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1.
BMJ Open ; 10(10): e043763, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33020109

RESUMO

OBJECTIVES: We evaluated whether implementation of lockdown orders in South Africa affected ambulatory clinic visitation in rural Kwa-Zulu Natal (KZN). DESIGN: Observational cohort SETTING: Data were analysed from 11 primary healthcare clinics in northern KZN. PARTICIPANTS: A total of 46 523 individuals made 89 476 clinic visits during the observation period. EXPOSURE OF INTEREST: We conducted an interrupted time series analysis to estimate changes in clinic visitation with a focus on transitions from the prelockdown to the level 5, 4 and 3 lockdown periods. OUTCOME MEASURES: Daily clinic visitation at ambulatory clinics. In stratified analyses, we assessed visitation for the following subcategories: child health, perinatal care and family planning, HIV services, non-communicable diseases and by age and sex strata. RESULTS: We found no change in total clinic visits/clinic/day at the time of implementation of the level 5 lockdown (change from 90.3 to 84.6 mean visits/clinic/day, 95% CI -16.5 to 3.1), or at the transitions to less stringent level 4 and 3 lockdown levels. We did detect a >50% reduction in child healthcare visits at the start of the level 5 lockdown from 11.9 to 4.7 visits/day (-7.1 visits/clinic/day, 95% CI -8.9 to 5.3), both for children aged <1 year and 1-5 years, with a gradual return to prelockdown within 3 months after the first lockdown measure. In contrast, we found no drop in clinic visitation in adults at the start of the level 5 lockdown, or related to HIV care (from 37.5 to 45.6, 8.0 visits/clinic/day, 95% CI 2.1 to 13.8). CONCLUSIONS: In rural KZN, we identified a significant, although temporary, reduction in child healthcare visitation but general resilience of adult ambulatory care provision during the first 4 months of the lockdown. Future work should explore the impacts of the circulating epidemic on primary care provision and long-term impacts of reduced child visitation on outcomes in the region.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde , Saúde Pública , Adulto , Fatores Etários , Betacoronavirus , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pandemias , Pediatria/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , População Rural
2.
Rev Saude Publica ; 54: 90, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33027343

RESUMO

OBJECTIVE: To analyze factors associated with diarrheal disease in the rural Caribbean region of Colombia. METHOD: A cross-sectional study conducted in the rural area of the Cesar Department, Colombia, between November 2017 and June 2018. Self-reported cases of diarrheal disease were surveyed, and water samples from 42 households were collected and analyzed. Descriptive statistics were employed in the analysis of socioeconomic status, environmental and sanitary conditions, and we evaluated their association with the diarrheal disease using the Poisson regression models. Each model was adjusted with variables suggested by specific directed acyclic graphs. RESULTS: Poor water supply conditions, hygiene and basic sanitation were reported in the study area. All water samples were classified either as high risk for health problems or unfit for human consumption. The diarrheal disease had a prevalence of 7.5% across all ages and of 23.5% in children under five years old. The variables rainy season (PR = 0.24; 95%CI 0.07-0.85), children under five years old (PR = 4.05; 95%CI 1.70-9.68), water from deep wells (PR = 16.90; 95%CI 2.45-116.67), water from artificial ponds (PR = 11.47; 95%CI 1.27-103.29), toilets availability (PRA = 0.23; 95%CI 0.06-0.96), and swine presence (PR = 0.20; 95%CI 0.05-0.74) were significantly associated with the occurrence of diarrheal disease. CONCLUSION: Water supply, hygiene and basic sanitation conditions have been associated with the diarrheal disease, affecting almost a quarter of the population under five years old. There is an urge for the design of effective policies that improve environmental and sanitation conditions in rural areas.


Assuntos
Diarreia/epidemiologia , População Rural/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Colômbia/epidemiologia , Estudos Transversais , Inquéritos Epidemiológicos , Humanos , Lactente , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
3.
Artigo em Inglês | MEDLINE | ID: mdl-33027398

RESUMO

Chagas disease is an important endemic morbidity in Latin America affecting millions of people in the American continent. It is caused by the protozoan Trypanosoma cruzi, and transmitted through the feces of the insect vector belonging to the subfamily Triatominae. The present conducted an entomological survey of triatomines and analyzed entomological indicators, such as the rate of infestation, colonization, triatomine density and natural infection in rural communities in the municipality of Campinas do Piaui, Piaui State, in the Northeast region of Brazil. Data on the search of triatomines performed in 167 domiciliary units (DUs), harvested during the period of February to July 2019, in 12 rural communities were analyzed. The capture of triatomines occurred in all studied communities, being 76 the number of positive DUs, of the 167 surveyed, presenting a global rate of infestation of 45.51%. Two triatomines species were collected: Triatoma brasiliensis (98.49%) and T. pseudomaculata (1.51%), the first was found in the domiciliary and peridomiciliary areas, while the second was captured only in peridomiciliary areas. The index of colonization was 17.1%. Natural infection was observed only in 5.44% of T. brasiliensis samples. The entomological survey was conducted in rural communities, showingthe risk of transmission of Chagas disease to the local population, requiring continuous entomological surveillance and vector control.


Assuntos
Triatoma/parasitologia , Triatominae/parasitologia , Animais , Brasil , Cidades , Humanos , População Rural
5.
BMC Public Health ; 20(1): 1559, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066763

RESUMO

BACKGROUND: Undernutrition among under five children in India is a major public health problem. Despite India's growth in the economy, the child mortality rate due to undernutrition is still high in both urban and rural areas. Studies that focus on urban slums are scarce. Hence the present study was carried out to assess the prevalence and determinants of undernutrition in children under five in Maharashtra, India. METHODS: A community-based cross-sectional study was conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. Data were collected through house to house survey by interviewing mothers of under five children. Total 2929 mothers and their 3671 under five children were covered. Multivariate logistic regression analysis was carried out to identify the determinants of child nutritional status seperately in urban and rural areas. RESULTS: The mean age of the children was 2.38 years (±SD 1.36) and mean age of mothers was 24.25 years (± SD 6.37). Overall prevalence of stunting among children under five was 45.9%, wasting was 17.1 and 35.4% children were underweight. Prevalence of wasting, stunting and underweight were more seen in an urban slum than a rural area. In the rural areas exclusive breast feeding (p < 0.001) and acute diarrhea (p = 0.001) were associated with wasting, children with birth order 2 or less than 2 were associated with stunting and exclusive breast feeding (p < 0.05) and low maternal education were associated with underweight. Whereas in the urban slums exclusive breast feeding (p < 0.05) was associated with wasting, sex of the child (p < 0.05) and type of family (p < 0.05) were associated with stunting,and low income of the family (p < 0.05) was associated with underweight. CONCLUSIONS: Factors like sex of the child, birth order,exclusive breast feeding,economic status of the family, type of family,acute diarrhea and maternal education have influence on nutritional status of the child. Improvement of maternal education will improve the nutritional status of the child. Strategies are needed to improve the economic status of the community. TRIAL REGISTRATION: Trial registration number: CTRI/2017/12/010881 ; Registration date:14/12/2017. Retrospectively registered.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Áreas de Pobreza , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Lactente , Masculino , Mães/estatística & dados numéricos , Prevalência , Fatores de Risco , Fatores Socioeconômicos
6.
Wei Sheng Yan Jiu ; 49(5): 731-743, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33070814

RESUMO

OBJECTIVE: To investigate the feeding status of infants and their feeder's feeding literacy in poor rural areas of Gansu Province. METHODS: From November 2018 to January 2019, a multi-stage cluster random sampling method was used to select 1200 infant and child families aged 0 to 23 months in 40 villages of Gansu Province. A standardized questionnaire from the Chinese Nutrition Society(CNS)was used to investigate the basic situation of infant and young children's families, the situation of breastfeeding and the addition of supplementary food, and parents feeding knowledge, attitude behavior(KAP). Using chi-square test, logistic regression and other method to statistically describe and infer the collected data. RESULTS: A total of 1193 infants and 1165 feeders were investigated. The exclusive breastfeeding rate of infants and young children under the age of 6 months was 39. 02%. The rate of continuous breastfeeding at 1 year old was 37. 40%, and the rate of continuous breastfeeding at 2 years old was 20. 88%, the difference between the two was significant(χ~2=13. 498, P<0. 01). The supplementary food supplement rate of infants and children over 6 months was 94. 37%, the highest supplementary supplement for cereals and potatoes(98. 01%), and the lowest percentage for beans and nuts(23. 51%), and the distribution of supplementary foods at different ages was significantly different(χ~2=52. 336, P<0. 01). The qualification rate of infants and young children's minimum dietary diversity was 64. 13%, the minimum eating frequency qualification rate was 70. 64%, the minimum acceptable dietary intake qualification rate was 42. 16%, and the qualification rates of various indicators were significantly different between different months(χ~2=85. 421, P<0. 01;χ~2=19. 66, P<0. 01; χ~2=17. 261, P<0. 01). The KAP score passing rate of infant caregivers was 37. 34%, and there was a statistical difference between the age of infants and young children, the education level and the sex of the caregiver(χ~2=9. 411, P<0. 05;χ~2=25. 901, P<0. 01;χ~2=3. 874, P<0. 05). Taking low-month-old infants and young children, low education and male caregivers as controls, infants and young children aged over 12 months, high school education and female caregivers were the protective factors of KAP scores(P<0. 05). CONCLUSION: The problems of infant breastfeeding and supplementary feeding in poor rural areas of Gansu Province were serious, and the knowledge and skills of raising people were scarce, which were related to the age of infants and young children, the education and the sex of raising people.


Assuntos
Fenômenos Fisiológicos da Nutrição do Lactente , População Rural , Dieta , Feminino , Humanos , Lactente , Alimentos Infantis , Recém-Nascido , Masculino , Estado Nutricional
7.
Pediatr Dent ; 42(5): 387-391, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-33087224

RESUMO

Purpose: The purpose of this study was to determine differences in dental services received between rural and urban residents in a national sample of children with private insurance. Methods: This was a retrospective study of deidentified claims data from a major national private insurer. Children younger than 18 years of age enrolled throughout 2018 and who had at least one visit to the dentist that year were included. Differences in the frequency of dental procedures received were determined by chi-square tests. Multilevel logistic regression was used to evaluate the effect of individual-level and ZIP Code-level covariates, including rurality, on the odds of receiving a preventive dental service or having a tooth extracted. Results: A total of 603,064 children, with an average age of 10.2±4.4 (standard deviation) years, visited a dentist, and 6.52 percent lived in a rural area. In a multilevel logistic regression correcting for patient age, patient gender, ZIP Code average income, and dental provider density, rurality was positively associated with receiving a tooth extraction (odds ratio [OR] equals 1.06; P<0.001) and negatively associated with receiving a preventive service (OR equals 0.85; P<0.001). Female gender was a negative predictor of preventive services and a predictor of having a tooth extracted. Conclusion: Children living in rural areas had reduced rates of preventive dental care and higher rates of tooth extraction than their nonrural counterparts.


Assuntos
Utilização de Instalações e Serviços , População Rural , Adolescente , Criança , Pré-Escolar , Assistência Odontológica , Feminino , Humanos , Seguro Saúde , Estudos Retrospectivos , Estados Unidos
8.
IEEE Pulse ; 11(5): 17-20, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064639

RESUMO

Before the novel coronavirus (COVID-19) started sweeping across the United States, it began on the coasts. The first known case was reported in a county just outside of Seattle, WA, with other cases quickly cropping up in California and in the greater New York City region. As the virus lingered on the periphery of the country, doctors and physicians working in inland, rural communities worried about what might happen if the virus hit their homes.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Pandemias , Pneumonia Viral/terapia , Serviços de Saúde Rural , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Criatividade , Humanos , Colaboração Intersetorial , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Saúde da População Rural , Serviços de Saúde Rural/organização & administração , População Rural , Estados Unidos/epidemiologia , Universidades , Voluntários
9.
J Med Libr Assoc ; 108(4): 651-655, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33013227

RESUMO

Migrant and seasonal farmworkers, who are essential workers in the coronavirus global public health emergency, face unique risks to their health as well as longstanding health inequities. This commentary highlights these risks and argues that Internet access represents an underappreciated but critical part of the public health response. The authors first discuss the unique risks farmworkers face. We note the importance of Internet access in the time of physical distancing, the fact that many health outreach workers are no longer visiting camps, the need for telemedicine infrastructure, and the role of Internet access in providing connections to families in communities of origin. We describe existing efforts that have been implemented in North Carolina to raise awareness among public health and health promotion practitioners and researchers. The current coronavirus pandemic demands the attention of medical libraries, public health practitioners, and policy makers to address the digital divide for farmworkers and their families.


Assuntos
Relações Comunidade-Instituição , Fazendeiros , Acesso à Internet , Bibliotecas Médicas , População Rural , Migrantes , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , North Carolina , Pandemias , Pneumonia Viral/epidemiologia
10.
PLoS Med ; 17(10): e1003150, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33027246

RESUMO

BACKGROUND: Evidence for the effectiveness of continuous quality improvement (CQI) in resource-poor settings is very limited. We aimed to establish the effects of CQI on quality of antenatal HIV care in primary care clinics in rural South Africa. METHODS AND FINDINGS: We conducted a stepped-wedge cluster-randomised controlled trial (RCT) comparing CQI to usual standard of antenatal care (ANC) in 7 nurse-led, public-sector primary care clinics-combined into 6 clusters-over 8 steps and 19 months. Clusters randomly switched from comparator to intervention on pre-specified dates until all had rolled over to the CQI intervention. Investigators and clusters were blinded to randomisation until 2 weeks prior to each step. The intervention was delivered by trained CQI mentors and included standard CQI tools (process maps, fishbone diagrams, run charts, Plan-Do-Study-Act [PDSA] cycles, and action learning sessions). CQI mentors worked with health workers, including nurses and HIV lay counsellors. The mentors used the standard CQI tools flexibly, tailored to local clinic needs. Health workers were the direct recipients of the intervention, whereas the ultimate beneficiaries were pregnant women attending ANC. Our 2 registered primary endpoints were viral load (VL) monitoring (which is critical for elimination of mother-to-child transmission of HIV [eMTCT] and the health of pregnant women living with HIV) and repeat HIV testing (which is necessary to identify and treat women who seroconvert during pregnancy). All pregnant women who attended their first antenatal visit at one of the 7 study clinics and were ≥18 years old at delivery were eligible for endpoint assessment. We performed intention-to-treat (ITT) analyses using modified Poisson generalised linear mixed effects models. We estimated effect sizes with time-step fixed effects and clinic random effects (Model 1). In separate models, we added a nested random clinic-time step interaction term (Model 2) or individual random effects (Model 3). Between 15 July 2015 and 30 January 2017, 2,160 participants with 13,212 ANC visits (intervention n = 6,877, control n = 6,335) were eligible for ITT analysis. No adverse events were reported. Median age at first booking was 25 years (interquartile range [IQR] 21 to 30), and median parity was 1 (IQR 0 to 2). HIV prevalence was 47% (95% CI 42% to 53%). In Model 1, CQI significantly increased VL monitoring (relative risk [RR] 1.38, 95% CI 1.21 to 1.57, p < 0.001) but did not improve repeat HIV testing (RR 1.00, 95% CI 0.88 to 1.13, p = 0.958). These results remained essentially the same in both Model 2 and Model 3. Limitations of our study include that we did not establish impact beyond the duration of the relatively short study period of 19 months, and that transition steps may have been too short to achieve the full potential impact of the CQI intervention. CONCLUSIONS: We found that CQI can be effective at increasing quality of primary care in rural Africa. Policy makers should consider CQI as a routine intervention to boost quality of primary care in rural African communities. Implementation research should accompany future CQI use to elucidate mechanisms of action and to identify factors supporting long-term success. TRIAL REGISTRATION: This trial is registered at ClinicalTrials.gov under registration number NCT02626351.


Assuntos
Infecções por HIV/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Cuidado Pré-Natal/normas , Carga Viral/estatística & dados numéricos , Adulto , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/diagnóstico , Humanos , Ciência da Implementação , Padrões de Prática em Enfermagem , Gravidez , Atenção Primária à Saúde , Avaliação de Processos em Cuidados de Saúde , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , RNA Viral/sangue , População Rural , África do Sul , Gestão da Qualidade Total , Adulto Jovem
11.
Pediatr Dent ; 42(5): 350-353, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-33087218

RESUMO

Purpose: Acute pain experienced during dental procedures can lead to distress, difficulty with behavior guidance, and dental fear/avoidance. The purpose of this study was to explore dental providers' perceptions of pediatric procedure-related pain and acute pain assessment practices. Methods: Fifteen dental providers (53 percent female; nine dentists, three dental therapists, three dental hygienists) currently/formerly employed by a single rural Alaskan health care organization were interviewed using a semi-structured guide. Recorded interviews were transcribed, verified, and coded using inductive qualitative analytic methods. Results: Six providers suggested that pediatric procedure-related pain is rarely encountered. Providers who reported encountering it rely on observation of body language, facial expression, behavior, crying, and verbalization to know whether a child is experiencing procedural pain. Even when available, only four interviewees reported using standardized pain scales. Conclusions: Dental providers have mixed perceptions about whether they encounter pediatric procedure-related pain. There is high variability in how providersassess procedural pain, and approaches often are nonstandardized.


Assuntos
Dor Aguda , População Rural , Dor Aguda/diagnóstico , Dor Aguda/etiologia , Criança , Feminino , Humanos , Medição da Dor , Pesquisa Qualitativa
12.
BMC Infect Dis ; 20(1): 727, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023498

RESUMO

BACKGROUND: Viral load (VL) testing is the gold-standard approach for monitoring human immunodeficiency virus (HIV) treatment success and virologic failure, but uptake is suboptimal in resource-limited and rural settings. We conducted a cross-sectional study of risk factors for non-uptake of VL testing in rural Uganda. METHODS: We conducted a cross-sectional analysis of uptake of VL testing among randomly selected people with HIV (PWH) receiving anti-retroviral treatment (ART) for at least 6 months at all eight primary health centers in Gomba district, rural Uganda. Socio-demographic and clinical data were extracted from medical records for the period January to December 2017. VL testing was routinely performed 6 months after ART initiation and 12 months thereafter for PWH stable on ART. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-uptake of VL testing (the primary outcome). RESULTS: Of 414 PWH, 60% were female, and the median age was 40 years (interquartile range [IQR] 31-48). Most (62.3%) had been on ART > 2 years, and the median duration of treatment was 34 months (IQR 14-55). Thirty three percent did not receive VL testing: 36% of women and 30% of men. Shorter duration of ART (≤2 years) (adjusted odds ratio [AOR] 2.38; 95% CI:1.37-4.12; p = 0.002), younger age 16-30 years (AOR 2.74; 95% CI:1.44-5.24; p = 0.002) and 31-45 years (AOR 1.92; 95% CI 1.12-3.27; p = 0.017), and receipt of ART at Health Center IV (AOR 2.85; 95% CI: 1.78-4.56; p < 0.001) were significantly associated with non-uptake of VL testing. CONCLUSIONS: One-in-three PWH on ART missed VL testing in rural Uganda. Strategies to improve coverage of VL testing, such as VL focal persons to flag missed tests, patient education and demand creation for VL testing are needed, particularly for recent ART initiates and younger persons on treatment, in order to attain the third Joint United Nations Program on HIV/AIDS (UNAIDS) 95-95-95 target - virologic suppression for 95% of PWH on ART.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , HIV-1/imunologia , População Rural , Carga Viral/efeitos dos fármacos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Infecções por HIV/virologia , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Testes Sorológicos , Resposta Viral Sustentada , Uganda/epidemiologia , Adulto Jovem
13.
Wei Sheng Yan Jiu ; 49(5): 724-730, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33070812

RESUMO

OBJECTIVE: To identify the relationship between fever and diarrhea 2-week prevalence and Yingyangbao(YYB) effective consumption among infants and young children. METHODS: A total of 2952 infants and young children aged from 6 to 24 month in 10 impoverished counties of Henan province were selected by multi-stage random sampling between June and September 2017. To acquire 2-week prevalence information of infants and young children, their caregivers were investigated by self-made questionnaire. The structural equation model was utilized in multi-factor analysis. RESULTS: After adjusting potential confounders, YYB effective consumption reduced2-week prevalence of fever(ß=-0. 279, P=0. 001) and diarrhea(ß=-0. 182, P=0. 042) among infants and young children. Nutrition knowledge and YYB benefit cognition of caregivers reduced2-week prevalence of fever(γ=-0. 002, 95%CI-0. 004~-0. 001, P=0. 003) and diarrhea(γ=-0. 001, 95%CI-0. 003~0. 000, P=0. 049) indirectly through chain mediation path of "nutrition knowledge-YYB benfit cognition-YYB effective consumption-fever/diarrheal". CONCLUSION: YYB effective consumption can reduce 2-week prevalence of fever and diarrhea among infants and young children. Nutrition knowledge and YYB benefit cognition can improve YYB effective consumption and thus reduce 2-week prevalence of fever and diarrhea indirectly.


Assuntos
Suplementos Nutricionais , População Rural , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/prevenção & controle , Alimentos Fortificados , Humanos , Lactente , Prevalência
14.
Glob Health Sci Pract ; 8(3): 396-412, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33008854

RESUMO

This article assesses the CORE Group Polio Project (CGPP) experience over a 20-year period in 5 countries. It examines how a program designed to provide social mobilization to eradicate one disease, and which did so effectively, functioned within the general framework of community health workers (CHWs). Vertical health programs often have limited impact on broader community health. CGPP has a 20-year history of social mobilization and effective program interventions. This history provided an opportunity to assess how CGPP community mobilizers (CMs) functioned in polio and maternal and child health. The Updated Program Functionality Matrix for Optimizing Community Health Programs tool of the CHW Assessment and Improvement Matrix (AIM) was used to examine CGPP CM roles across different contexts. The analysis determined that CGPP CMs met the basic level of functioning (level 3) for 6 of the 10 components of the AIM tool. This cross-country descriptive analysis of the CGPP demonstrates the importance of embracing the full range of CHW AIM components, even in a vertical program. Use of data, community involvement, local adaptation, and linkage with the health system are especially critical for success. This general lesson could be applied to other community mobilization and disease/epidemic control initiatives, especially as we face the issues of the COVID-19 pandemic.


Assuntos
Agentes Comunitários de Saúde , Erradicação de Doenças/métodos , Poliomielite/prevenção & controle , Avaliação de Programas e Projetos de Saúde/métodos , Serviços de Saúde Rural , África , Ásia , Humanos , População Rural
15.
BMC Infect Dis ; 20(1): 737, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028228

RESUMO

BACKGROUND: Chronic hepatitis C virus (HCV), which is a concern in many countries, is the leading cause of liver cancer around the world. Since Taiwan launched its national health insurance system in 1995, it has managed to extend health coverage to 99% of the Taiwanese population, providing free but limited antiviral treatment each year since 2017. However, many people in rural areas are unaware that they have chronic HCV; nor do they realize that new drugs with high cure rates could drastically reduce their health burden. The aim of this study is to explore the implementation facilitators of and barriers to inviting potentially infected patients in rural areas to be transferred for HCV ribonucleic acid (RNA) confirmation and new drug treatment. METHODS: A descriptive and prospective study design with an interdisciplinary collaboration approach was implemented. After five elements of referral were developed, telephone counseling was conducted between August 2018 and May 2019 in Yunlin, Taiwan. The elements of referral developed by the research team were: (1) forming and coordinating physicians' schedules, (2) recruiting and training volunteers, (3) training the nursing staff, (4) raising funds or resources, and (5) connecting with village leaders. Thereafter, we collaborated with two district health centers, a private local hospital, and health clinics. Based on the medical records provided by these agencies, community adults that were HCV antibody (anti-HCV) positive were invited to join the program. RESULTS: Of the 1795 adults who were serum anti-HCV positive, 1149 (64%) accepted transfer to a qualified hospital; of these, 623 (54.2%) had an HCV infection. 552 (88.6%) of those infected started receiving direct-acting antivirals (DAAs) treatment. The top four barriers to accepting transfer were: (1) they perceived themselves to be healthy (n = 98, 32.3%); (2) mistrust of treatment/healthcare (n = 60, 20.2%); (3) limited transportation to the hospital (n = 52, 17.5%); and (4) work conflict (n = 30, 10.1%). CONCLUSION: An interdisciplinary collaboration approach significantly contributed to the invitation of CHC patients, as well as their acceptance of HCV RNA confirmation and free DAAs treatment. Using anti-HCV data from previous medical records for case-finding and collaborating with a hospital and health clinics proved to be an efficient strategy.


Assuntos
Antivirais/uso terapêutico , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , RNA Viral/metabolismo , Adulto , Feminino , Hepacivirus/isolamento & purificação , Anticorpos Anti-Hepatite C/sangue , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/psicologia , Humanos , Comunicação Interdisciplinar , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Encaminhamento e Consulta , População Rural , Taiwan
16.
Artigo em Inglês | MEDLINE | ID: mdl-33019735

RESUMO

A growing body of literature recognises the profound impact of adversity on mental health outcomes for people living in rural and remote areas. With the cumulative effects of persistent drought, record-breaking bushfires, limited access to quality health services, the COVID-19 pandemic and ongoing economic and social challenges, there is much to understand about the impact of adversity on mental health and wellbeing in rural populations. In this conceptual paper, we aim to review and adapt our existing understanding of rural adversity. We undertook a wide-ranging review of the literature, sought insights from multiple disciplines and critically developed our findings with an expert disciplinary group from across Australia. We propose that rural adversity be understood using a rural ecosystem lens to develop greater clarity around the dimensions and experiences of adversity, and to help identify the opportunities for interventions. We put forward a dynamic conceptual model of the impact of rural adversity on mental health and wellbeing, and close with a discussion of the implications for policy and practice. Whilst this paper has been written from an Australian perspective, it has implications for rural communities internationally.


Assuntos
Acesso aos Serviços de Saúde , Saúde Mental , População Rural , Austrália/epidemiologia , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia
17.
Rev Soc Bras Med Trop ; 53: e20200048, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32997048

RESUMO

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.


Assuntos
Administração de Caso , Serviços de Saúde Comunitária/organização & administração , Malária , População Rural , Brasil , Pesquisa Participativa Baseada na Comunidade , Humanos , Malária/diagnóstico , Malária/tratamento farmacológico , Saúde Pública
18.
Environ Health Prev Med ; 25(1): 51, 2020 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912134

RESUMO

BACKGROUND: China has the largest elderly population in the world; little attention has been paid to the mental health of elderly in areas of extreme poverty. This is the first study to investigate the mental health of the rural elderly in poverty state counties in Chongqing and was part of the Chongqing 2018 health literacy promotion project. METHODS: In 2019, a cross-sectional study was conducted to investigate the mental health status of the rural elderly in fourteen poverty state counties of Chongqing, in which a total of 1400 elderly aged ≥ 65 years were interviewed, where mental health status was measured by the ten-item Kessler10 (K10) scale. Ordered multivariate logistic regression was performed to evaluate the influencing factors related to mental health of the elderly in these areas. RESULTS: The average score of K10 in 14 poverty state counties was 17.40 ± 6.31, 47.6% was labeled as good, 30.2% was moderate, 17.0% was poor, and lastly 5.1% was bad, and the mental health status of the elderly in the northeastern wing of Chongqing was better than the one in the southeastern wing of Chongqing. A worse self-rated health was the risk factor for mental health both in the northeastern and southeastern wings of Chongqing (all P < 0.001). Lower education level (OR (95% CI) = 1.45 (1.12-1.87), P = 0.004) was a risk factor in the northeastern wing, whereas older age (OR (95% CI) = 1.33 (1.13-1.56), P = 0.001) was a risk factors in the southeastern wing. CONCLUSIONS: The results showed that mental health of the elderly in poverty state counties was poor, especially in the southeastern wing of Chongqing. Particular attention needs to be paid to the males who were less educated, older, and single; female with lower annual per capital income; and especially the elderly with poor self-rated health.


Assuntos
Saúde Mental/estatística & dados numéricos , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Idoso , Idoso de 80 Anos ou mais , China , Estudos Transversais , Feminino , Política de Saúde , Humanos , Modelos Logísticos , Masculino , Análise Multivariada
19.
Mem Inst Oswaldo Cruz ; 115: e190431, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32935748

RESUMO

BACKGROUND: Long lasting insecticide-treated nets (LLINs) may be effective for vector control of cutaneous leishmaniasis (CL). Their efficacy, however, has not been sufficiently evaluated. OBJECTIVE: To evaluate the large-scale efficacy of LLINs on Lutzomyia longiflocosa entomological parameters up to two years post-intervention in the sub-Andean region of Colombia. METHODS: A matched-triplet cluster-randomised study of 21 rural settlements, matched by pre-intervention L. longiflocosa indoor density was used to compare three interventions: dip it yourself (DIY) lambda-cyhalothrin LLIN, deltamethrin LLIN, and untreated nets (control). Sand fly indoor density, feeding success, and parity were recorded using CDC light trap collections at 1, 6, 12, and 24 months post-intervention. FINDINGS: Both LLINs reduced significantly (74-76%) the indoor density and the proportion of fully engorged sand flies up to two years post-intervention without differences between them. Residual lethal effects of both LLINs and the use of all nets remained high throughout the two-year evaluation period. CONCLUSIONS: Both LLINs demonstrated high efficacy against L. longiflocosa indoors. Therefore, the deployment of these LLINs could have a significant impact on the reduction of CL transmission in the sub-Andean region. The DIY lambda-cyhalothrin kit may be used to convert untreated nets to LLINs increasing coverage.


Assuntos
Anopheles/efeitos dos fármacos , Insetos Vetores/efeitos dos fármacos , Mosquiteiros Tratados com Inseticida , Inseticidas/administração & dosagem , Leishmaniose Cutânea/prevenção & controle , Controle de Mosquitos/métodos , Animais , Colômbia , Resistência a Inseticidas , Leishmaniose Cutânea/parasitologia , Mosquitos Vetores , População Rural
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