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Pharmacovigilance of antimalarial treatment in Uganda: community perceptions and suggestions for reporting adverse events.
Tropical Medicine and International Health. 2008 Sep; 13(9):1143-52.OBJECTIVES: The deployment of new antimalarials in Africa provides an important opportunity to develop systems for pharmacovigilance. To inform strategies for reporting adverse events in Uganda, we investigated local perceptions and experiences with antimalarial treatment, and evaluated existing and potential systems for pharmacovigilance. METHODS: Focus group discussions (FGD) were conducted with community members and health workers from urban and rural Uganda exploring knowledge of fever/malaria, perceptions and expectations of treatment, understanding of adverse effects, and experiences with adverse events. Sessions were recorded, transcribed into English, and analysed using a coding scheme developed from pre-defined topics together with themes emerging from the data. RESULTS: Between April and July 2006, we conducted 25 FGDs; 16 with community members and nine with health workers. All respondents had extensive experience with malaria and its treatment. Community members commonly recognized adverse effects of antimalarial therapy. However, events were uncommonly reported, and certain events were often interpreted as signs of successful treatment. Community members often felt that the costs of reporting or seeking additional care outweighed the potential benefits. Health workers were unfamiliar with formal pathways for reporting, and were deterred by the additional work of reporting and fear of incrimination. Respondents provided suggestions for incentives and methods of reporting, emphasizing that pharmacovigilance should ideally encompass the public and private sector, and the community. CONCLUSIONS: To be successful, pharmacovigilance relying on voluntary reporting will require active participation of patients and health workers. Addressing the costs and benefits of reporting, and providing sensitization, training and feedback will be important.
A community-based bacteriological study of quality of drinking-water and its feedback to a rural community in western Maharashtra, India.
Journal of Health, Population and Nutrition. 2008 Jun; 26(2):139-150.A longitudinal study of the bacteriological quality of rural water supplies was undertaken for a movement towards self-help against diseases, such as diarrhoea, and improved water management through increased community participation. Three hundred and thirteen water samples from different sources, such as well, tank, community standpost, handpumps, percolation lakes, and streams, and from households were collected from six villages in Maharashtra, India, over a one-year period. Overall, 49.8% of the 313 samples were polluted, whereas 45.9% of the samples from piped water supply were polluted. The quality of groundwater was generally good compared to open wells. Irregular and/or inadequate treatment of water, lack of drainage systems, and domestic washing near the wells led to deterioration in the quality of water. No major diarrhoeal epidemics were recorded during the study, although a few sporadic cases were noted during the rainy season. As a result of a continuous feedback of bacteriological findings to the community, perceptions of the people changed with time. An increased awareness was observed through active participation of the people cutting across age-groups and different socioeconomic strata of the society in village activities. (author's)
Differential community response to introduction of zinc for childhood diarrhea and combination therapy for malaria in southern Mali.
Journal of Nutrition. 2008 Mar; 138:642-645.Developing effective, affordable, and sustainable delivery strategies for the isolated low-income populations that stand to gain the most from micronutrient interventions has proven difficult. We discuss our experience with implementation of zinc as treatment for diarrhea in children less than 5 y of age over the course of 3 operational research studies in rural Sikasso Region, Mali, West Africa. The initial formative research study highlighted how malaria affects perceptions of diarrhea and its causes and that malaria and diarrhea are not necessarily viewed as distinct conditions. The second-phase pilot introduction demonstrated that, in introducing zinc treatment in malaria-endemic regions, it is especially important that both community and facility-level providers be trained to manage sick children presenting with multiple symptoms. The third-phase study on large-scale implementation detected that the experience with implementation of new treatments for malaria is distinct from that of diarrhea. To some extent zinc treatment is the solution to a problem that communities may not recognize at all. Interventions to improve case management of sick children must be integrated across diseases and nutritional problems at both the facility and community levels. Operational research can identify points where integration should occur and how it should be carried out. Programs targeting single diseases or single nutritional problems can have a variety of deleterious effects on health systems, no matter how well they are planned. (author's)
[Unpublished] 2003 Nov. 36 p.The GTZ supported Community Based Distribution (CBD) of family planning (FP) methods, implemented in Tanga region of Tanzania, aimed to increase the use of contraceptives through better geographical and social access. An evaluation collecting views from community members found that CBD activities are felt to improve child and maternal health, and to free women to participate in economic and community work. Clients felt that the FP accessed through CBD gave them improved capacity to care for their smaller families and to work more productively. Community members also felt that CBD introduced sensitive topics such as HIV/AIDS in a culturally acceptable way. In short, the community clearly expressed how CBD activities contribute to reaching the MDG. Much of the programme has been successfully absorbed into the district work plan, but initial training of CBD is still financially dependent on GTZ, putting into question the programme's sustainability. The issues that the feedback on the CBD Programme focused on which are summarized in this report include the following: its usefulness, its organization, its main strengths and successes, its weaknesses and problems, suggestions given to enhance performance. (excerpt)
Community attitudes towards sexual activity and childbearing by HIV-positive people in South Africa.
AIDS Care. 2006 Oct; 18(7):772-776.While the ability to lead a healthy sexual life and to choose whether and when to have children are well-established features of reproductive health and human rights, issues surrounding sexual activity and childbearing among HIV-infected women and men have received little attention in sub-Saharan Africa. We conducted a semi-structured, cross-sectional survey at 26 primary health care clinics in South Africa to investigate community attitudes towards sexual activity and reproduction by HIV-infected individuals. Of the 843 women interviewed, slightly less than half (43%, n = 361) thought that people living with HIV/AIDS should remain sexually active if they choose, while 13% (n = 113) said they thought that people living with HIV/AIDS should have children if they wished to do so. In multivariate analysis, negative attitudes towards both sexuality and childbearing were persistently associated with not knowing someone infected with HIV (p = 0.001 and 0.043, respectively). These findings suggest that the sexual and reproductive health rights of HIV-infected women and men may be an important target as part of efforts to reduce HIV/AIDS-related stigma. Health policies and services are required to reinforce the reproductive rights of HIV-infected individuals in South Africa and other countries in sub-Saharan Africa where HIV is most prevalent. (author's)
Mumbai, India, Centre for Enquiry into Health and Allied Themes [CEHAT], 2003 Jun. , 51 p.This study report is based on a need-assessment survey conducted in connection with the BMC's plant to set up a municipal general hospital in one of its ward. The study area is unique in the sense that it is the most populous ward in Greater Mumbai, and yet, it does not have a single public hospital within its limits. Data was collected from 1,035 households spread across three health-post areas around the proposed hospital site. The study was able to bring out the utility of public health care services in the area, and to find out how the population copes with their health care needs when public health care services are not available in their locality. It is to be noted that this is a predominantly lower middle class and lower class population, which resides in the study area. In spite of not having a public hospital, for ailments reported during the reference period, about 30 per cent of the patients had sought inpatient care services from the public sector outside the locality, and about 15 per cent had sought outpatient care services from BMC facilities. Though travel time and travel costs were higher, because of financial reasons the public were still seeking health care from public health care outlets outside their locality. Analysis shows that non-availability of a public hospital was forcing about 44 per cent of the households to seek inpatient care services from the private sector, even if they were interested in seeking care from the public sector. Even the outpatient care services that were currently available in the area seemed to be inadequate, as 67 per cent of the households were having their need for outpatient care services unmet. When the poorest of the poor were left with no alternative but to seek care from public health care facility in other wards, others were "managing" with the services in the private sector where out-of-pocket expenses of treating an ailment was several times higher than that in the public sector. A majority of those who were currently "managing" their inpatient care needs through private hospitals, were willing to shift to the public health care system if made available in the locality. (author's)
Alliance News. 2001 Dec; (12): p..Increasing attention is being paid to the role of stigma as a major contributory factor in the global HIV/AIDS pandemic. Stigma associated with HIV/AIDS is especially powerful and pervasive because the disease is usually closely associated with such fundamental issues as life and death, sex and sexuality, and morality. (excerpt)
Development. 2000 Mar; 43(1):23-7.This article is an excerpt of the research report on the Children's Movement for Peace in Colombia. The research conducted by Sara Cameron in 1998, interviewed 150 Colombian children about their opinion of war and their efforts to build peace. This research was then submitted to the Nobel Committee in support of the nomination of the Children's Movement for Peace for the 1998 Nobel Peace Prize. Most of the cases being related by these children include killing of parents, killing young innocent people, conflict within the family, and war between the army and guerrillas. The Children's Movement for Peace exerted effort to build peace by conducting workshops and counseling of the children victimized by violence. Also, they help these victims express their feelings either verbally or through paintings. Lastly, the volunteers of peace movement in Colombia hope to promote peace in the home, community, and the country.
[Family planning expansion project in Burkina Faso: initial community study, 1992. Preliminary report] Projet d'expansion de la planification familiale au Burkina Faso: etude communautaire initiale 1992. Rapport preliminaire.
[Ouagadougou, Burkina Faso], Ministere de la Sante et de l'Action Sociale, Direction de la Sante Familiale, 1992. , xv, 48,  p.This report describes and presents preliminary results from an initial community study for a family planning (FP) expansion project in Burkina Faso. The study was conducted during May 1992 in 4 of 15 provinces retained for information, education, and communication (IEC) activities, with the goal of obtaining preliminary data on the knowledge, attitudes, and practices (KAP) of the target population with regard to FP, their contact and understanding of the logo on population issues, and their opinion of health agents and social workers. 494 men and 506 women were interviewed by questionnaire. 40% of the study respondents were from Kadiogo, 30% from Yatenga, 20% from Kossi, and 10% from Namentenga. 73% were married and 26% were single. 64% were Muslim and 27% were Catholic. About half of the respondents had received no formal education, while 15% had attained a secondary school education. Recommendations are made with regard to increasing FP awareness among some target groups, inadequate FP knowledge and use in Yatenga, the limited knowledge about FP methods other than the oral pill and the condom, partner communication about FP, ideal family size, knowledge and use of modern contraceptives, intentions to practice FP in the future, the less than universal use of IEC by health agents and social workers, respondents doubts about the abilities and intentions of social workers, and the inability of many respondents to clearly associate the national FP logo with FP.
POPULATION AND ENVIRONMENT. 1998 Jan; 19(3):247-77.This study examined the relationships between US county-level in- and out-migration streams and environmental risks. Data were obtained from the 1990 US Census among 3109 counties during 1985-90. Risk measures included air and water quality, hazardous waste sites, toxic releases, and Superfund sites. Environmental data were obtained from the US Environmental Protection Agency's (EPA's) Right to Know Network (RTK-NET) on-line database. Air quality data were based on the Aerometic Information Retrieval System. Water quality data were based on EPA defined public water contamination levels from EPA's Office of Groundwater and Drinking Water. Hazardous waste data were available from LandView II database and EPA's Biennial Reporting System. Toxic release data were obtained from the EPA Office of Pollution Prevention and Toxic Release Inventory database. Superfund sites data were obtained from the Comprehensive Environmental Response, Compensation, and Liability Information System accessed through RTK-NET. Socioeconomic measures included economic conditions, population compositions, home ownership, urban location, and region. High levels of in-migration were in the West. High environmental risk locations were in counties surrounding Los Angeles, New York City, and portions of Washington state. Findings suggest decreasing rates of population influx with increasing environmental risk, particularly for air quality. 831 counties had hazardous waste facilities. High risk areas did not lose residents at rates greater than areas without high risk. Areas with little environmental risk and low population density were migrant destinations. Aggregation at the county level may mask within county relationships. Analysis within metropolitan statistical areas confirmed the negative relationship. Hazardous conditions may not be a push factor due to lack of economic opportunities and lower housing costs.
Immigration reform and the browning of America: tensions, conflicts and community instability in metropolitan Los Angeles.
INTERNATIONAL MIGRATION REVIEW. 1997 Winter; 31(4):1,055-95.Tensions, conflicts, and community instability associated with heightened immigration--especially of nonwhite immigrant groups--threaten to balkanize America. This article highlights the root causes of the growing opposition to both immigrants and U.S. immigration policy--the nativist backlash, presents a typology of the community-level conflicts that have arisen as a consequence of heightened immigration--legal and illegal--to the United States over the last 30 years, and outlines the conditions under which diversity can be brought to the forefront as one of society's strengths....The 1992 Los Angeles County Social Survey (LACSS)...provides insights into the nature and magnitude of intergroup stereotyping and prejudice in a community in which large numbers of immigrants have settled. (EXCERPT)
Creating awareness of the issues and problems of the elderly: among planners and policy makers; in the local community.
In: Implications of Asia's population future for older people in the family. Report and selected background papers from the Expert Group Meeting on the Implications of Asia's Population Future for Family and the Elderly, 25-28 November 1996, Bangkok, compiled by United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]. New York, New York, United Nations, 1996. 104-16. (Asian Population Studies Series No. 145; ST/ESCAP/1736)Asians have long held their elderly in high esteem as being both wise and the focal points of family and community unity, especially in rural areas. Asian societies, however, are undergoing rapid technological advancement, modernization, rapid demographic changes, and rapid national economic growth amid persistent mass poverty which have led to the ongoing decline in the status of the aged and very old in Asia. As their lifespans and numbers increase, old people are also becoming more poor and marginalized, and increasingly seen as burdens by contemporary families. Asian families need to establish a sustainable balance between the old and basic Asian family values and current modernization. Future aging in Asia, the Asian response to aging, raising awareness of aging, the need for a new philosophy of aging, an agenda for research and policy awareness, legislating the consequences of population aging, what can be done about aging in the region, public awareness and action, families, institutional support systems, and the mass media's role in changing public perception are discussed. Asian families and communities need to change how they perceive the elderly, giving priority to empowering older people and the organizations which fight for their interests. Such efforts should not, however, provoke a move away from the focus upon keeping families strong, healthy, and stable.
Design and implementation of a citywide breastfeeding promotion program: the New York City approach.
FAMILY AND COMMUNITY HEALTH. 1990 Feb; 12(4):71-8.Breastfeeding has regained more popularity in the US since 1970, but there has been a definite disparity in its resurgence among minority, poor, and less educated mothers. This article outlines the history of breastfeeding prevalence in the US and New York City as an introduction to explaining the design and implementation of New York City's breastfeeding promotion program. In 1982, the Steering Committee to Promote Breastfeeding in New York City was generated and it designed task forces to address each of their defined barriers to breastfeeding promotion (e.g. lack of relevant data, centralized compilation, data analysis, health care professional education, inhibitory practices by hospitals and ambulatory services, public misinformation, and unsupportive public policy). The Research Task Force, Professional Education Task Force, Hospital Practices Task Group, Policy and Legislation Task Group, and Public Information Task Group were outlined and some policies, strategies, and practices they have enacted were described. Some of their accomplishments include: educational kits on breastfeeding for health care professionals, guidelines for work-site health and nutrition programs for pregnant and lactating workers, research on the economics of breastfeeding, breastfeeding information posters on the subway, and establishment in 1984 of a breastfeeding coordinator in each municipal hospital. These strategies demonstrate a successful model for breastfeeding promotion in large urban areas as seen by the rise in breastfeeding at the time of newborn discharge from New York City hospitals.
In: Profession: demographer. Ten population studies in honour of F.H.A.G. Zwart, [edited by] B. van Norren and H.A.W. van Vianen. Groningen, Netherlands, Geo Pers, 1988. 155-79.Based on case studies in a village ward in West Java, this paper gives an account of how local public opinion developed concerning family planning and how the process of family planning adoption was shaped by it. The events described took place in the early 1970s in the Cianyar ward of the village of Ciendah, on the southern border of the plain of Bandung. By the end of 1969 a family planning program was started in the village. From 1970-1973 about 35 couples became acceptors, 22 of whom were studied afterwards. 15 of these couples belonged to the non-orthodox group and 7 to the orthodox group of the community. According to the data, the adoption process started early but slowly among the non-orthodox community members and relatively late but rapidly among the orthodox. The description starts with a sketch of the sociopolitical relations in the community. Subsequently the opinions of the leaders and the influence thereof on the course of public opinion are extensively discussed. Then the influence of public opinion on the community members' motivating activities and on the adoption process are described. Within the non-orthodox group the adoption process started in all 3 social classes well before public opinion turned in 1972. In the process the couples of the higher class began quite early (beginning 1970) after which the couples of the middle and lower classes followed rather slowly (after about 1 1/2 years in the course of 1971). On the other hand within the orthodox group the adoption process started in all 3 social classes only during or after the turn of public opinion in 1972. In this case the couples of the higher and middle classes began late (1972) after which the couples of the lower class followed rather quickly (after about a good half year, beginning 1973). So long as public opinion was anti-family planning in Cianyar, it prevented the start of an adoption process among the orthodox and slowed down its take-off among the non-orthodox in the community. During and immediately following its turn to being pro-family planning, public opinion sped up considerably the adoption process among the orthodox members of the community.
AMERICAN JOURNAL OF SOCIOLOGY. 1986 Mar; 91(5):1,154-69.The author uses 1980 survey data for the United States to test the hypothesis that "community size leads to heterogeneity in values and attitudes that compose the sets of cultural elements of a subculture....An independent size-heterogeneity relationship is found for political and sexual attitudes....It is concluded that community size does increase social heterogeneity, but, consistent with subcultural theory, the relationship is restricted to subcultural elements." (EXCERPT)