Comparative Analysis of Glaucoma Screening Uptake Among First-Degree Relatives After Community-Based and Hospital-Based Approaches.

Purpose: Glaucoma is the second leading cause of irreversible blindness globally. Primary open-angle glaucoma (POAG) can be genetically transmitted among first-degree relatives (FDRs). Therefore, screening for glaucoma in FDRs can significantly increase the chances of early detection. This study aimed to evaluate the differences in glaucoma screening uptake among FDRs in community and hospital-based settings and the underlying factors, as well as the prevalence of glaucoma in FDRs. Patients and Methods: Probands and FDRs who underwent screening were classified into two: community-based (group 1) and hospital-based (group 2). They were invited for screening by Village Health Volunteers and ophthalmic nurses, respectively, using information brochures. The FDRs underwent eye examinations, and those with suspected glaucoma underwent further testing for confirmation. Results: The response rates of probands were 261 (38.2%) for group 1 and 196 (48.8%) for group 2. The uptake screening of FDRs was 30.1% and 64.5%, respectively. Multivariate analysis identified that female FDRs {odds ratio [OR]=1.64; 95% CI 1.14-2.38} and those aged above 45 years (OR=2.06; 95% CI 1.32-3.21) were more likely to participate. FDRs residing outside Chanthaburi Province were less likely to attend than those within Chanthaburi (OR=0.36;95% CI 0.22-0.58). FDRs related to probands with blindness were more likely to participate (OR=1.69; 95% CI 1.13-2.54), as were FDRs with secondary school education or higher (OR=2.49;95% CI 1.48-4.18). Those receiving both medical and surgical treatment were more likely to participate (OR=2.22;95% CI 1.51-3.25). The prevalence of glaucoma was 8.3%, and 19.2% of screened FDRs were glaucoma suspects. Conclusion: Group 1 showed a significantly lower screening uptake than Group 2. The factors influencing the uptake of screening by FDRs are gender, age, geographic location, visual acuity of the worse eye in probands, education status of FDRs, and treatment modalities of probands.

Implementation opportunities and challenges to piloting a community-based drug-checking intervention for sexual and gender minority men in Vancouver, Canada: a qualitative study.

BACKGROUND: In response to the overdose crisis, a collaborative group of two community-based organizations, a health authority and a research institute in Vancouver, Canada, implemented a pilot community-based drug checking (CBDC) intervention for sexual and gender minority (SGM) men. This study identified key factors that influenced the implementation of the CBDC intervention, including opportunities and challenges. METHODS: We conducted semi-structured interviews with seven pertinent parties involved in the CBDC, including policymakers, researchers and representatives from community-based organizations. These interviews were coded and analyzed using domains and constructs of the Consolidated Framework for Implementation Research. RESULTS: While drug-related stigma was identified as a challenge to deliver drug checking services, participants described the context of the overdose crisis as a key facilitator to engage collaboration between relevant organizations (e.g., health authorities, medical health officers, community organizations) to design, resource and implement the CBDC intervention. The implementation of the CBDC intervention was also influenced by SGM-specific needs and resources (e.g., lack of information about the drug supply). The high level of interest of SGM organizations in providing harm reduction services combined with the need to expand drug checking into community spaces represented two key opportunities for the CBDC intervention. Here, SGM organizations were recognized as valued partners that fostered a broader culture of harm reduction. Participants' emphasis that knowing the composition of one's drugs is a "right to know", particularly in the context of a highly contaminated illicit drug market, emerged as a key implementation factor. Lastly, participants emphasized the importance of involving SGM community groups at all stages of the implementation process to ensure that the CBDC intervention is appropriately tailored to SGM men. CONCLUSIONS: The context of the overdose crisis and the involvement of SGM organizations were key facilitators to the implementation of a drug checking intervention in SGM community spaces. This study offers contextualized understandings about how SGM knowledge and experiences can contribute to implement tailored drug checking interventions.

The Development and Implementation of a Custom-Tailored Suicide Response Training for Muslim Communities.

Research indicates that the suicide attempt rate among American Muslims is at least twice the rate of the national US average and follows a different trend of suicide behavior compared to other groups. Religious leaders, such as Imams, are commonly sought out for support, but many lack training in mental health crisis management. The Stanford Muslim Mental Health and Islamic Psychology Lab created the Muslim Community Suicide Response Manual and its accompanying training modules to address this issue. This paper describes the creation, evolution, and future directions of the Suicide Response Training from an Islamic perspective to reduce suicide risk in Muslim communities.

Community-Based Approach to Promote Rational Use of Antibiotics in Indonesia: The Development and Assessment of an Education Program for Cadres.

BACKGROUND: Cadres play an important part in providing community-based education. This study developed and assessed an education program for cadres in Malang, Indonesia, as 'change agents' to promote rational antibiotic use. METHODS: In-depth-interviews with stakeholders (N = 55) and a subsequent group discussion with key personnel (N = 5) were conducted to develop a relevant education tool for cadres. This was followed with a pilot study with cadres (N = 40) to assess the effectiveness and acceptability of the new tool. RESULTS: Consensus was reached on the education tool media: an audio-recording (containing full information) with a pocketbook (containing key information) as a supplement. A pilot study on the new tool reported its effectiveness in improving knowledge (p < 0.001) and demonstrated a high acceptability (all respondents stated 'Strongly Agree' or 'Agree' on all statements). CONCLUSION: This study has created a model for an education tool which can potentially be implemented for cadres to educate their communities about antibiotics in the Indonesian context.

Facility-led community based approach in Mamfe health district, Cameroon: a differentiated service delivery option in complex humanitarian settings.

BACKGROUND: The government of Cameroon's 2017 operational guidelines for the implementation of the "test and treat" strategy expressly incorporates and prescribes the differentiated service delivery (DSD) model with testing and treatment services being decentralized and task shifted at community level. However, express guidance on DSD approach in conflict situations, characterized by pressure on existing health systems remains a limitation. The outbreak of COVID-19 further confounded humanitarian responses for fear of spread. Facility-led community-based approach (FLCBA) was employed as a model of care in addressing DSD for HIV in conflict-affected settings within the COVID-19 context. METHODS: A retrospective quantitative cross-sectional study was conducted in Mamfe District Hospital. Descriptive statistics was used to evaluate the implementation of FLCBA as a DSD model from April 2021 to June 2022 along the clinical cascades. Data were collected using a chart abstraction template from the respective registers. Analyses were done using Microsoft excel 2010. RESULTS: In 15 months, a total number of 4707 (2142 males, 2565 females) people were screened for HIV and 3795 (1661 males, 2134 females) eligible individuals were tested. Out of the 11 targeted health areas, 208 (5.5%) new positive cases were identified, all (100%) of whom were linked to care and treatment. During this period, 61% (34/55) targeted missing clients were tracked through this means among which 31 were defaulters and 3 LTFU. Of the 196 target clients for FLCBA, eligible for viral load sample collection, 142 (72%) samples were collected. CONCLUSIONS: The FLCBA as an integral primary health care delivery package is an efficient and effective variant of DSD for conflict settings; however it requires bravery of health care providers.

Incorporating local stakeholders' voices and knowledge into conservation decisions: a case study on the Chinese Hwamei (Garrulax canorus Linnaeus, 1758) in Taijiang, Guizhou, China.

BACKGROUND: The Chinese Hwamei (Garrulax canorus Linnaeus, 1758) is a widely distributed species and has long been kept as a pet, especially by the ethnic communities in Southwest China. According to conservation experts' suggestions, it has been designated as a second-level national key protected species in February, 2021 to protect this bird, indicating that keeping it at home is no longer permitted in China. However, a key factor to ensure effectiveness and success of conservation initiatives is local stakeholders' acceptance and support. METHODS: Interviews and focus group discussions were used to document the policy outcomes and the views of 108 local bird-keepers in a county in Guizhou province. RESULTS: Despite awareness about the illegality of the practice, the bird was still commonly caged both in rural and urban regions. To justify their unwillingness to stop keeping these birds, the interviewees presented many arguments, such as benefits for the community members' health, cultural heritage and contributions to local livelihoods. Fewer than 30% of the bird-keepers believed that the practice of self-keeping has reduced the wild population. Most argued the decline was mainly generated by the harvesting and keepers with monetary interests. They suggested enforcement should target those people and bird markets, as well as the harvesting methods. They also recommended restricting the number of birds allowed to be kept by one keeper, establishing protected areas and a harvesting ban period. The study participants demonstrated considerable local ecological knowledge about approaches for managing the species' use. CONCLUSIONS: Due to the benefits for the people and the bird's large distribution, I argued that a conservation goal to lower the harvesting and keeping rates would be more appropriate than a strict ban on keeping them. Such a policy would be more feasible and culturally acceptable because it is built on keepers' support and suggestions. It is necessary to monitor the effects of bird keeping on the wild population. Overall, this qualitative study demonstrated the advantage of factoring in local voices in conservation decisions.

COVID-19: an opportunity of systematic integration for Chagas disease. Example of a community-based approach within the Bolivian population in Barcelona.

BACKGROUND: As a Neglected Tropical Disease associated with Latin America, Chagas Disease (CD) is little known in non-endemic territories of the Americas, Europe and Western Pacific, making its control challenging, with limited detection rates, healthcare access and consequent epidemiological silence. This is reinforced by its biomedical characteristics-it is usually asymptomatic-and the fact that it mostly affects people with low social and financial resources. Because CD is mainly a chronic infection, which principally causes a cardiomyopathy and can also cause a prothrombotic status, it increases the risk of contracting severe COVID-19. METHODS: In order to get an accurate picture of CD and COVID-19 overlapping and co-infection, this operational research draws on community-based experience and participative-action-research components. It was conducted during the Bolivian elections in Barcelona on a representative sample of that community. RESULTS: The results show that 55% of the people interviewed had already undergone a previous T. cruzi infection screening-among which 81% were diagnosed in Catalonia and 19% in Bolivia. The prevalence of T. cruzi infection was 18.3% (with 3.3% of discordant results), the SARS-CoV-2 22.3% and the coinfection rate, 6%. The benefits of an integrated approach for COVID-19 and CD were shown, since it only took an average of 25% of additional time per patient and undoubtedly empowered the patients about the co-infection, its detection and care. Finally, the rapid diagnostic test used for COVID-19 showed a sensitivity of 89.5%. CONCLUSIONS: This research addresses CD and its co-infection, through an innovative way, an opportunity of systematic integration, during the COVID-19 pandemic.

Community perceptions of enrolment of indigents into the National Health Insurance Scheme in Ghana: a case study of the Livelihood Empowerment against Poverty Programme.

BACKGROUND: The Livelihood Empowerment against Poverty (LEAP) programme in Ghana as part of its beneficiary programme, identifies the poor/indigents for exemptions from premium payments in the National Health Insurance Scheme (NHIS). This paper sought to understand community perceptions of enrolling the poor in the NHIS through LEAP in order to inform policy. METHODS: The study adopted a descriptive cross-sectional study design by using a qualitative approach. The study was conducted in three geographical regions of Ghana: Greater Accra, Brong-Ahafo and Northern region representing the three ecological zones of Ghana between October 2017 and February 2018. The study population included community members, health workers, NHIS staff and social welfare officers/social development officers. Eighty-one in-depth interviews and 23 Focus Group Discussions were conducted across the three regions. Data were analysed thematically and verbatim quotes from participants were used to support the views of participants. RESULTS: The study shows that participants were aware of the existence of LEAP and its benefits. There was, however, a general belief that the process of LEAP had been politicized and therefore favours only people who were sympathizers of the ruling government as they got enrolled into the NHIS. Participants held the view that the process of selecting beneficiaries lacked transparency, thus, they were not satisfied with the selection process. However, the study shows the ability of the community to identify the poor. The study reports varying concepts of poverty and its identification across the three ecological zones of Ghana. CONCLUSION: There is a general perception of politicization and lack of transparency of the selection of the poor into the NHIS through the LEAP programme in Ghana. Community-based approaches in the selection of the indigent are recommended to safeguard the NHIS-LEAP beneficiary process.

Opportunities for Capacity Building to Create Healthy School Communities in the Netherlands: Focus Group Discussions With Dutch Pupils.

Background: To sustainably implement a healthy school community in which stakeholders, including pupils, feel ownership over health-promotion activities, building community capacity is important. Pupils have experiential knowledge that is complementary to professional knowledge, but their perspectives on capacity-building processes are underexposed. This study aims to explore secondary-school pupils' perceptions about key influencers on physical activity and dietary choices and starting points for building community capacity. Methods: Seven focus groups with forty one pupils were held in four secondary schools engaged in a capacity-building intervention. Transcripts were analysed thematically regarding key influencers about choices in the home and school setting and capacity-building strategies (leadership, participation, tailored health-promotion activities and local networks). Results: Parents remained important influencers for making healthy choices, but snacking choices were increasingly made independently from parents based on attractiveness, availability and cost. Choices to engage in physical activity depended on social aspects and opportunities in the physical environment. Pupils considered their influence over the healthy school community limited, desired more involvement, but require this to be facilitated. They identified leaders mainly within formal structures, for example, student councils. They believed health-promotion activities related to the physical environment and project-based activities within the curriculum have the maximum potential to stimulate healthy behaviours in school communities. Conclusion: This study shows that pupils can reflect critically on their physical activity and dietary choices, and on how this can contribute to processes in creating a healthy school community. In order to take an active role, they need to be considered as full partners and leadership roles should be facilitated in existing structures.

Closing the gap between practice and science in school- and community-based participatory physical literacy promotion: study protocol of the StuPs project.

BACKGROUND: The role of physical activity in the promotion of children's well-being and health is widely known. However, research indicates that the time spent physically exercising and participating in organized sport activities is decreasing among children. Although there is currently no gold standard for promoting sustainable physical activity in children, community-based approaches, particularly those that are multicomponent, appear to be the most successful. The project StuPs: a school- and community-based participatory approach for promoting physical activity in children and their families aims to develop a community-based approach to promoting physical activity by increasing physical literacy among elementary school children and their household members. METHODS: The project is built upon the intervention mapping approach and consists of two periods with an overall duration of 3 years. Period I will last 9 months and include an assessment of needs, wants, strengths, and weaknesses regarding physical activity and health promotion at the community- and school-based level according to the keywords "capacity building" and "physical literacy." Based on the knowledge gained in this stage, measures for capacity building to promote healthy lifestyles and physical literacy in children will be developed using the community-based participatory research and capacity building approach. In Period II, the measures will be applicated, implemented and evaluated using a pre-/post-design to assess efficacy. DISCUSSION: Although the efficacy of using community-based and capacity building approaches to reach children is promising, there remains a gap regarding best practices for changing existing structures and habits over the long term and in the sense of promoting physical literacy.

Impact of a community health conversation upon advance care planning attitudes and preparation intentions.

Background: Advance care planning conversations and preparations do not occur as frequently as they should. Framing advance care planning as a health behavior and an opportunity for community engagement can help improve community-dwellers' intentions to have discussions and preparations regarding facing serious illness, death and dying.Methods: A multi-setting confidential pre/post paper survey assessing advance care planning discussions and preparation intentions was given to community-dwelling citizens residing in the New York metropolitan area. Survey items were adapted from a previous end of life survey to include questions on chronic illnesses, important conversations, comfort levels and concerns about end of life. The intervention was a 1-hour presentation on advance care planning (importance, laws, effective communication and audience questions)Results: Our study found significant interest in discussing advanced care planning across age groups. There were significant changes for participant intentions regarding: having conversations with loved ones, a health care proxy or similar document and none; as well as differences in participant intentions for discussions with caregiver, family, friends, primary physician and no-one.Conclusion: Educating individuals on the importance of advance care planning may be effective in changing community dwellers' intentions to start the conversation and put advanced care planning measures in place.Abbreviations: ACP: Advance Care Planning; CHAT: Conversations Health and Treatments; EoL: End of Life; HCP: Health Care Proxy; MOLST: Medical Orders for Life-Sustaining Treatments; PCP: Primary Care Physician.

Experiencia fonoaudiológica con niños y niñas para la promoción de derechos: análisis desde el enfoque comunitario / Speech-language therapy experience with children for the promotion of rights: analysis from a community-based approach

El artículo analiza, desde los planteamientos del enfoque comunitario, una experiencia fonoaudiológica para la promoción de derechos de niños y niñas, efectuada en una organización social, con participación de un grupo de estudiantes de la carrera de Fonoaudiología de la Universidad de Chile en el año 2013. En los abordajes comunitarios, la comunidad construye conocimientos y realiza acciones para lograr el fortalecimiento de sus relaciones, bienestar social, justicia, autonomía y emancipación. El análisis de la experiencia se realiza a partir de una selección de las bitácoras de campo del equipo de estudiantes participantes, en base a los principios y dimensiones del paradigma de la construcción y transformación crítica de Maritza Montero (2004). Los resultados se dividen en tres momentos (inicio, transición y reconfiguración del trabajo), los cuales dan cuenta del grado de complejidad del proceso y los alcances obtenidos en base a las dimensiones: ontológica, epistemológica, metodológica, ética y política del enfoque comunitario. La discusión enfatiza la importancia de la reflexión crítica sobre los fundamentos y las prácticas de la Fonoaudiología en el abordaje de la comunicación y el desarrollo humano, para aportar a la justicia social desde el enfoque comunitario.

This paper analyzes, from a community-based approach, a speech, language and hearing sciences therapy experience for the promotion of children's rights, carried out in a social organization, with the participation of a group of speech, language and hearing sciences therapy undergraduate students at the Universidad de Chile in 2013. In community approaches, all community members build knowledge and take actions to build stronger social relationships and welfare, justice, autonomy and emancipation. The analysis of this experience was conducted by selecting sections from the fieldwork diaries of the team of participating students, based on the principles and dimensions of the paradigm of construction and critical transformation of Maritza Montero (2004). The results were divided into three moments (beginning, transition and reset of the work), which account for the level of complexity of the process and the goals achieved basedon the ontological, epistemological, methodological, ethical and political dimensions of the community-based approach. The discussion emphasizes the importance of critical reflection on the foundations and practices of speech, language and hearing sciences therapy in the approach to communication and human development, to contribute to social justice from a community perspective.

Prevalence and management of tuberculosis among people who use drugs in Abidjan, Ivory Coast.

Background Although people who use drugs (PWUD) are a high-risk group for tuberculosis (TB), there is practically no data on TB prevalence in Ivory Coast. The aim of the study was to estimate pulmonary TB prevalence and assess the cascade of care with confirmed pulmonary TB (TB+) among PWUD in Abidjan. Methods The study targeted adult people who had used heroin and/or cocaine/crack in the previous six months. A first part consisted in a cross-sectional prevalence estimation survey using mobile facility testing in smoking spots. A multivariable logistic regression was performed to determine the factors associated with TB infection. In a second part, all participants who tested positive for pulmonary TB were offered follow-up for the duration of their treatment and invited to participate in a community-based support program (e.g. family mediation visits or self-support groups). Results Between October 2016 and May 2017, 545 PWUD were informed about the survey and 532 agreed to participate. Most of them were male (n = 484; 91.0%) single (n = 434; 81.6%), with an average age of 34.9 (SD 8.3) years. Drugs most commonly consumed were heroin and crack (n = 530; 99.6% and n = 353; 66.4% respectively) and were inhaled (i.e. smoked). Out of the 531 participants with an Xpert MTB/RIF® test result, 52 were diagnosed with pulmonary TB, i.e. a prevalence of 9.8%, 95% CI [7.5%-12.7%]. Among them, 17.3% had rifampicin-resistant TB. Factors significantly associated with TB infection in the multivariable analysis were: having been recruited in Treichville smoking spot (OR=2.0 [1.1 - 3.7]; p = 0.03), being unemployed (OR = 1.8 [1.0 - 3.4]; p = 0.05), and being co-infected with HIV (OR=3.3 [1.2 - 8.1]; p = 0.01); 60.0% of the patients were successfully treated. Conclusion TB prevalence among the PWUD is high. The community-based support model enables good treatment efficacy among this usually hard-to-reach population.

A Community-Based Response to a Suicide Cluster.

Background: A 45-month community-based suicide prevention program was launched in response to the emergence of a suicide cluster in 2010 in Hong Kong. Aims: This study aimed to evaluate the effectiveness of the program, document the implementation and outcomes of the project, and identify factors that contribute to the outcomes. Method: The program was delivered following the five key components of the public health approach: (a) community consensus building; (b) surveillance and monitoring; (c) development of coordinated action strategies; (d) interventions development and implementation at the universal, selective, and indicated levels; and (d) program evaluation. Results: A significant decreasing trend of suicide was found in the study site during the intervention period, whereas no changes were found in the three control sites. Spatial analysis also showed that the suicide cluster subsided after the intervention. Three impacts and one challenge of the program were identified from the qualitative feedback of the program stakeholders. Limitations: More investigations should be made to assess the sustainability of this community-based suicide prevention effort in the long run. Conclusion: A community-based suicide prevention program was successfully implemented to address the suicide cluster. A reduction in the suicide rate was observed after the intervention.

Community-based approaches for malaria case management in remote communities in the Brazilian Amazon

Abstract INTRODUCTION Malaria case management is a pivotal intervention in malaria elimination. However, many remote areas in Brazil still lack access to basic health services. This study describes a community-based approach (CBA) for malaria case management in the large remote area of the Jaú National Park (JNP), Amazonas, Brazil. METHODS In 2001, a general health CBA was initiated with a motor group (MG); a participative community health diagnosis (PCHD) was subsequently implemented between 2001 and 2005. In 2006, a CBA for malaria case management started with an expanded MG including all sectors with a stake in malaria control, from the local residents to the federal government. In 2008, community microscopists were selected and trained to diagnose hemoparasites. A full malaria strategy was implemented in 2009 with subsequent quality control follow-up. RESULTS Two educational materials were co-created with local communities. The MG identified malaria as a major health problem and the malaria MG planned the control activities. Ten communities selected a resident to become malaria microscopists, and ten solar-operated health centers were built. The number of slide readings increased from 923 in 2006 to 1,900 in 2009, while malaria infections decreased from 354 cases in 2005 to 20 cases in 2015. The excess time (≥ 48 hours) between first symptoms and diagnosis/treatment decreased from 68.9% of cases in 2005 to 14.3% in 2010. CONCLUSIONS While many factors were likely involved in the reduction of malaria transmission in the JNP, the CBA played an important role in the sustained success of the initiative.

Impact of the village health center project on contraceptive behaviors in rural Jordan: a quasi-experimental difference-in-differences analysis.

BACKGROUND: Appropriate contraceptive use remains a major health challenge in rural Jordan. The Japan International Cooperation Agency implemented a project aimed at enhancing the capacity of village health centers (VHCs) to improve the quality and quantity of family planning (FP) services in rural Jordan in 2016-2018. Facility- and community-based approaches were integrated into the interventions. We evaluated the project's impacts on contraceptive behaviors and the effectiveness of the two approaches. METHODS: We used a difference-in-differences analysis based on the project baseline and endline surveys, and logistic regression analysis to assess associations between eight primary outcomes and three secondary outcomes (impacts). The unit of intervention was five target VHCs; the unit of analysis was currently married women of reproductive age (15-49 years) in five intervention and five control villages. RESULTS: Overall, 2061 married women participated; 83.8% were in need of FP. Compared with the control villages, significant effects, ranging from + 0.4% points (pp) to + 11.5 pp., were observed in the intervention villages for six primary outcomes in these categories: increasing the use of FP services at VHCs, participation in health promotion activities, and changing the sources of reproductive health information. There was a trend toward improved secondary outcomes in the intervention villages, but no significant differences were observed between the intervention and control villages regarding modern contraceptive use (mCU; + 4.3 pp), traditional contraceptive use (tCU; - 0.5 pp), and spousal agreement on contraception (+ 5.1 pp). mCU was positively associated with five primary outcomes: obtaining contraceptives at VHCs [adjusted odds ratio (AOR) 3.44, 95% confidence interval (CI) 1.26-9.40], education sessions at VHC (AOR 7.41, 95% CI 1.60-34.39), health activities in communities (AOR 7.41, 95% CI 3.28-16.78), counseling by private doctor/clinic (AOR 0.62, 95% CI 0.40-0.97), and information gained through TV (AOR 0.50, 95% CI 0.32-0.76). Spousal agreement on contraception showed similar positive trends. tCU was associated only with TV. CONCLUSIONS: The project had impacts on increased mCU and husbands' perception of contraception in rural Jordan. The integration of facility- and community-based approaches may be effective in shifting from tCU to mCU in other rural areas.

Background and evaluation design of a community-based health-promoting school intervention: Fit Lifestyle at School and at Home (FLASH).

BACKGROUND: A community-based approach can be a promising strategy for implementing school-based health promotion aimed at stimulating healthy physical activity and dietary behaviour. Such an approach builds on the community capacity of multiple stakeholders, empowering them to design and implement tailored activities, supported by the whole school community. This paper describes the background and evaluation design of the community-based school intervention 'Fit Lifestyle at School and at Home' (FLASH) in four prevocational schools. FLASH includes four strategies for building the community capacity of students, school personnel and parents: 1) identifying leaders in each stakeholder group, 2) stimulating a school culture of participation, 3) having stakeholders design and implement tailored activities and 4) creating a network of local partners for structural embedding. The objective is to monitor the capacity-building processes of the FLASH intervention and to explore if these processes contribute to changes in community capacity. In addition, we will explore if the FLASH intervention is related to changes in PA, dietary behaviours and BMI of students. METHODS: This study has a mixed methods design and uses a participatory action-oriented approach to monitor and evaluate changes in community capacity, tailored health-promotion activities and implementation processes. Methods include semi-structured interviews, focus groups, journals, document analysis and observational scans of the physical environment. In addition, changes in BMI, physical activity and dietary behaviours of prevocational students will be explored by comparing the four intervention schools to four control schools. Data are collected by questionnaires and anthropometric measurements. DISCUSSION: The main strength of this study is its use of mixed methods to evaluate real-life processes of creating a healthy-school community. This will provide valuable information on capacity-building strategies for the structural embedding of health-promotion activities within school settings. The results could help schools become more empowered to adapt and adopt integral health-promotion interventions in daily practice that suit the needs of their communities, that are expected to be sustainable and that could lead to favourable changes in the PA and dietary behaviour of students. TRIAL REGISTRATION: ISRCTN67201841 ; date registered: 09-05-2019, retrospectively registered.

Comprehensive management of epilepsy in onchocerciasis-endemic areas: lessons learnt from community-based surveys.

BACKGROUND: Onchocerciasis-endemic regions are known to have a high epilepsy prevalence. Limited resources in these areas and poor access to healthcare by persons with epilepsy (PWE) result in a wide anti-epileptic treatment gap, poor seizure control and a high burden of seizure-related complications. Recent community-based surveys highlight the need for epilepsy management strategies suitable for remote onchocerciasis-endemic villages to ensure better health outcomes for PWE. In this paper, we propose a feasible approach to manage PWE in such settings. MAIN TEXT: Improved management of PWE in onchocerciasis-endemic areas may be achieved by decentralizing epilepsy care. Simplified approaches for the diagnosis and treatment of epilepsy may be used by non-physicians, under the supervision of physicians or specialists. To reduce the treatment gap, a regular supply of subsidized anti-epileptic drugs (AED) appropriate for different types of onchocerciasis-associated epilepsy should be instituted. Setting up a community-based epilepsy surveillance system will enable early diagnosis and treatment of PWE thereby preventing complications. Community awareness programs on epilepsy must be implemented to reduce stigma and facilitate the social rehabilitation of PWE. Finally, strengthening onchocerciasis elimination programs by optimizing community-directed treatment with ivermectin (CDTI) and considering alternative treatment strategies might reduce the incidence of epilepsy. CONCLUSIONS: A community-based approach with task-shifting of epilepsy care from specialists to non-physician health workers will reduce epilepsy-associated morbidity. Increased advocacy and collaboration with various stakeholders is needed to establish a sustainable, cost-effective chronic care model for epilepsy that will significantly improve the quality of life of PWE in onchocerciasis-endemic regions.

Empowering Malian women living with HIV regarding serostatus disclosure management: Short-term effects of a community-based intervention.

OBJECTIVE: The objective of this study was to assess the short-term effects of Gundo-So-a program aimed at empowering Malian women living with HIV (WLHIV) regarding serostatus disclosure management. METHODS: A pre-experimental study with two measures (one week before and four weeks after Gundo-So) was carried out. A 35-item questionnaire was administered to a convenience sample of 210 WLHIV. Six outcomes were considered: ability to decide whether or not to disclose HIV status, self-efficacy to keep HIV status a secret, self-efficacy to disclose HIV status, feeling crushed by the weight of secrecy, perceived physical health, and perceived psychological health. For each outcome, temporal changes associated with the intervention were assessed using linear regressions with random intercepts. RESULTS: Statistically significant change was observed for all six outcomes between the pre- and post-intervention measures. Furthermore, several variables were associated with the baseline levels of the outcomes and the intervention effect. CONCLUSION: The results suggest that Gundo-So empowers Malian WLHIV with regard to serostatus disclosure management, thus improving their perceived physical and psychological health. PRACTICAL IMPLICATIONS: These results highlight the need for programs to empower WLHIV regarding serostatus disclosure, so that WLHIV can make free and informed decisions regarding serostatus disclosure.

Gender-Based Violence and Armed Conflict: A Community-Informed Socioecological Conceptual Model From Northeastern Uganda.

The high prevalence of gender-based violence (GBV) in armed conflict has been documented in various national contexts, but less is known about the complex pathways that constitute the relation between the two. Employing a community-based collaborative approach, we constructed a community-informed socioecological conceptual model from a feminist perspective, detailing how armed conflict relates to GBV in a conflict-affected rural community in Northeastern Uganda. The research questions were as follows: (1) How does the community conceptualize GBV? and (2) How does armed conflict relate to GBV? Nine focus group discussions divided by gender, age, and profession and six key informant interviews were conducted. Participants' ages ranged from 9 to 80 years (n =34 girls/women, n = 43 boys/men). Grounded theory was used in analysis. Participants conceptualized eight forms of and 22 interactive variables that contributed to GBV. Armed conflict affected physical violence/quarreling, sexual violence, early marriage, and land grabbing via a direct pathway and four indirect pathways initiated through looting of resources, militarization of the community, death of a parent(s) or husband, and sexual violence. The findings suggest that community, organizational, and policy-level interventions, which include attention to intersecting vulnerabilities for exposure to GBV in conflict-affected settings, should be prioritized. While tertiary psychological interventions with women and girls affected by GBV in these areas should not be eliminated, we suggest that policy makers and members of community and organizational efforts make systemic and structural changes. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index.