Mobile health technology-enabled community health workers as pesticide interventionists in rural Suriname

OBJECTIVE: To bolster access for vulnerable communities to urgent pesticide-related health information and services using a mobile health technology-enabled community health worker (CHW) strategy. DESIGN AND METHODS: The project was designed to demonstrate the effectiveness of mobile health technology–enabled CHWs in promoting safe pesticide use in pesticide-induced suicide-prone communities in Suriname. The team focused on three interconnected components: message mapping, validation, and delivery testing. The text messages were tested to assess content, literacy, and the ability to solicit a recipient response to determine the effectiveness of mobile technology as a health intervention tool. RESULTS: Thirty-nine text messages addressed the following key themes: pesticide miss/overuse, pesticide accessibility contributing to its use as an attempted or successful suicide strategy, and pesticide handling and disposal. For each of these themes, at least three messages were developed. Most text messages emphasized safe pesticide handling as the root cause of both misuse and access. (The pesticide awareness and education campaign will be expanded country-wide.) CONCLUSION: The mobile health technology- enabled CHWs functioning as pesticide interventionists demonstrated that bidirectional text messaging was a promising awareness and education intervention strategy. Focusing on safe handling was a reasonable target for intervention in the absence of a comprehensive national pesticide policy governing import, distribution, access, handling, and disposal. Of note is that none of the messages to date directly focused on suicide, confirming the strategy to address suicide prevention as a holistic public health issue under a safe pesticide use “umbrella” rather than as an isolated, stigma-provoking problem.

Instrument N° 2. HRH Program Evaluation Questionnaire: Expanded version

This instrument serves as the core document for evaluation and description of the HRH program selected. In order to complete the information requested, use the documents, reports, evaluations, budgets and HRH data available for program evaluation. Attached is a sample (fictional) of a rural health physician program from Canada. This document should be completed by the Director of HRH or the equivalent person in the Health Authority who has access to national information and is in consultation with the national institutions. (AU)

Community participation for health - an assessment of a community's response [abstract]

OBJECTIVE: To evaluate factors influencing community participation in promoting community health. METHODS: This operational research project was carried out in the urban community of Air Pipe and Chambers Lanes, St.Andrew. Household heads of 50 percent of the 70 families were interviewed about their health needs, values, resources, cultural beliefs and desire to improve their health status. Community participation in ensuing interventions was observed. RESULTS: Poor water supply reported by 63 percent of family heads interviewed; indiscriminate dumping of refuse and its attendant insect, rodent and odour nuisances and low levels of health literacy were the priority problems identified by the community. Community participation in the process, including relevant solutions, was influenced by a willingness among field personnel to meet with residents at their convenience. Cleaning up of the community, an intervention undertaken, had participation of 75 percent of families subsequent to an agreement that the clean-up would exclude a gully which provided Christmas work for them. Fifty percent of the families signed up for a scheme to bring water supply into their homes. This effort failed due to lack of trust, the presence of laggards in paying the required contributions and, primarily, the withdrawal of outside leadership for sustained efforts at community empowerment. CONCLUSION: Organizing this community for participation in health was facilitated by the social influence of the organizers and respect for community values. The need for sustained efforts at attaining empowerment seems relevant and vital. (AU)

The development of a community-based comprehensive mental health service delivery system for the Cayman Islands (1989-2001)

This paper reviews the development of mental health services in the Cayman Islands throughout a twelve-year period (1989 to 2001). I was appointed the resident consultant psychiatrist to the islands in 1989, after which time a consultative process between the Ministry of Health, Senior Management of the George Town Hospital and myself allowed the development and establishment of a comprehensive community-based mental health service delivery system (MHSDS), specifically designed to suit the needs of the Cayman Islands. The framework for the service is outlined, and the concerns and objectives of the MHSDS are discussed, along with short-term and long-term goals. (AU)

HIV Voluntary Counselling and Testing in Community Health Services

Compares the effectiveness of voluntary counselling and testing for AIDS or reproductive health education among people in Kenya, Tanzania and Trinidad. Changes in sexual behaviour that occured among individuals in the counselling and testing group; Reports in this issue of the Lancet that deal with AIDS vaccines in developing countries and the cost-effectiveness of counselling and testing for HIV and AIDS.(Au)

An evaluation of the Jamaica drug for the elderly programme in Kingston and St. Andrew

The presence of chronic disease is accompanied by the threat of complications that can be averted if the elderly can obtain the necessary health care. In 1996, the government of Jamaica launched the Jamaica Drug for the Elderly Programme (JADEP) to assist persons 60 years and over with any of six chronic diseases, in the purchase of medication. The study aims to evaluate public attitude toward and participation in the programme. A cross-sectional study was conducted in randomly selected pharmacies in Kingston and St. Andrew among 49 elderly persons with certain chronic diseases and 9 providers of JADEP. All elderly persons who entered the selected pharmacy, fulfilled the criteria and who consented to be interviewed were included in the study as was the main pharmacist for that location. A focus group discussion with ten persons helped to elucidate information already obtained. The study revealed that while most elderly persons had neither a positive nor negative attitude towards the programme, the level of registration was not high (52 percent, n=49). Among JADEP participants many (67.4 percent or 29/43) were unable to obtain all their medication at one time due to cost constraints. Both providers and the elderly raised concerns about the limited range of drugs available which was the reason commonly cited for not being able to use the benefit card. The study showed that the extent to which the programme was able to assist the elderly was dependent on their awareness of how the programme functioned and the availability of their medication. The service is a necessary one and its failure would have public health implications as chronic illnesses that are not well managed will increase the health burden of the population and overall health care costs. It is recommended that the range and quantity of drugs that can be prescribe for the particular chronic conditions be re-examined (AU)

Montserrat. Managing health care in a volcanic crisis

The volcano on Montserrat, after being dormant for over 400 years, has been active for the past two years, last erupting on 27 June, 1997. With the capital, Plymouth, in the unsafe zone, major dislocation of people, facilities and services has occurred. The Health Department is splintered over five sites across an eight mile span and the temporary 30 bed hospital, sited at a primary school, is separated from its Casualty and Out-patient Department and Operating Theatre by 0.25 mile. In order to maintain continuity of care for communities, efforts have been made to keep evacuated clients and their community health workers as close together as possible. The mass emigration has depleted the health services, creating severe stress for those remaining. Elderly relatives have frequently been left behind, necessitating the establishment of special geriatric care facilities to cater to their needs. Increased and continuous health surveillance and mass media education have been integral to the prevention of major disease outbreak - particularly with added challenges to food safety, and management of liquid and solid waste disposal. Cooperation from neighbouring states, particularly Antigua, Barbados and Guadeloupe, as well as from the United Kingdom, has been critical in the management of the continuing crisis.(Au)

An AIDs-related survey of knowledge, attitudes and practices among people in Ocho Rios, St. Ann Jamaica

Acquired immune deficiency syndrome (AIDS), caused by infection with the human immunodeficiency virus (HIV), is now of pandemic proportion and taking a severe toll in human suffering and death. The stigman attached to AIDS, with fear of contagion, moral issues relating to drug use and sexual orientation have greatly affected individuals and communities experiencing HIV/AIDS. For persons with HIV/AIDS community based care may also be a problem because of rejection by family members, discrimination and harassment. A cross-sectional survey was carried out among residents of Ocho Rios, St. Ann, Jamaica, during February of 1998, to determine their level of knowledge of HIV/AIDS; their attitude towards persons with HIV/AIDS; current practices toward HIV/AIDS person known to them, and their level of support for community based care of these persons. A total of 188 questionnaires were completed from a sample size of 276, selected from the 1997 Electoral Register, using the systematic sampling technique.(AU)

Improving the effectiveness of screening for haemoglobinopathies in primary and community care in Lambeth: antenatal findings

An antenatal screening programme for haemoglobinopathies aims to allow couples to make informed choices about reproductive options. Screening must be carried out early in pregnancy and must be supported with accurate information and a genetic counselling service. An audit in 1990 at St. Thomas' found that couples were referred for genetic counselling late in pregnancy or not at all. The aim of the study was to icrease the uptake of screening and counselling in the antenatal clinic by improving midwives knowledge of the condition and available counselling services. A research worker was employed to evaluate the intervention. METHODS: Knowledge of haemoglobionpathies, genetic risk and available services was assessed by means of a questionnaire. An audit of ante-natal screening was undertaken before and after the introduction of specific guidelines and a porforma by reviewing over 1400 antenatal notes of those recieving community or shared care. Laboratory data on the number of tests requested for both the women and their partners was obtained for the year of the first audit. RESULTS: 23/44 midwives completed the questionnaire (65 percent). Analysis of the responses indicated that hospital midwives were better informed on every question. There was a significant difference (p<<0.001 in the proportion of questions answered correctly by hospital midwives compared to community midwives (77 percent of 45 percent, 95 percent CI 17-45 percent). (AU)

Evaluation of a pilot study for breast and cervical cancer screening with Bradford's minority ethnic women; a community development approach, 1991-93

The objectives were to provide information about breast and cervical cancer and related screening services to minority ethnic women, to enable them to make well informed decisions and choices; to adopt a health education strategy based on a community development approach, augmented by a local publicity campaign; and to evaluate both the direct and indirect effects of this project. To this end a community development intervention study was made over 18 months from October 1991 to March 1993 in Bradford, a multicultural city with 87,000 residents from minority ethnic groups. The subjects of the study were 1,628 women from minority ethnic groups in three geographical areas of Bradford. A stratified sample of 1,000 women (670 South Asian, 163 African-Caribbean, 96 Eastern European and 71 other) was interviewed at the beginning of the project and six months after the health promotion intervention. Two specifically trained Health Promotion Facilitators from minority ethnic groups undertook community development work within three neighbourhoods in Bradford with the largest minority ethnic populations. There were group sessions in both formal and informal settings, which included the health education about breast and cervical cancer and the associated screening programmes. These sessions were in the women's preferred languages and audio-visual material and a specially designed teaching pack were used. There were significant differences in the baseline levels of knowledge about cervical cancer and breast cancer and breast across the different minority ethnic groups. The South Asian women had the lowest levels of knowledge and also showed the most significant improvements. Significant increases in attendance for cervical smear and breastcancer screening were self-reported. These were confirmed by anecdotal views of local health professionals. In addition, a local self-help group for South Asian women was established; also the contacts with other related organisations and professionals has help to raise the issues of ethnically sensitive services within the voluntary and statutory sectors. A community development approach to health promotion is particularly valuable in communities with low levels of knowledge about a disease/s or health service provision. Community development approaches often produce outcomes that had not been predicted. (AU)

Community needs in mental health

A cross-sectional survey using a probability sample of 6,727 adults, (> 15 years) was conducted in Trinidad and Tobago from November 1994 to April 1995. General and mental well-being (assessed with Goldberg's GHQ 12), socio-economic status, alcohol use, disability and utilization patterns were assessed. There were few demographic differences between the sample and the census population and between males and females. On the GHQ 12, 11.5 percent of males and 14.3 percent of females had a severe problem. These results were comparable to international data published by Goldberg. Seeking help varied with severity. Only 8 per 1,000 of the sample population sought help from a primary care provider. This is much lower than the rates from comparable datasets from the UK and The Netherlands. Persons with emotional problems used significantly more general health care than persons without. Forty-nine per cent of persons with an emotional problem had received a prescription during the past year, indicating contact with the health service. It is concluded that (a) the prevalence of mental health problems in the population is comparable to that in other populations; (b) up to 25 percent of these persons seek help and (c) 49 percent were in a position to receive help as judged by their ability to access a prescription. It would appear that there is scope for training primary care providers in the early identification, basic care and efficient referral of these persons, thus improving the quality of life of approximately 20 percent of the population (AU)

Community based, effective, low cost approach to the treatment of severe malnutrition in rural Jamaica

Moderate and severe malnutrition are endemic in much of the developing world and in association with pockets of deprivation in the developed world. The cost in terms of individual and social development is high. The principles of effective management are clearly documented. A low cost, community based treatment programme for moderately and severely malnourished children under three years of age was established at a health center in rural Jamaica. Children were followed up monthly and defaulters were rigorously recalled. Management consisted of carefully delivered dietary advice, antibiotics, anthelminthics and vitamin supplements. All children improved and the response of 36 children, who were treated in the first year, showed an accelerated weight gain. There was a significant increase in the weight for age, at 1.9 percent per month over six months, which exceeds the rate reported with food supplementation programmes and nutrition rehabilitation centers. (AU)

Current findings indicate that substance abuse constitutes a major threat to health, family and social systems in Jamaica

Substance abuse is a complex and progressively expanding global problem. The insidious nature of Substance Abuse makes it a major Public Health issue of no mean order. This study is of correlational design, seeking to identify prevalence and patterns of drug use in the Jamaican population. The sample was selected to represent the national population characteristics by utilizing a multiusage stratified random sampling technique. Seventeen communities were randomly selected from a grouping stratified for this purpose. The stratification criteria are as follows: socio-economic levels; community size; community complexity; urban/rural characteristics; economic base (e.g., sugar, tourism, agriculture, fishing); and potential exposure to facilities for drug use. Based on the sample size, the sample error is estimated at +- 3.0 percent. In the national sample (2005), reported drug use during the past month (30 days) among respondents shows the most popular of all drugs used by rank are: 1. Alcohol 51 percent, 2. Pain-killers 27.9 percent, 3. Tobacco 14.6 percent. The most popular illegal drugs used are: 1. Marijuana 11.5 percent, 2. Cocaine 0.6 percent. Opiates and phencyclidine (PCP) are used in equal proportions (0.2 percent) respectively. With the exception of alcohol (51 percent), the majority of respondents reported non-use in the past month for the substances specified. For eight of the thirteen identified substances, 98 percent reported non-use. Multiple drug use is a phenomenon which exists among substance abusers. Alcohol is the drug most frequently used with other substances. Alcohol and tobacco are the most popular combinations among multiple drug users. The pattern of substances used reported by respondents shows that the majority (56.2 percent) use only one substance. The highest use of drugs is found in those parishes in the middle and western sections of the island namely: Manchester, St. Ann, Trelawny and St. Elizabeth. The use of alcohol and marijuana in all parishes with few exceptions tended to be fairly widespread. Alcohol and marijuana were the substances most popularly used across all parishes. (AU)

Using a simple information system to monitor and evaluate a community mental health service - abstract

Montserrat has an above average rate for schizophrenia (1 - 3), prevention strategies are weak and the need for improved care of the mentally ill is well recognized. As part of a Government four-year Public Sector Investment Programme (PISP) (4),the health department developed a mental health plan, one aspect of which was to reduce admission rates of acute mental illness by setting a target for the service (75 per cent reduction in 5 years). One of the main strategies to achieve this was to develop a simple information system to monitor and evaluate the service in achieving its target. This paper describes the development of the information system after two years in operation. Two groups of indices were monitored, the workload of professionals working in the unit (unit activity) and the monthly rates of acute admissions and court orders (outcome). By plotting both these groups of data, professionals were able to monitor their work in achieving the target they had set. It was found that an increase in the prevention activity of the unit had indeed led to the reduction of court orders and acute admissions. This very simple information clearly demonstrates how a health information system, even without computer technology, can strengthen a service and provide evidence of a positive outcome (AU)

Service needs of children with disabilities in Jamaica

We investigated the service needs of children attending a medical assessment as part of a two stage survey of 2 to 9-year-old children in mid and south Clarendon, Jamaica. Parents were asked about symptoms relating to six different disabilities: visual, hearing, speech, motor, cognitive and fits. Following medical and psychological assessment, a diagnosis of mild, moderate, severe or no disability was made. For children with disabilities, the frequencies of five possible types of intervention recommended by the physician were analysed and related to the prevalence of the six disabilities in the parish. To estimate the needs of the Jamaican child population the figures were extrapolated based on an estimate of 1 million children under the age of 15 years. These needs were then compared with places in existing services. Of the disabled children, 62 percent needed special education, 29.5 percent needed community-based services, 21 percent needed spectacles, 21 percent needed specialist referral, and 6 percent required medical treatment. Although the vast majority of these needs are not met, many more could be met in the community if existing health and education personnel are trained in basic techniques of screening and assessment. (AU)