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1.
Stud Health Technol Inform ; 265: 48-53, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431576

RESUMO

Community Health Workers (CHW) perform important healthcare and health promotion in many low and middle income countries. They are increasingly supported in their work by the use of mHealth. This study aims to explore how mHealth services can support the everyday work for CHWs when delivering home care in rural areas in South Africa. A single case study was performed, mapping CHWs workflow and investigating where and when CHW can be supported by mHealth services. Despite the very positive feedback from the CHWs and the fact that the studied mHealth solutions appears to support the majority of the important activities in the CHWs work process, the application is no longer in use. Financial and strategic decisions are behind the discontinuation of the project, further stressing the importance of taking all socio-technical dimensions into account when evaluating success or failure of implementation projects.


Assuntos
Telemedicina , Fluxo de Trabalho , Agentes Comunitários de Saúde , Assistência à Saúde , Humanos , África do Sul
2.
Stud Health Technol Inform ; 265: 195-200, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431598

RESUMO

Community health workers, led by trained nurses who are linked to a health facility are well positioned to play an important role in improving health of the communities in low and middle-income countries. The South African Department of Health has implemented various mobile health programmes to improve community-based services. This paper presents a component of a study that evaluates mHealth interventions in South Africa. The study was conducted in Pretoria urban and semi-urban areas, with the aim of understanding how community health workers experience mHealth technologies. Three focus group interviews were conducted and data analysis followed Thorne Interpretive Description framework. An overarching theme was that the mHealth application provided clinical content that empowered community health workers to develop confidence, higher efficacy, independent decisions making and experience higher social standing with their clients. This in turn, translated into informed clients. There is evidence of strengthened capacity in the use of mHealth technology and application of knowledge to provide an engaged client care. Functionalities in the application allowed timely exchange of information and decision support.


Assuntos
Fortalecimento Institucional , Telemedicina , Agentes Comunitários de Saúde , Humanos , Renda , África do Sul
3.
Lima; Perú. Ministerio de Salud; 1 ed; 20190700. 15 p. ilus.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1006509

RESUMO

La presente cartilla proporciona información sobre la tuberculosis a los agentes comunitarios de salud, a fin de que desarrollen comportamientos saludables, apliquen en su hogar entornos saludables para evitar el riesgo de desarrollar la tuberculosis; sepan reconocer los síntomas para una detección precoz; y si detectaran un posible caso de la enfermedad, acudir al establecimiento de salud para su diagnóstico y tratamiento oportuno.


Assuntos
Tuberculose , Agentes Comunitários de Saúde , Prevenção de Doenças , Promoção da Saúde
4.
J Glob Health ; 9(1): 010811, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263554

RESUMO

Background: The use of mobile health (mHealth) technology to improve quality of care (QoC) has increased over the last decade; limited evidence exists to espouse mHealth as a decision support tool, especially at the community level. This study presents evaluation findings of using a mobile application for integrated community case management (iCCM) by Malawi's health surveillance assistants (HSAs) in four pilot districts to deliver lifesaving services for children. Methods: A quasi-experimental study design compared adherence to iCCM guidelines between HSAs using mobile application (n = 137) and paper-based tools (n = 113), supplemented with 47 key informant interviews on perceptions about QoC and sustainability of iCCM mobile application. The first four sick children presenting to each HSA for an initial consultation of an illness episode were observed by a Ministry of Health iCCM trainer for assessment, classification, and treatment. Results were compared using logistic regression, controlling for child-, HSA-, and district-level characteristics, with Holm-Bonferroni-adjusted significance levels for multiple comparison. Results: HSAs using the application tended to assess sick children according to iCCM guidelines more often than HSAs using paper-based tools for cough (adjusted proportion, 98% vs 91%; P < 0.01) and five physical danger signs - chest in-drawing; alertness; palmar pallor; malnourishment; oedema (80% vs 62%; P < 0.01), but not for fever (97% vs 93%; P = 0.06), diarrhoea (94% vs 87%; P = 0.03), and three danger signs - not able to eat or drink; vomits everything; has convulsions (88% vs 79%; P = 0.01). Across illnesses and danger signs, 81% of HSAs using the application correctly classified sick children, compared to 58% of HSAs using paper-based tools (P < 0.01). No differences existed for their treatment (P = 0.27). Interview respondents corroborated these findings that using iCCM mobile application ensures protocol adherence. Respondents noted barriers to its consistent and wide use including hardware problems and limited resources. Conclusion: Generally, the mobile application is a promising tool for improving adherence to the iCCM protocol for assessing sick children and classifying illness by HSAs. Limited effects on treatments and inconsistent use suggest the need for more studies on mHealth to improve QoC at community level.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde/psicologia , Prestação Integrada de Cuidados de Saúde , Fidelidade a Diretrizes/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Pré-Escolar , Agentes Comunitários de Saúde/estatística & dados numéricos , Diarreia/mortalidade , Diarreia/terapia , Feminino , Humanos , Lactente , Malária/mortalidade , Malária/terapia , Malaui/epidemiologia , Masculino , Pneumonia/mortalidade , Pneumonia/terapia , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa
5.
J Glob Health ; 9(1): 010812, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263555

RESUMO

Background: Under the World Health Organization's (WHO) integrated community case management (iCCM) Rapid Access Expansion Program (RAcE), World Vision Niger and Canada supported the Niger Ministry of Public Health to implement iCCM in four health districts in Niger in 2013. Community health workers (CHWs), known as Relais Communautaire (RCom), were deployed in their communities to diagnose and treat children under five years of age presenting with diarrhea, malaria and pneumonia and refer children with severe illness to the higher-level facilities. Two of the districts in southwest Niger piloted RCom using smartphones equipped with an application to support quality case management and provide good timely clinical data. A two-arm cluster randomized trial assessed the impact of use of the mHealth application mainly on quality of care (QoC), but also on motivation, retention and supervision. Methods: A two-arm cluster randomized trial was conducted from March to October 2016 in Dosso and Doutchi districts. The intervention arm comprised 66 RCom equipped with a smartphone and 64 in the paper-based control arm. Trained expert clinicians observed each RCom assessing sick children presenting to them (264 in intervention group; 256 in control group), re-assessed each child on the same set of parameters, and made further observations regarding perceptions of motivation, retention, supervision, drug management and caregiver satisfaction. The primary outcome was a QoC score composed of diagnostic and treatment variables. Other factors were assessed by questionnaires. Results: On average, the mHealth equipped RCom showed a 3.4% higher QoC score (mean difference of 0.83 points). They were more likely to ask about the main danger signs: convulsions (69.7% vs 50.4%, P < 0.001); incapacity to drink or eat (79.2% vs 59.4%, P < 0.001); vomiting (81.4% vs 69.9%, P < 0.01); and lethargy or unconsciousness (92.4% vs 84.8%, P < 0.01). Specifically, they consistently asked one more screening question. They were also significantly better at examining for swelling feet (40.2% vs 13.3%, P < 0.01) and advising caretakers on diarrhea, drug dosage and administration, and performed (though non-significantly) better when examining cough and breathing rates, referring all conditions, getting children to take prescribed treatments immediately and having caregivers understand treatment continuation. The control group was significantly better at diagnosing fast breathing, bloody diarrhea and severe acute malnutrition; and was somewhat better (non-significant) at treating fever and malaria. With treatment in general of the three diseases, there was no significant difference between the groups. On further inspection, 83% of the intervention group had a QoC score greater than 80% (25 out of 31), whereas only 67% of the control group had comparable performance. With respect to referrals, the intervention group performed better, mostly based on their better assessment of danger signs, with more correct (85% vs 29%) and fewer missed, plus a lower proportion of incorrect referrals, with the reverse being true for the controls (P = 0.012). There were no statistically significant differences in motivation, retention and supervision between the two groups, yet intervention RCom reported double the rate of no supervision in the last three months (31.8% vs 15.6%). Conclusions: Results suggest that use of the mHealth application led to modestly improved QoC through better assessment of the sick children and better referral decisions by RCom, but not to improvement in the actual treatment of malaria, pneumonia and diarrhea. Considering mHealth's additional costs and logistics, questions around its viability remain. Further implementation could be improved by investing in RCom capacity building, building organization culture and strengthened supervision, all essential areas for improving any CHW program. In this real-world setting, in poor and remote communities in rural Niger, this study did not support the overall value of the mHealth intervention. Much was learned for any future mHealth interventions and scale-up.


Assuntos
Agentes Comunitários de Saúde , Diarreia/terapia , Malária/terapia , Pneumonia/terapia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Administração de Caso/organização & administração , Pré-Escolar , Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Níger , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta , Adulto Jovem
6.
J Glob Health ; 9(1): 010810, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263553

RESUMO

Background: Integrated community case management (iCCM) is a strategy to train community health workers (relais communautaires or RECOs in French) in low-resource settings to provide treatment for uncomplicated malaria, pneumonia, and diarrhea for children 2-59 months of age. The package of Ministry of Public Health tools for RECOs in the Democratic Republic of Congo that was being used in 2013 included seven data collection tools and job aids which were redundant and difficult to use. As part of the WHO-supported iCCM program, the International Rescue Committee developed and evaluated a simplified set of pictorial tools and curriculum adapted for low-literate RECOs. Methods: The revised training curriculum and tools were tested in a quasi-experimental study, with 74 RECOs enrolled in the control group and 78 RECOs in the intervention group. Three outcomes were assessed during the study period from Sept. 2015-July 2016: 1) quality of care, measured by direct observation and reexamination; 2) workload, measured as the time required for each assessment - including documentation; and 3) costs of rolling out each package. Logistic regression was used to calculate odds ratios for correct treatment by the intervention group compared to the control group, controlling for characteristics of the RECOs, the child, and the catchment area. Results: Children seen by the RECOs in the intervention group had nearly three times higher odds of receiving correct treatment (adjusted odds ratio aOR = 2.9, 95% confidence interval CI = 1.3-6.3, P = 0.010). On average, the time spent by the intervention group was 10.6 minutes less (95% CI = 6.6-14.7, P < 0.001), representing 6.2 hours of time saved per month for a RECO seeing 35 children. The estimated cost savings amounts to over US$ 300 000 for a four-year program supporting 1500 RECOs. Conclusion: This study demonstrates that, at scale, simplified tools and a training package adapted for low-literate RECOs could substantially improve health outcomes for under-five children while reducing implementation costs and decreasing their workload. The training curriculum and simplified tools have been adopted nationally based on the results from this study.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde/educação , Prestação Integrada de Cuidados de Saúde/organização & administração , Pré-Escolar , Currículo , República Democrática do Congo , Diarreia/terapia , Humanos , Lactente , Alfabetização/estatística & dados numéricos , Malária/terapia , Pneumonia/terapia , Avaliação de Programas e Projetos de Saúde
7.
J Glob Health ; 9(1): 010808, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31275568

RESUMO

Background: Home visits by community health workers (CHWs) during pregnancy and soon after delivery are recommended to improve newborn survival. However, as the roles of CHWs expand, there are concerns regarding the capacity of community health systems to deliver high effective coverage of home visits. The WHO's Rapid Access Expansion (RAcE) program supported the Malawi Ministry of Health to align their Community-Based Maternal and Newborn Care (CBMNC) package with the latest WHO guidelines and to implement and evaluate the feasibility and coverage of home visits in Ntcheu district. Methods: A population-based survey of 150 households in Ntcheu district was conducted in July-August 2016 after approximately 10 months of CBMNC implementation. Thirty clusters were selected proportional-to-size using the most recent census. In selected clusters, five households with mothers of children under six months of age were randomly selected for interview. The Health Surveillance Assistants (HSAs) providing community-based services to the same clusters were purposively selected for a structured interview and register review. Results: Less than one third of pregnant women (30.7%; 95% confidence interval CI = 21.7%-41.5%) received a home visit during pregnancy and only 20.7% (95% CI = 13.0%-29.4%) received the recommended two visits. Coverage of postnatal visits was even lower: 11.4% (95%CI = 6.8%-18.5%) of mothers and newborns received a visit within three days of delivery and 20.7% (95%CI = 12.7%-32.0%) received a visit within the first eight days. Reaching newborns soon after delivery requires timely participation of the family and/or health facility staff to notify the HSA - yet only 42.9% (95% CI = 33.4%-52.9%) of mothers reported that the HSA was informed of the delivery. Coverage of postnatal home visits among those who informed the HSA was significantly higher than among those in which the HSA was not informed (46.7% compared to 1.3%; P = 0.00). Most HSAs had the necessary equipment and supplies and were active in CBMNC: 83.9% (95% CI = 70.2%-97.6%) of HSAs had pregnancy home visits and 77.4% (95% CI = 61.8%-93.0%) had postnatal home visits documented in their registers for the previous three months. Conclusions: We found low coverage of home visits during pregnancy and soon after delivery in a well-supported program delivery environment. Most HSAs were conducting home visits, but not at the level needed to reach high coverage. These findings were similar to previous studies, calling into question the feasibility of the current visitation schedule. It is time to re-align the CBMNC package with what the existing platform can deliver and identify strategies to better support HSAs to implement home visits to those who would benefit most.


Assuntos
Agentes Comunitários de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Visita Domiciliar/estatística & dados numéricos , Serviços de Saúde Materna , Serviços de Saúde Materno-Infantil , Estudos de Viabilidade , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Recém-Nascido , Malaui , Gravidez , Organização Mundial da Saúde
8.
J Glob Health ; 9(1): 010809, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31275569

RESUMO

Background: Mozambique has one of the highest under-5 mortality rates in the world. Community health workers (CHWs) are deployed to increase access to care; in Mozambique they are known as agentes polivalentes elementares (APEs). This study aimed to investigate child deaths in an area served by APEs by analysing the causes, care seeking patterns, and the influence of social capital. Methods: Caregivers of children under-5 who died in 2015 in Inhambane province, Mozambique, were interviewed using Verbal Autopsy/Social Autopsy (VA/SA) tools with a social capital module. VA data were analysed using the WHO InterVA analytical tool to determine cause of death. SA was analysed using the INDEPTH SA framework for illnesses lasting no more than three weeks. Social capital scores were calculated. Results: 117 child deaths were reported; VA/SA was conducted for 115. Eighty-five had died from an acute illness lasting no more than three weeks, which in most cases could have been treated at community level; 50.6% died from malaria, 11.8% from HIV/AIDS, and 9.4% for each of diarrhoea and acute respiratory infections. In 35.3% the caregiver only noticed that the child was sick when symptoms of very severe illness developed. One in four children were never taken outside the home before dying. Sixteen children were first taken to an APE; of these 7 had signs of very severe illness. Caregivers who waited to seek care until the illness was very severe had a lower social capital score. The mean travel time to go to the APE was 2hrs 50min, which was not different from any other provider. Most received treatment from the APE, 3 were referred. The majority went to another provider after the APE; most to a health centre. Conclusions: The leading causes of death in children under-5 can be detected, treated or referred by APEs. Major care seeking delays took place in the home, largely due to lack of early disease recognition and late decision-making. Low social capital, distance to APEs and to referral facilities likely contribute to these delays. Increasing caregiver illness awareness is urgently needed, as well as stronger referral linkages. A review of the geographical coverage and scope of work of APEs should be conducted.


Assuntos
Causas de Morte/tendências , Mortalidade da Criança/tendências , Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde , Acesso aos Serviços de Saúde , Mortalidade Infantil/tendências , Pré-Escolar , Pesquisa sobre Serviços de Saúde , Humanos , Lactente , Moçambique/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Capital Social , Tempo para o Tratamento/estatística & dados numéricos
9.
J Glob Health ; 9(1): 010435, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31217962

RESUMO

Background: Community Health Workers (CHWs) are considered to be a cost-effective and inclusive solution to address the persistent health workforce shortage in many low and middle-income countries. In recent years, microfinance institutions (MFIs) got increasingly engaged in providing health services delivered by CHWs. Despite their growing importance, little is known about the impacts and implementation barriers of these mostly small-scale initiatives. This paper evaluates an MFI-led CHW program in the Philippines and studies the role of microfinance group networks in influencing program outreach and impact. The intervention aims at disseminating information in poor communities, improving health monitoring through increased check-ups and raising social support. Methods: Clustered randomized controlled trial in 70 communities in the greater area of Metro Manila, the Philippines. The main data was collected in a baseline and follow-up survey and is complemented with extensive sociometric network and geographical data. The main outcome variable is a composite health index based on 10 indicators. The role of the health worker's embeddedness and connectedness in the community for program success is tested using tools of social network analysis. Results: The intervention led to a 3.8% (95% confidence interval (CI) = 1.3, 6.4) improvement in the composite health outcome. Effects across indicators are mixed and mainly driven by changes in immediate health monitoring behavior: The probability for routine examinations increased in the treatment group by 10.6% (95% CI = 3.2, 18.1), for regular blood pressure checks by 9.6% (95% CI = 3.3, 15.9), and for having access to a health care provider by 7.2% (95% CI = 0.93, 13.5). No statistical effects on general knowledge and social support are observable. Social networks are a key driver of program outreach and impact. Close friends and acquaintances of health workers used and benefited substantially more from the program than more distant ties. Conclusions: Despite the promising immediate behavioral impacts, it remains questionable to what extent such small-scale MFI initiatives can bring transformative and sustainable changes without external support. Microfinance group networks played an important role for the success of the health intervention and further research is needed to better understand how these affect the health care utilization decisions of the clients.


Assuntos
Agentes Comunitários de Saúde/economia , Apoio Financeiro , Agentes Comunitários de Saúde/organização & administração , Humanos , Filipinas , Avaliação de Programas e Projetos de Saúde
10.
Sante Publique ; Vol. 31(1): 165-175, 2019 January February.
Artigo em Francês | MEDLINE | ID: mdl-31210511

RESUMO

OBJECTIVE: Community Health Workers (CHWs) were promoted in Benin to improve maternal and child health care (MCH). To improve community health workers' performance, a Quality Improvement Team (QIT) was set up to reinforce CHW capacities. The objective of this work is to present an assessment of QIT's contribution to CHW's performance and MCH coverage in the municipality of Savè. METHODOLOGY: The design of the study includes a pre- and post- analysis. Data were extracted from CHWs' activity reports and routine health information systems from 2011 to 2014 in 22 health facilities. Individual in-depth interviews were also performed with some key informants. The performance of CHW and the MCH indicators were determined according to the National Community Health Policy. RESULTS: The QIT improved Community Health Workers' performance and maternal and child health indicators in Savè. Educational sessions, skilled delivery care coverage, percentage of newborn seen over twice a week, percentage of children treated according national standards, percentage of children fully immunized, percentage of women using family planning methods were increased. CONCLUSION: The establishment of QIT improved CHW's performance and the use of maternal and child health services in Savè. This strategy could be useful for community-based surveillance.


Assuntos
Agentes Comunitários de Saúde/organização & administração , Serviços de Saúde Materno-Infantil/organização & administração , Melhoria de Qualidade/organização & administração , Benin , Criança , Saúde da Criança , Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/normas , Agentes Comunitários de Saúde/normas , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materno-Infantil/normas
11.
BMC Public Health ; 19(1): 759, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200685

RESUMO

BACKGROUND: Due to multiple and interacting factors, Latino children are disproportionately at risk for overweight and obesity in the United States. Childhood obesity increases the risk for adverse physical and psychosocial outcomes throughout the lifespan. Intensive behavioral interventions recommended in primary care settings may not conform to current practices, and the most vulnerable populations are often unable to access these services. Community Health Workers (CHWs) offer a promising approach to bridging the gap between vulnerable communities and culturally competent services. La Vida Buena (The Good Life) is an 8-week family-focused intervention for Latino children 5-8 years old and their parents or caregivers who are patients at a Federally-Qualified Community Health Center (FQHC). It is a culturally and linguistically appropriate curriculum, facilitated by CHWs, that targets family behaviors to foster a healthy lifestyle in order to prevent and mitigate childhood overweight and obesity. METHODS: The primary objective is to test the effectiveness of the La Vida Buena (LVB) childhood obesity program among Latino children 5-8 years old and their families as compared with a single educational session. This study uses a parallel two-arm quasi-experimental design. The intervention group receives the 8-week La Vida Buena intervention and the comparison group receives a single educational session. The primary outcome is the change in the child's BMI z-score from baseline to 6 months. DISCUSSION: The implementation and evaluation of La Vida Buena may inform research and practice for linking Latino patients in FQHCs to culturally responsive community-based childhood obesity interventions. It will also contribute to the literature about CHWs as facilitators of behavior change for families underserved by health services and preventive programs. La Vida Buena can serve as a culturally and linguistically appropriate early intervention curriculum that will foster a healthy home environment for childhood obesity mitigation and prevention. TRIAL REGISTRATION: The trial was retrospectively registered on December 18, 2018. The ClinicalTrials.gov Identifier is NCT03781856.


Assuntos
Agentes Comunitários de Saúde , Família/etnologia , Hispano-Americanos/psicologia , Obesidade Pediátrica/etnologia , Programas de Redução de Peso/organização & administração , Criança , Pré-Escolar , Família/psicologia , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , México , Obesidade Pediátrica/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Estados Unidos
12.
BMC Public Health ; 19(1): 682, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159778

RESUMO

BACKGROUND: Type 2 diabetes is increasing globally, with the highest burden in low- to middle-income countries (LMICs) such as the Philippines. Developing effective interventions could improve detection, prevention, and treatment of diabetes. The Cardiovascular Health Awareness Program (CHAP), an evidence-based Canadian intervention, may be an appropriate model for LMICs due to its low cost, ease of implementation, and focus on health promotion and disease prevention. The primary aim of this study is to adapt the CHAP model to a Philippine context as the Community Health Assessment Program in the Philippines (CHAP-P) and evaluate the effect of CHAP-P on glycated hemoglobin (HbA1c) compared to a random sample of community residents in control communities. METHODS: Six-month, 26-community (13 intervention, 13 control) parallel cluster randomized controlled trial in Zamboanga Peninsula, an Administrative Region in the southern Philippines. Criteria for community selection include: adequate political stability, connection with local champions, travel feasibility, and refrigerated space for materials. The community-based intervention, CHAP-P sessions, are volunteer-led group sessions with chronic condition assessment, blood pressure monitoring, and health education. Three participant groups will be involved: 1) Random sample of community participants aged 40 or older, 100 per community (1300 control, 1300 intervention participants total); 2) Community members aged 40 years or older who attended at least one CHAP-P session; 3) Community health workers and staff facilitating sessions. PRIMARY OUTCOME: mean difference in HbA1c at 6 months in intervention group individuals compared to control. SECONDARY OUTCOMES: modifiable risk factors, health utilization and access (individual); diabetes detection and management (cluster). Evaluation also includes community process evaluation and cost-effectiveness analysis. DISCUSSION: CHAP has been shown to be effective in a Canadian setting. Individual components of CHAP-P have been piloted locally and shown to be acceptable and feasible. This study will improve understanding of how best to adapt this model to an LMIC setting, in order to maximize prevention, detection, and management of diabetes. Results may inform policy and practice in the Philippines and have the potential to be applied to other LMICs. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT03481335 ), registered March 29, 2018.


Assuntos
Conscientização , Países em Desenvolvimento , Diabetes Mellitus Tipo 2/prevenção & controle , Educação em Saúde , Promoção da Saúde/métodos , Avaliação de Programas e Projetos de Saúde , Saúde Pública , Adulto , Idoso , Determinação da Pressão Arterial , Canadá , Sistema Cardiovascular , Agentes Comunitários de Saúde , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/sangue , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados (Cuidados de Saúde) , Filipinas , Pobreza , Projetos de Pesquisa
13.
Public Health ; 171: 15-23, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31075546

RESUMO

OBJECTIVES: Rheumatic heart disease (RHD) is a preventable disease frequently recognized in urban slums. Disease rates in Brazilian slums are incommensurate with the country's economic status and the existence of its universal healthcare system. Our study aimed to investigate what system issues may allow for disease persistence, focusing on issues surrounding access and utilization of primary and specialized healthcare services. STUDY DESIGN: This was a two-part (formative phase followed by implementation phase) qualitative study based on interviews and focus groups and analyzed via content analysis. METHODS: One focus group and 17 in-depth interviews with community health workers, primary care providers, and cardiologists who serve slum residents in Brazil and six interviews with key informants (community health researchers and cardiologists) were performed. Interviews with community health workers and primary care providers were from a single heath post in the neighborhood of Liberdade, a populous and previously unstudied slum in Salvador. Cardiologists were recruited from tertiary care referral hospitals in Salvador. RESULTS: Our findings revealed six major chronological categories/themes of issues and twenty subthemes that patients must overcome to avoid developing RHD or to have it successfully medically managed. Major themes include the effects of living in a slum (1), barriers to access and utilization of primary healthcare services (2), treatment in primary healthcare services (3), access/utilization of specialized healthcare services (4), treatment in specialized healthcare services (5), and certain systemic issues (6). CONCLUSION: Slums make residents sick in a manner of ways, and various bottlenecks impeding medical access to both primary care and specialty care exist, requiring multifaceted interventions. We detail major themes and finally suggest interventions that can allow for the health system to successfully eliminate RHD as a public health concern for slum residents.


Assuntos
Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Áreas de Pobreza , Cardiopatia Reumática/prevenção & controle , Cobertura Universal do Seguro de Saúde , Brasil/epidemiologia , Cardiologistas/psicologia , Agentes Comunitários de Saúde/psicologia , Grupos Focais , Humanos , Médicos de Atenção Primária/psicologia , Pesquisa Qualitativa , Cardiopatia Reumática/epidemiologia , Determinantes Sociais da Saúde
14.
Rev Saude Publica ; 53: 45, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31066823

RESUMO

OBJECTIVE: To address the implementation of the Lab for Innovation in Chronic Conditions in Santo Antonio do Monte, indicating the main challenges and lessons of a new chronic condition model. METHODS: This is an observational study based on two sources of data: 1) two cross-sectional household surveys, 2013 (2012 as reference year) and 2015 (2014 as reference year), representative for the entire population and four target groups (pregnant women; children under two years old; individuals with hypertension and diabetes); medical records of individuals who self-reported having hypertension or diabetes in the household survey of 2013. A descriptive statistics analysis was performed. RESULTS: The main findings showed that the public health system is the main provider of health services, mainly primary care, in Santo Antonio do Monte. Besides, the implementation of Lab for Innovation in Chronic Conditions showed the importance of building a Primary Health Care network in small municipalities. CONCLUSIONS: Community health agents and health managers played a fundamental role in the Primary Health Care network. The case study of Santo Antonio do Monte poses some challenges and lessons that clarify future interventions on building a Primary Health Care network that is essential to provide an adequate and longitudinal care to chronic conditions.


Assuntos
Serviços de Saúde Comunitária/normas , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Atenção Primária à Saúde/normas , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Pré-Escolar , Doença Crônica , Agentes Comunitários de Saúde , Estudos Transversais , Características da Família , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Gravidez , Valores de Referência , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
16.
BMC Public Health ; 19(1): 641, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31132997

RESUMO

BACKGROUND: Child health, nutrition, and responsive stimulation interventions have been developed to improve child survival, growth and development outcomes in low- and middle-income countries. Nevertheless, research on integrated implementation approaches to deliver and promote uptake of these interventions is needed, particularly in sub-Saharan Africa. METHODS/DESIGN: We will conduct a cluster-randomized controlled trial of a supply-side community health worker (CHW) delivered child health, nutrition, and responsive stimulation intervention alone and in combination with a demand-side conditional cash transfer (CCT) intervention to promote antenatal care and child growth monitoring attendance in rural Morogoro region, Tanzania. Twelve village clusters will be randomly assigned to one of the three trial arms: (1) CHW, (2) CHW + CCT, or (3) Control. Mothers (or another primary caregiver) residing in study villages are eligible for trial enrollment if they are currently pregnant or have a child < 1 year of age at the time of enrollment. For the duration of the trial, CHWs will visit households once every 4-6 weeks to deliver the intervention package and CCTs will be provided for documented antenatal care and routine child health and growth monitoring clinic visits. Participants will be followed-up at 9 months (midline) and 18 months (endline) post-randomization. The primary outcomes of the trial are child development assessed by the Bayley Scales of Infant and Toddler Development (BSID-III) and child height-for-age z-score. Secondary outcomes include a range of maternal, child and household outcomes. DISCUSSION: This trial will provide evidence on the effect of CHWs and conditional cash transfers on child growth and development. The results of the trial may be generalizable to similar settings in sub-Saharan Africa. TRIAL REGISTRATION: ISRCTN10323949 , Retrospectively registered on October 3, 2017.


Assuntos
Desenvolvimento Infantil , Agentes Comunitários de Saúde , Promoção da Saúde/organização & administração , População Rural , Pré-Escolar , Feminino , Apoio Financeiro , Promoção da Saúde/métodos , Humanos , Lactente , Masculino , Estado Nutricional , Gravidez , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Tanzânia
17.
Parasit Vectors ; 12(1): 246, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109348

RESUMO

BACKGROUND: The global burden of onchocerciasis is the heaviest in sub-Saharan Africa. Studies have shown the importance of the role of Community-Directed Distributors (CDDs) and nurses in onchocerciasis control, but little is known about their experience in implementing onchocerciasis control programmes. Our aim was to document the barriers that CDDs and local health administrators face in implementing onchocerciasis control activities. METHODS: We conducted a qualitative survey consisting of 16 in-depth interviews and 8 focus group discussions (FGDs) across three health districts of Cameroon. We interviewed a total of 9 local health officials at the district and Health Area levels, and 7 CDDs. Eight FGDs were conducted with CDDs and Health Committee members. RESULTS: The major barriers to the implementation of Community Directed Treatment with Ivermectin that we identified were linked and interrelated. Examples of these barriers included: contextual factors (geographical and cultural background), top-to-bottom planning, insufficient human and material resources, and lack of transparency in the management of the programme's funds. CONCLUSIONS: The CDTI at operational level still faces many obstacles which negatively affect therapeutic coverages. This can lead to the non-adhesion of the communities to the programme, consequently jeopardizing the sustainability of the onchocerciasis elimination programme. We recommend that the national programme planners put in place a transparent management and planning system for onchocerciasis elimination activities, with better communication with local programme stakeholders.


Assuntos
Implementação de Plano de Saúde/organização & administração , Controle de Infecções/organização & administração , Oncocercose/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Participação dos Interessados , África ao Sul do Saara/epidemiologia , Animais , Antiparasitários/uso terapêutico , Camarões/epidemiologia , Serviços de Saúde Comunitária , Agentes Comunitários de Saúde , Efeitos Psicossociais da Doença , Estudos de Avaliação como Assunto , Feminino , Filaricidas/uso terapêutico , Grupos Focais , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Controle de Infecções/estatística & dados numéricos , Ivermectina/uso terapêutico , Masculino , Oncocercose/tratamento farmacológico , Inquéritos e Questionários
18.
Nurse Educ Today ; 79: 175-179, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31136868

RESUMO

BACKGROUND: Considering the key role of health volunteers in promoting community's health, their effective training is of particular importance. Training can be more effective through cooperative and learner-centered methods. Role-play is among the cooperative methods with numerous advantages. Considering the positive impact of training via various methods, we aimed to compare training through role-play and lecture on health volunteers' health knowledge in selected comprehensive health centers of Shiraz, Iran. METHODS: This quasi-experimental study was conducted on all health volunteers in four comprehensive health centers selected via random cluster sampling during the second half of 2017. The participants were divided into intervention and control groups and took part in the pretest based on the book entitled "Promotion of Breastfeeding". Based on the pretest results, health volunteers trained the participants in three educational sessions. The two groups were evaluated again immediately and two months after the intervention. RESULTS: The mean age of the participants was 49.97 ±â€¯8.1 and 46.52 ±â€¯10.74 years in intervention and control groups, respectively. Most participants were married (94.8%) and had diplomas (92.1%).A significant difference was seen between both groups in knowledge scores at the three time points (P < 0.001). A significant difference was found between the two groups regarding knowledge scores immediately and two months after the intervention (P < 0.001), indicating the effectiveness of training through role-play. CONCLUSION: The advantages of role-play, including development of communication skills and active listening, resulted in the learners' enthusiasm and motivation. This method was accompanied with higher educational output as well as longer knowledge persistence. Role-play increased cooperation and group discussions performed after the role-play promoted the transfer emotional experiences.


Assuntos
Agentes Comunitários de Saúde , Educação em Saúde/métodos , Aprendizagem , Desempenho de Papéis , Voluntários , Aleitamento Materno , Feminino , Humanos , Irã (Geográfico) , Pessoa de Meia-Idade , Inquéritos e Questionários
19.
Glob Health Action ; 12(1): 1606570, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31066343

RESUMO

BACKGROUND: Global health research partnerships, which promote the exchange of ideas, knowledge and expertise across countries, are considered key to addressing complex challenges facing health systems. Yet, many studies report inequalities in these partnerships, particularly in those between high and low-and-middle-income countries (LMICs). OBJECTIVE: This paper examines global research collaborations on community health worker (CHW) programmes, specifically analysing the structures of authorship teams and networks in publications reporting research on CHW programmes in low-income countries (LICs). METHODS: A sub-set of 206 indexed journal articles reporting on CHW programmes in LICs was purposefully selected from a prior review of research authorship on CHW programmes in all LMICs over a five year period (2012-2016). Data on country and primary organisational affiliation and number of publications for all individual authors, programme area (e.g. maternal child health) and total citations per paper were extracted and coded in excel spreadsheets. Data were then exported and analysed in Stata/ICV.14 and Gephi. RESULTS: The 206 papers were authored by 1045 authors from 299 institutions, based in 43 countries. Half (50.1%) the authors came from LIC-based institutions, 43.8% from high-income country (HIC) institutions, 2.9% from middle-income country (MIC) institutions and 3.2% had different first affiliations in different publications. Authors based in the USA (302) and UK (68) accounted for just over a third (35.4%) of all authors. Partnership patterns revealed a primary mode of North-South collaboration with authors from the US, and to a lesser extent the UK, playing central bridging roles between institutions. Strong network clusters of multiple-affiliated authors were evident in research on MCH and HIV/TB aspects of CHW programmes. CONCLUSION: Knowledge production on CHW programmes in LICs flows predominantly through a pool of connected HIC authors and North-South collaborations. There is a need for strategies harnessing more diverse, including South-South, forms of partnership.


Assuntos
Autoria , Bibliometria , Pesquisa Biomédica/estatística & dados numéricos , Agentes Comunitários de Saúde/estatística & dados numéricos , Saúde Global , Colaboração Intersetorial , Publicações/estatística & dados numéricos , Adulto , Países em Desenvolvimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza
20.
BMC Health Serv Res ; 19(1): 263, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035983

RESUMO

BACKGROUND: Effective referral systems from the community to the health care facility are essential to save lives and ensure quality and a continuum of care. The effectiveness of referral systems in Mozambique depends on multiple factors that involve three main stakeholders: clients/community members; community health workers (CHWs); and facility-based health care workers. Each stakeholder is dependent on the other and could form either a barrier or a facilitator of referral within the complex health system of Mozambique. METHODS: This qualitative study, aiming to explore barriers and enablers of referral within the lens of complex adaptive health systems, employed 22 in-depth interviews with CHWs, their supervisors and community leaders and 8 focus group discussion with 63 community members. Interviews were recorded, transcribed and read for identification of themes and sub-themes related to barriers and enablers of client referrals. Data analysis was supported by the use of NVivo (v10). Results were summarized in narratives, reviewed, discussed and adjusted. RESULTS: All stakeholders acknowledged the centrality of the referral system in a continuum of quality care. CHWs and community members identified similar enablers and barriers to uptake of referral. A major common facilitator was the existence of referral slips to expedite treatment upon reaching the health facility. A common barrier was the failure for referred clients to receive preferential treatment at the facility, despite the presence of a referral slip. Long distances and opportunity and transport costs were presented as barriers to accessibility and affordability of referral services at the health facility level. Supervisors identified barriers related to use of referral data, rather than uptake of referral. Supervisors and CHWs perceived the lack of feedback as a barrier to a functional referral system. CONCLUSIONS: The barriers and enablers of referral systems shape both healthcare system functionality and community perceptions of care. Addressing common barriers to and strengthening the efficiency of referral systems have the potential to improve health at community level. Improved communication and feedback between involved stakeholders - especially strengthening the intermediate role of CHWs - and active community engagement will be key to stimulate better use of referral services and healthcare facilities.


Assuntos
Agentes Comunitários de Saúde , Programas Governamentais/organização & administração , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas , Adulto , Agentes Comunitários de Saúde/organização & administração , Feminino , Grupos Focais , Humanos , Masculino , Moçambique/epidemiologia , Saúde Pública , Pesquisa Qualitativa , Adulto Jovem
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