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A steep decline of death in a shigellosis epidemic in Bangladesh by a community--participated intervention.

The outcome of an intervention of a shigellosis epidemic during April-July 1985 at Dimla, northern Bangladesh is reported. People of the epidemic-affected community operated a makeshift hospital to provide early indoor treatment for 1,708 patients of blood dysentery, based on empirically selected antibiotic(s), oral rehydration of the patients and giving them high-protein diets. They raised funds and received technical and logistic assistance from the physicians and officials of the local government health centre and of the International Centre for Diarrhoeal Disease Research, Bangladesh. In comparison with the number of deaths recorded before intervention, there was a 187-fold reduction of case-fatality ratio from 11.2 to 0.06% (p less than 0.0001). Probable causes for this precipitious decline of mortality are discussed. It is concluded that such a community action in the intervention of a rural shigellosis epidemic in a developing country may avert death almost totally.

Adolescent↗

[Community participation as a strategy of hypertension control in a health district of Ecuador].

The results of a program for the treatment and control of arterial hypertension in a rural community of the northern area of Ecuador are reported through the voices and the posters used for patients education, by nurses and health promoters (non professional representatives of the community, with a nursing role) of the district. The steps of the program, from the awareness of the problem because of its high impact on mortality; to the organization of the screening for hypertension of 4284 adults (half of the local adult population); to the systematic collection of data on mortality are described. One of the strategies adopted is the discussion of patients' stories with the local communities: the death of a young patient who refused the treatment and died had a strong influence in convincing at risk patients to enter the program. Treatments were available for 1 dollar a month. Nurses and community health promoters have a pivotal role in guaranteeing pressure control and in identifying at risk patients with the help of community adapted risk tables. From the analysis of data of the first 18 months of follow-up some improvements can be observed: grade II hypertensive patients shifted from 34% to 25%; grade III from 35% to 29%. Lack of compliance with the drug therapy is still one of the main problems.

Adolescent↗

Community participation in malaria surveillance and treatment. II. Evaluation of the volunteer collaborator Network of Guatemala.

To evaluate the effectiveness of the Volunteer Collaborator Network (VCN) of Latin America as a community-based malaria case detection and treatment system, we conducted a study of the VCN of Guatemala. Volunteer Collaborators took 72.6% of all blood smears and identified 81.3% of all malaria cases reported by the Guatemalan National Malaria Service. The average volunteer treated 5.8 patients per month (range 0-32.8). In contrast, passive case detection (PCD) posts in government hospitals and health centers treated an average of 12.5 patients per month (range 0.5-91.4). The slide positivity rate of blood smears taken by Volunteer Collaborators was 16.2% compared with 9.7% for PCD posts in health centers and 10.3% for malaria workers during active case detection. The average delay between the date a blood smear was taken and examined ranged from 18.1 days on the Pacific coastal plain to 26.3 days in the less accessible northern region of the country. An additional 14.5 to 47.6 days elapsed before the radical treatments were initiated in these two regions. Seventy percent of the patients completed their radical treatments. In a survey conducted on the Pacific coastal plain of Guatemala, of 1,021 patients with chills and/or fever who believed they had malaria, 20.0% had visited a Volunteer Collaborator and 4.9% were treated at a government health center. Thus, the PCD network detected only 25% of all patients with symptoms suggestive of malaria. Most of the remaining patients treated themselves with antimalarial medications purchased in stores and pharmacies, but less than 15% of these patients used adequate courses of therapy. Furthermore, the rate of detection of symptomatic patients with malaria varied considerably from one community to another. Thus, data from the VCN are probably most useful when groups of communities or geographic areas are stratified for malaria control activities because at this level, variations between individual Volunteer Collaborator posts will be minimized. In spite of these problems, the VCN remains an excellent source of epidemiologic data for malaria control programs and the most practical means available for providing timely, appropriate antimalarial therapy to febrile patients in rural areas.

Adolescent↗

Community participation in cardiac rehabilitation.

Cardiac patients are not solely responsible for their own rehabilitation. The rehabilitative process is a prolonged one, and success lies in multidisciplinary management involving the patient, the immediate family and the community. The Health Act (Act No. 63 of 1977) has various implications for the future provision of rehabilitative services in South Africa. Each member of the health team and the community has a specific role to play, either within or outside the hospital setting, thus providing ongoing rehabilitative supervision of cardiac patients.

Aftercare↗

Local injury information, community participation and injury reduction.

Better injury prevention is now a national health priority in Australia. Applying the health promotion strategies of the Ottawa Charter to injury prevention forms the basis of the World Health Organization's worldwide Safe Communities program. Taking such a community-focused approach has led to quantifiable reductions in injuries in several overseas countries, particularly in Scandinavia where falls of up to 30 per cent in particular injuries have been reported over a three-year period. In the Illawarra area of New South Wales, data from local hospital emergency departments have been used as the basis for a 'community information' strategy, in an attempt to replicate this overseas experience in an Australian setting. Reductions of 17 per cent in attendances by children for injuries (P < 0.001) and a 14 per cent fall in accident-related hospital admissions of children (not statistically significant) have been observed over the course of the four-year intervention. Problems of community definition and external confounding influences outside the control of the project make it difficult to confirm a causal relationship. However, community information forms one important component in a comprehensive local injury-reduction strategy.

Accident Prevention↗

Risk assessment and community participation model for environmental asthma management in an elementary public school: a case study in Puerto Rico.

Asthma is a rapidly growing chronic disease in the general population of the world, mostly in children. Puerto Ricans have the highest prevalence of children with asthma among the Hispanic community in the US and its territories. Asthma and air quality are becoming a significant and potentially costly public health issue in Puerto Rico. The CDC has reported that in Puerto Rico, 320,350 adults have asthma and this number represents 11.5% of the island adult population. The north east municipality of Carolina, Puerto Rico, has the highest asthma prevalence in the 0 to 17 year old range (2001 data). In this study, we address the potential relationship between anthropogenic and naturally occurring environmental factors, and asthma prevalence in an urban elementary public school in Carolina in an effort to empower and engage communities to work on their environmental health issues. We integrated geographic information systems (GIS) data of anthropogenic activities near the school as well as the natural resources and geomorphology of the region. We found that as Carolina is close by to Caribbean National Forest (El Yunque), this together with the temperature and precipitation cycles in the zone creates the ideal environmental conditions for increased humidity and pollen, mold and fungi development through out the year. We also collected health and socio economic data to generate an asthma profile of the students, employees and parents from the school community, and through a survey we identified perceptions on environmental asthma triggers, and indoor air quality in the school and homes of the students and employees. Finally, we implemented a workshop on indoor air quality designed to engage the school community in managing asthma triggers and the school environment. Our results showed that nearly 30 % of its student's population has asthma, and from this group 58% are males and 42% are female students. Of all asthmatic children, only 43% receive treatment for the disease. The study also showed that most asthmatic children are between 7 and 9 year old, and live in households with an annual income below 10,000 dollars. It also showed that 25 % of the student's parents have the condition, and that 25% of the employees are also affected by this chronic condition. All these numbers are significantly higher than those reported by the CDC for Puerto Rico. The perception component had a response of 83% of school employees, and a 39% response from parents. It showed that people know asthma as a disease but many can't identify most environmental asthma triggers. Pre and post tests of the workshop protocol showed that before the activity only 21% of participants can identify asthma triggers. At the end of the workshop nearly 80% were able to identify and manage environmental asthma triggers. This work validates the fact that Puerto Rico continues to have a significant number of people with asthma, particularly children asthma, and that schools are an important settings to create community based action plans to manage environmental asthma triggers through outreach and training.

Asthma↗

Effect of health education on community participation in control of dengue hemorrhagic fever in an urban area of Thailand.

Dengue hemorrhagic fever (DHF), a disease transmitted by Aedes mosquitos, remains a serious public health problem in Thailand. This paper describes the effect of health education efforts on a community-based DHF vector control program in the municipality of Mae Sot District, Tak Province, northern Thailand, from 1988 through 1990. In 1988, public health education on DHF and larval control through mass media, lectures and discussions reduced the Aedes Breteau index from 241 in March to 126 in June 1988. In 1989 and 1990, twice a year house-to-house visits by trained health workers were added to the health education campaigns. Aedes larval indices were decreased far more in the epidemic year of 1990 than in 1989. During this 3-year period, water-storage containers for drinking, washing, bathing and ant-traps were the primary sources of larval habitats, accounting for about 90% of the total breeding places. Reduction of Aedes larvae in these sources was due to various larval control measures. By August 1990 water containers for non-drinking purposes were the remaining important breeding places. The introduction of larvivorous fish may be an effective method of larval control for these containers. Most houses were supplied by public piped water system; however, a shortage of piped water for a period of time resulted in a significant increase in the number of water containers. An adequate water supply to the community should be provided continuously to prevent creation of new breeding places. Modifying behavioral practices to reduce domestic man-made water containers should be encouraged.

Adolescent↗

[Integrated control of the filariasis vector with community participation in an urban area of Recife, Pernambuco, Brazil]

A pilot study for the control of Bancroftian filariasis transmission was developed in two areas of Recife, Brazil, where microfilaraemic prevalence was 10% in 1991. Mass treatment with diethylcarbamazine (DEC) using low and spaced doses was employed in both areas. In one such instance, DEC therapy was associated with vector control using physical measures and periodic treatment of Culex breeding sites with the entomopathogen Bacillus sphaericus. The vector population density, reaching 60 - 120 Culex/room /night before the intervention, was drastically reduced to 4 - 16 Culex/room/night, and maintained at this level for more than two years. Actions to engage the local school community in the vector control process were implemented, and as a consequence several classroom and extracurricular activities were put into practice, culminating with the effective participation of a team of students called the "Vector Vigilantes", in the application of control measures against the vector. The enthusiastic involvement of schoolteachers and students pointed to schools as a place amenable to programs such as this.

Journal Article↗

Importance of schistosomiasis in the Isoka district of Zambia: a prerequisite for its control using community participation.

The opinion has long been held that only by treating cases individually could diseases be controlled or eradicated. This view has been adopted from time immemorial and has failed miserably in, for instance, the control of schistosomiasis. This paper presents views of the head teachers on the prominence of schistosomiasis in the Isoka district, Zambia, as a step towards their involvement in a community mediated programme for the control of schistosomiasis. Information was sought on the importance of schistosomiasis in the district by means of two questionnaires, one distributed to head teachers, and the other to school children. Lack of clean water was considered to be the leading factor by 71 (82.6%) teachers. Generally, schistosomiasis was not considered to be a prominent disease in the district. Nevertheless, teachers from highly infected areas ranked schistosomiasis as a health problem higher than those teachers from schools with lower prevalences (P = 0.002). The implications of these results to implementing a district wide schistosomiasis control programme covering both infected and uninfected areas are discussed.

Humans↗

Health education and community participation in mass drug administration for malaria in Nicaragua.

A malaria control effort in Nicaragua involving the mass, short-term distribution of anti-malaria medicines to a target population of all citizens above one year of age is detailed. About 70% of the population received anti-malarials in November, 1981 and 8 million packets of chloroquine and primaquine were distributed by 70,000 health campaign workers and their assistants. Training and mobilization efforts used volunteers from local community organizations. Mass public education was a key focus in the weeks before drug administration. The effects of the campaign were immediately apparent with a rapid decline in incidence after drug administration. Ongoing community environmental control, case finding, and health education activities continued to improve the malaria situation post-campaign. Further, the campaign promoted the decentralization of malaria control activities and integration of the malaria efforts with the nationwide primary health care system.

Advertising↗

Environmental control of schistosomiasis through community participation in a Moroccan oasis.

Summary Akka oasis, in the province of Tata, southern Morocco, is one of the oldest foci of urinary schistosomiasis in Morocco where transmission is still taking place. We report the results of two studies: a cross-sectional snail survey investigated the distribution of Bulinus truncatus in relation to habitat factors in the Akka traditional irrigation system. The presence of aquatic vegetation, especially Potamogeton sp. was identified as a key factor determining snail occurrence and abundance in canals, impoundments and isolated small puddles and streamlets in the Akka riverbed. In a participatory rapid appraisal, the community identified snail control as a way to reduce transmission of schistosomiasis. Without any further outside incentives, the local irrigation committee implemented repeated cleaning and vegetation removal in canals. A longitudinal study evaluated the effect of these measures on populations of B. truncatus. Snail and egg mass densities showed significant reductions after repeated vegetation clearing in the study sites. The participatory approach led to low-cost, environment-friendly schistosomiasis control measures that were effective and sustainable.

Animals↗

[Citizenship, community participation, and health as seen by health care professionals: a case study in public health services].

This paper deals with the subject of citizenship and people's participation in the health area through an analysis of ideas pertaining to a specific group: health care professionals working in Basic Health Care Clinics in the 3.1 Programmatic Area of the City of Rio de Janeiro (Brazil). The article analyzes their views on the subject and presents them in light of health-related legislation in the Brazilian constitution. It also analyzes the professionals' role vis-à-vis users in raising community awareness that health care is one of their basic rights. Field data from qualitative social research methodology showed a significant heterogeneity in the professionals' conceptions, dividing them into two groups: those belonging to teaching institutions and those working in institutions providing health care. This analysis shows the strategic role that day-to-day relationships between professionals and the community can play in the social change process and the establishment of social rights. It also discusses the viability of this process in view of the discovery of the subjective involvement of the health professionals who promote this process.

English Abstract↗