PPFP will likely be influenced by a set of low-cost interventions. At the health service delivery level, the implementation of this trial will probably require a shift in behavior and accountability of providers regarding the systematic integration of PPFP into their clinical practice, as well as the optimization of health service organization to ensure the availability of competent staff and contraceptive supplies.
Arlington, Virginia, JSI Research and Training Institute, Strengthening High Impact Interventions for an AIDS-free Generation [AIDSFree], 2018 May. 70 p. (USAID Cooperative Agreement No. AID-OAA-A-14-00046)To effectively address maternal and under-five mortality rates, health facilities must have ready access to key maternal, neonatal, and child health (MNCH) commodities such as oral rehydration salts and antibiotics. In response to this need, USAID’s AIDSFree Project and Ethiopia’s Federal Ministry of Health conducted a national assessment of the national Integrated Pharmaceutical Logistics System to identify gaps and set goals and strategies to strengthen the national MNCH commodities supply chain.
Integrating systematic screening for gender-based violence into sexual and reproductive health services: results of a baseline study by the International Planned Parenthood Federation, Western Hemisphere Region.
International Journal of Gynaecology and Obstetrics. 2002 Sep; 78 Suppl 1:S57-S63.Three Latin American affiliates of the International Planned Parenthood Federation, Western Hemisphere Region, Inc. (IPPF/WHR) have begun to integrate gender-based violence screening and services into sexual and reproductive health programs. This paper presents results of a baseline study conducted in the affiliates. Although most staff support integration and many had already begun to address violence in their work, additional sensitization and training, as well as institution-wide changes are needed to provide services effectively and to address needs of women experiencing violence. (c) 2002 International Federation of Gynecology and Obstetrics.
International Journal of Tuberculosis and Lung Disease. 2017 Mar 1; 21(3):256-262.BACKGROUND: Tuberculosis (TB) screening in Prevention of Mother-To-Child Transmission (PMTCT) programs is important to improve TB detection, prevention and treatment. METHODS: As part of a national PMTCT program evaluation, mother-infant pairs attending 6-week and 9-month immunization visits were enrolled at 141 maternal and child health clinics throughout Kenya. Clinics were selected using population-proportion-to-size sampling with oversampling in a high human immunodeficiency virus (HIV) prevalence region. The World Health Organization (WHO) TB symptom screen was administered to HIV-infected mothers, and associations with infant cofactors were determined. RESULTS: Among 498 HIV-infected mothers, 165 (33%) had a positive TB symptom screen. Positive maternal TB symptom screen was associated with prior TB (P = 0.04). Women with a positive TB symptom screen were more likely to have an infant with HIV infection (P = 0.02) and non-specific TB symptoms, including cough (P = 0.003), fever (P = 0.05), and difficulty breathing (P = 0.01). TB exposure was reported by 11% of the women, and 15% of the TB-exposed women received isoniazid preventive therapy. CONCLUSIONS: Postpartum HIV-infected mothers frequently had a positive TB symptom screen. Mothers with a positive TB symptom screen were more likely to have infants with HIV or non-specific TB symptoms. Integration of maternal TB screening and prevention into PMTCT programs may improve maternal and infant outcomes.
Improving the screening and treatment of hypertension in people living with HIV: An evidence-based policy brief by Malawi's Knowledge Translation Platform.
Malawi Medical Journal. 2017 Jun; 29(2):224-228.Add to my documents.