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PubMed1997

Breastfeeding training improves health worker performance in rural Nigeria.

The training of health workers in breastfeeding and lactation management is to enable them make correct breastfeeding recommendations to mothers. This study aims to provide answers to two research questions: what components of breastfeeding training are easily achieved with extension health workers, and what health worker variables affect these outcomes. Multivariable analysis of the outcomes of a controlled breastfeeding training programme for community health workers (CHW) in rural communities of Osun State, Nigeria, was performed by logistic regression. The results show that the training was the most powerful predictor of correct CHW recommendations on breastfeeding (OR = 60.25, p-0.0000), and of 'perfect' breastfeeding knowledge (OR = 192.49, p = 0.0000). Younger CHWs (in the age bracket 20 to 29 years) were significantly more likely to make correct recommendations on exclusive breastfeeding (OR = 3.02, p = 0.0304). Other CHW variables such as sex, experience, job status, and marital status did not make consistently significant independent contributions to the outcomes. The results suggest that breastfeeding education can enhance CHW professional recommendations on breastfeeding and should be extended to all categories of health workers.

Adult↗
PubMed2006

Occupational health survey of farm workers by camp health aides.

Little is known about the magnitude of occupational health problems among migrant farm workers. A community-based cross-sectional survey was conducted in two migrant farm worker communities: Homestead, Florida, and Kankakee, Illinois. Camp Health Aides (CHAs) interviewed 425 workers about job tasks, personal protective equipment (PPE), field sanitation, work exposures, and selected health conditions. Limited provision of personal protective equipment was reported among those reporting early re-entry tasks: 35% in Kankakee and 42% in Homestead were provided gloves, and 22% in Homestead and 0% in Kankakee were provided protective clothing. About two-thirds were provided toilet facilities and water for hand-washing. Workers reported high prevalences of health conditions consistent with exposure to ergonomic hazards and pesticides. The prevalence of back pain in the past 12 months was 39% in Homestead and 24% in Kankakee. Among Homestead participants, 35% experienced eye symptoms, while 31% reported skin symptoms. These symptoms were less prevalent among Kankakee participants (16% for both eye and skin symptoms). Specific areas of concern included back pain associated with heavy lifting and ladder work; eye and skin irritation associated with fertilizer application tasks and with working in fields during or after spraying of chemicals, especially early re-entry of sprayed fields; and skin irritation associated with a lack of access to hand-washing facilities. In both Kankakee and Homestead, better adherence to safety standards is needed, as well as greater efforts to implement solutions that are available to help prevent work-related musculoskeletal problems.

Adolescent↗
PubMed2004

[Domestic violence as a women's health issue--activities of health professionals in Thailand].

OBJECTIVES: This paper reports the results of a qualitative study on domestic violence (DV) and interventions against DV in Khon Kaen province in northeastern Thailand. We analyzed the roles of health professionals for identifying, treating and supporting abused women, and examined a network model of DV interventions in developing countries. METHODS: We interviewed abused women, health professionals, staff of the government and legal authorities, community health workers and other relevant people in Khon Kaen city and surrounding areas. We analyzed the health consequences of DV, and the roles of health professionals and other actors regarding care and assistance for abused women. We also visited and observed homes of the victims and health facilities where those women were treated. RESULTS AND DISCUSSION: We interviewed 4 abused women in a slum area. One of the women was identified by a nurse of a nearby health center and a social worker when they visited homes in the area. Another woman was successfully supported by nurses of the health center, a community leader and a Buddhist monk. Health professionals played important roles in identifying, treating and protecting abused women. The Khon Kaen provincial hospital established an One-Stop Crisis Center (OSCC) to provide counseling, care and protection for physically or sexually abused women, with a team consisting of doctors, nurses and social workers who were trained in the care of abused women. The Nampol community hospital in a suburban area also established an OSCC to work together with health centers and communities for effective intervention. OSCC team members pointed out several problems: insufficient mental care, shortage of staff, and the difficulty of caring for women coming to the hospital at night or early in the morning. In Thailand, a legal framework against DV has yet to be established and government agencies are not greatly involved in DV interventions. Health professionals play leading roles in identifying, treating and supporting abused women in Thailand. It is important to provide relevant training for health professionals and to develop cooperation networks with government staff and legal authorities, community health workers, and community leaders. Legal frameworks for protecting and supporting DV victims are often insufficient in developing countries, while health care systems tend to be more reliable. Taking into account the social background, health professionals in developing countries can be expected to continue to play the most important role in looking after abused women.

Adolescent↗
PubMed1993

Trial of an asthma action plan in the Maori community of the Wairarapa.

AIMS: An asthma action plan has been tested in a study conducted by Wairarapa Maori community health workers and the Wellington asthma research group. There were several distinctive features of the project, including the programme of marae-based asthma clinics, and the partnership between the researchers and the Maori community groups. This paper describes the process by which the study was conducted since this experience may be relevant to future Maori health research projects. METHODS: The programme was launched with a series of hui at marae in the Wairarapa, and marae-based clinics were set up. These were followed up by further support from the Maori community health workers who helped people to keep diaries to monitor their asthma, and generally maintained contact. The severity of asthma in the participants was compared for a two-month period before the action plan was introduced, and for a four-month period after the plan was introduced. RESULTS: There was a high participation rate, with 91% (63/69) of participants finishing the programme, 75% of whom adequately completed their daily asthma diaries. Asthma control improved significantly in the participants. They commented positively on the programme, and particularly on the marae-based clinics. CONCLUSIONS: The study was successful in terms of participation in the marae-based clinics, acceptance and use of the plan, and improvement in asthma control of the participants. The findings indicate what can be achieved when researchers and Maori community groups work in partnership.

Asthma↗
PubMed1990

Worldwide impact of oral rehydration therapy.

Oral rehydration therapy (ORT) has had a dramatic global impact. The worldwide consequences of this therapy are discussed in four categories: (1) adoption of ORT as the primary therapy for acute dehydrating diarrhea; (2) establishment of national ORT programs; (3) scientific knowledge gained from studies into intestinal absorption of oral rehydration solutions; and (4) implications of ORT for the next decade. The Diarrheal Disease Control Program has been assigned a high priority by the World Health Organization. It now includes 99% of the population of the developing world, although it is not uniformly implemented. Because knowledge of how to use ORT parallels implementation, it is hoped that expanded training of community health workers will increase implementation. In addition, specific indications for ORT need further study and refinement so that community health workers may learn to distinguish between diarrheal episodes that require such therapy and those that do not. Better scientific understanding of intestinal absorption of ORT fluids has led to the development of new formulations that enhance absorption of nutrients and repletion of electrolytes. The optimal composition of such revised solutions has yet to be established. In addition to these improvements in utilization, distribution, education, and application of ORT, other measures to reduce the morbidity and mortality from diarrhea can be expected in the areas of better infant feeding practices, improved sanitation, management of persistent diarrhea, targeted therapy for particular groups of infants at high risk, and immunization.

Diarrhea↗
PubMed2005

Texas' community health workforce: from state health promotion policy to community-level practice.

BACKGROUND: Imagine yourself in Texas as a newly arrived immigrant who does not speak English. What would you do if your child became ill? How would you find a doctor? When you find one, will the doctor speak your native language or understand your culture? In a state of approximately 22 million people, many Texas residents, marginalized by poverty and cultural traditions, find themselves in this situation. To help them, some communities across Texas offer the services of promotores, or community health workers, who provide health education and assist with navigating the health care system. CONTEXT: In 1999, Texas became the first state in the nation to recognize these workers and their contributions to keeping Texans healthy. This paper examines a state health promotion policy that culminated in a training and certification program for promotores and the impact of this program on the lay health education workforce in Texas. METHODS: In 1999, the Texas legislature established the 15-member Promotor(a) Program Development Committee to study issues involved in developing a statewide training and certification program. During its 2-year term, the committee met all six of its objectives toward establishing and maintaining a promotor(a) certification program. CONSEQUENCES: By the end of December 2005, it is estimated that there will be more than 700 certified promotores in Texas. State certification brings community health workers into the public health mainstream as never before. INTERPRETATION: Promotores, a community health safety net and a natural extension of the health and human services agencies, improve health at the neighborhood level. Certification brings renewed commitment to serving others and a distinction to those who have been the unsung heroes of public health for decades.

Community Health Services↗
PubMed2003

Evaluation of community contribution to tuberculosis control in Cape Town, South Africa.

SETTING: Low income, high density, urban settlements in Cape Town, South Africa. OBJECTIVES: To evaluate community treatment supervision as part of tuberculosis (TB) programme implementation. DESIGN: A non-randomised prospective study was conducted under programme conditions from January 1998 to December 1999, comparing TB programme performance in an area with (Guguletu), and an area without (Nyanga) the option of TB treatment supervision by community health workers. RESULTS: Data were collected for 2873 adult TB patients. For smear-positive TB patients, treatment cure rates were higher in the intervention area (Guguletu) than in the control area (Nyanga) (58% vs. 50%, P = 0.0378) and for retreatment cases (47% vs. 35%, P = 0.0791), treatment success rates were similar. CONCLUSIONS: Community health worker support contributed to better TB control programme performance than an approach based exclusively on health facilities. Clear government policy and support for lay health worker programmes in TB control is needed.

Adolescent↗
PubMed2006

[Evaluation of an educational strategy on malaria in rural areas of the Colombian Pacific Coast].

INTRODUCTION: Health education interventions have proved effective in improving knowledge, preventing practices and decreasing occurrence of malaria. OBJECTIVE: To evaluate the impact of the educational intervention "The World of Malaria: Let's Learn to Manage it in Community" developed in Colombian malarial areas, in terms of increasing knowledge, preventive practices, treatment-seeking, and decreasing malaria occurrence. MATERIALS AND METHODS: A quasi-experimental post-test study with a non-equivalent control group was carried out. Four hundred and fifty people living in 20 rural villages were interviewed. These localities were randomly selected from 110 intervened localities. Paired "t" test was performed to evaluate the effect on malaria knowledge of the community health workers (n=243). The effect of the intervention on the effect variables was measured by using logistic regression and by comparing people who were exposed and non-exposed to the educational strategy. RESULTS: Knowledge on malaria in community health workers increased after the intervention (p < 0.05). In the communities, 170/447 (38%) interviewed individuals had contact with the intervention in the communities. Those exposed to the intervention showed improvements in knowledge about breeding sites (OR: 2.53, 95% IC:1.7-3.76), bed-nets use (OR:1.81, 95% IC:1.10-2.97) and a decrease in self-medication with antimalarial drugs (OR:1.97, 95% IC: 1.04-3.73). Contact with the intervention reduced reported episodes of malaria (OR:0.58, 95% CI: 0.39-0.87). CONCLUSION: Significant improvements in preventive practices may be achieved with educational interventions, which in turn may reduce malaria ocurrence.

Colombia↗
PubMed2002

From local concern to randomized trial: the Watcombe Housing Project.

BACKGROUND: A randomized study of the effect on people's health of improving their housing is underway in Torbay. The link between poor health, particularly respiratory health, and poor housing conditions has been recognized for a long time, but there have been few intervention studies to demonstrate that improving housing can improve health. In 1994, South and West Devon Health Authority set up a community development project in a deprived area of Torbay, in response to the concerns of local primary health-care workers. A community development worker helped local residents survey their homes for dampness and record their respiratory symptoms. The survey reported high levels of condensation/dampness and respiratory illness and the Council agreed to direct the majority of their housing improvement funds to the estate over the next 3 years. The Health Authority, University of Plymouth and Torbay Council were successful in obtaining funding to evaluate the housing improvements from the NHS R & D programme. PARTICIPANTS AND METHODS: Of 119 houses eligible for the study, 50 were chosen at random and improved in the first year. The rest were improved the following year. Questionnaires screening for health problems were sent to all 580 residents and baseline surveys of the indoor environment were also carried out. More detailed health surveys were completed by community nurses visiting residents in their homes. All adults were asked to complete SF-36 and GHQ 12 questionnaires, as well as disease-specific questionnaires if appropriate. PROGRESS: All houses in the study have now been improved, including insulation, double-glazing, re-roofing, heating, ventilation and electrical rewiring. Follow-up surveys are underway.

Community Health Planning↗
PubMed1993

A culturally orientated curriculum for Aboriginal health workers.

A culturally orientated, competence-based curriculum has been developed for Aboriginal community health workers in the Pitjantjatjara Homelands of South Australia. Among the difficulties encountered were problems associated with delivering holistic health care to a widely dispersed, seminomadic population in a remote semidesert area, the perception that Western health care is exclusively curative, and the high turnover of non-Aboriginal nursing and medical staff.

Community Health Workers↗
PubMed2004

Pasos Adelante: the effectiveness of a community-based chronic disease prevention program.

BACKGROUND: Implementing programs that target primary prevention of chronic diseases is critical for at-risk populations. Pasos Adelante, or "Steps Forward," is a curriculum aimed at preventing diabetes, cardiovascular disease, and other chronic diseases in Hispanic populations. Pasos Adelante is adapted from the National Heart, Lung, and Blood Institute's cardiovascular disease prevention curriculum, Su Corazon, Su Vida, and includes sessions on diabetes and community advocacy and incorporates walking clubs. CONTEXT: The Pasos Adelante curriculum was implemented in two Arizona, United States-Sonora, Mexico border counties. Key issues in these communities are safety, access to recreational facilities, climate, and cultural beliefs. METHODS: Pasos Adelante is a 12-week program facilitated by community health workers. The program includes interactive sessions on chronic disease prevention, nutrition, and physical activity. Evaluation of the program included precurriculum and postcurriculum questionnaires with self-reported measures of physical activity and dietary patterns. Approximately 250 people participated in the program in Yuma and Santa Cruz counties. CONSEQUENCES: Postprogram evaluation results demonstrate a significant increase in moderate to vigorous walking among participants and shifts in nutritional patterns. INTERPRETATION: The Pasos Adelante program demonstrates that an educational curriculum in conjunction with the support of community health workers can motivate people in Arizona/Sonora border communities to adopt healthy lifestyle behaviors.

Chronic Disease↗
PubMed2000

Community nurses and social workers learning together: a report of an interprofessional education initiative in South Wales.

Collaboration between different professional groups and agencies is an essential element in the provision of high quality community care for people with complex health and social needs. There are, however, a number of barriers to effective interprofessional working. These include: the differing structures and operational philosophies of organizations; the differing languages and values of professional groups; professional and agency rivalries; and the fact that professional groups are, still, largely educated and trained in isolation. Interprofessional learning has been advocated as a possible solution to some of these problems. In this paper the rationale, planning, delivery and evaluation of one interprofessional education initiative are presented. Twelve months of planning between a team of three university teachers working in South Wales, United Kingdom, led to a combined group of community nursing and social work students following post-qualifying courses at undergraduate diploma and first degree level participating in two shared learning sessions. Using an interactive approach the student group explored, first, professional roles and responsibilities and secondly, engaged in group work focused on the discussion of case studies. Student evaluation of the sessions indicated an overwhelming appreciation of the importance of interprofessional education in unidisciplinary education programmes.

Journal Article↗
PubMed1996

Social support as road map and vehicle: an analysis of data from focus group interviews with a group of African American women.

As part of a larger study of the impact of a social support intervention on pregnancy outcome for lower-income African American women, 6 African American women (a medical social worker, a physician's assistant, 2 community outreach workers, a lactation consultant, and a health project representative) participated in focus group discussions concerning the unique social support needs of lower-income African American women during pregnancy. Transcripts of focus group interviews were analyzed using qualitative content analysis. Emergent themes included strengths of African American communities, deficiencies in social support for many lower-income African American women, the meaning of pregnancy for African American women, the ability of many pregnant women to "make it" without visible means of support, young women's locations "inside" and "outside" of "mainstream" life, and the importance of social support as a mechanism for guiding and transporting "lost souls" back into the mainstream.

Black or African American↗
PubMed1993

Control of epidemic group A meningococcal disease in Auckland.

AIM: To study group A meningococcal vaccine delivery to infants less than 2 years of age in Auckland in 1987 to control epidemic disease. METHODS: Mechanisms of vaccine delivery and its facilitation are described. A detailed audit of delivery of vaccine to children less than two years using signed consent forms determined delivery source. This was the age group at highest risk, and poorly covered by routine childhood vaccines. Primary health care source of children presenting with disease was determined by telephone. RESULTS: The epidemic of group A meningococcal disease in the winters of 1985 and 1986 abated most likely due to the vaccination of high risk children (3 months-13 years) in 1987. 90% of the target population were vaccinated. In south Auckland the majority (92%) of vaccine doses for children less than two years of age was delivered by the Plunket Society with Department of Health backing aided by community health workers. By contrast delivery by, general practitioners was greater in north-west and central Auckland (approximately 25%, of dose 1), especially after the publicity over possible side effects (approximately 50% of dose 2). Coverage for dose 1 of children < 2 years was similar (89%) in south Auckland. Of children presenting with meningococcal disease 1 in 4 did not have an identifiable general practitioner. CONCLUSIONS: Vaccines to prevent serious paediatric illness are known to be highly cost effective. The best method of delivery of vaccinations may vary from area to area. Major community involvement including community health workers for the Maori and Pacific Island communities may have facilitated the dissemination of information in this campaign.

Adolescent↗
PubMed1989

Community-based health care in Kibwezi, Kenya: 10 years in retrospect.

In response to the interest of the Kenya government in community-based health care, the Kibwezi Rural Health Scheme was developed by the African Medical and Research Foundation (AMREF) in a semi-arid district in eastern Kenya. Based on a community co-operative philosophy and focussing on health promotion and prevention, the scheme includes the following: a health centre with a 15-bed in-patient unit including four maternity beds, out-patient services, and a 15-bed nutrition rehabilitation unit; a cadre of volunteer community health workers, trained by AMREF, who form the backbone of the project; maternal child health/family planning and nutrition services including an applied nutrition programme, a water project; and a mobile health unit. Designed as a replicable model health programme, the intention was that services would be gradually taken over by the Ministry of Health of Kenya. Much has been learned in the development of the project which should be meaningful to others considering similar endeavours. One of the first lessons learned was that the time taken to sensitize the community to community-based health care is critical to the success of the project and may need to be as long as 1-2 years. Another was that gaining the support of the community for the community health workers (CHW) requires a considerable effort on the part of project staff, but seems to be the only viable solution to the remuneration and recognition of the CHW's work. It also became apparent that preventive and promotive health services should be integrated structurally and operationally with curative health services to provide the most benefits for the community served. Finally, although there are some differences of opinion, it is felt that with some refinements, the project could be replicated in other parts of Kenya.

Child Health Services↗
PubMed2006

Special Populations Networks--how this innovative community-based initiative affected minority and underserved research programs.

The Special Populations Networks (SPN) Program was created to address both community needs for cancer information and NCI's desire to obtain community-based answers to research questions and promote training opportunities for racial/ethnic minority and underserved researchers in populations with an unequal burden of cancer. The SPN program included 3 components: 1) infrastructure and capacity building combined with cancer awareness, 2) community-based research, and 3) community-centered training. The 18 SPN grantees conducted more than 1000 cancer awareness activities. More than 2000 community lay health workers were trained. Communities formalized more than 300 partnerships with Memoranda of Understanding (MOU). More than 255 pilot research project applications were submitted by junior researchers and over 135 were funded. Approximately 90% of the applications were submitted by minority junior researchers; of which more than 100 were funded. More than 290 scientific publications thus far have resulted from the work of the SPNs. In the first 3 years of the program, the SPNs also secured an additional $20 million in outside funding. The SPN program effected a paradigm shift for minority research programs by combining community-based cancer awareness, research, and training into a single program. By engaging research leaders of minority and underserved populations to aid their own, train their own, and develop research to help their own, the SPN program activated the power of their commitment to their own. That commitment was reflected in the trust and participation offered by their communities. Cancer 2006. (c) 2006 American Cancer Society.

Community Networks↗
PubMedDate not supplied

Understanding referral from primary care clinics in rural Kenya: using health information systems to prioritize health services.

This study analyses the referral patterns of patients, over time, from primary care to secondary or tertiary level facilities in rural Africa. The data come from a health information system of a non-governmental organization with a decade of experience in health services delivery in Samburu District, Kenya. The differential referral patterns from two communities are examined in some detail to shed more light on the meaning of a 'referral rate' in this context. First, referral rates over time for two clinics are calculated and compared. These quantitative data, obtained from monthly reports from 1989 to 1997, are interpreted in the light of qualitative data obtained from interviews with community health workers, nurses and members of the communities. The main differences in referral between these ostensibly similar communities are for malaria, trauma and anaemia. Social, environmental and specific health services factors are used to explain these differences. We demonstrate that basic information from health information systems, which tell us little on their own because referral in this context is a rare event, can be combined with local knowledge from the community to provide evidence for health managers to set priorities for public health and clinical interventions.

Health Care Rationing↗
PubMed2006

Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India.

OBJECTIVE: Two-thirds of women globally give birth at home, yet little data are available on use of skin-to-skin care (STSC) in the community. We describe the acceptability of STSC in rural Uttar Pradesh, India, and measured maternal, newborn, and ambient temperature in the home in order to inform strategies for introduction of STSC in the community. STUDY DESIGN: Community-based workers in intervention clusters implemented a community mobilization and behavior change communication program that promoted birth preparedness and essential newborn care, including adoption of STSC, with pregnant mothers, their families, and key influential community members. Acceptance of STSC was assessed through in-depth interviews and focus groups, and temperature was measured during home visits on day of life 0 or 1. RESULTS: Incidence of hypothermia (<36.5 degrees C) was high in both low birth weight (LBW) and normal birth weight (NBW) infants (49.2%, (361/733) and 43% (418/971), respectively). Mean body temperature of newborns was lower (P<0.01) in ambient temperatures <20 degrees C (35.9+/-1.4 degrees C, n=225) compared to > or =20 degrees C (36.5+/-0.9 degrees C, n=1450). Among hypothermic newborns, 42% (331/787) of their mothers had a lower temperature (range -6.7 to 0.1 degrees C, mean difference 0.4+/-1.2 degrees C). Acceptance of STSC was nearly universal. No adverse events from STSC were reported. STSC was perceived to prevent newborn hypothermia, enhance mother's capability to protect her baby from evil spirits, and make the baby more content. CONCLUSION: STSC was highly acceptable in rural India when introduced through appropriate cultural paradigms. STSC may be of benefit for all newborns and for many mothers as well. New approaches are needed for introduction of STSC in the community compared to the hospital.

Body Temperature Regulation↗