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PubMedDate not supplied

Dermatophytomycoses in children in rural Kenya: the impact of primary health care.

In a survey of 5780 children from 13 schools in rural Kisumu District (western Kenya) in 1993, a prevalence rate of dermatophytomycoses of 10.1% was found. Three-quarters of the affected children suffered from tinea capitis (prevalence rate 7.8%), caused by Microsporum audouinii var. langeronii, Trichophyton violaceum and Microsporum canis. In 1994, a dermatology programme within the primary health care system was started. Twelve community health workers (CHWs), trained in diagnosis and treatment of the most common skin diseases, carried out regular school visits once a week. All dermatophytomycoses, dry forms of tinea capitis included, were treated locally with Whitfield's ointment. In 1995 the prevalence rate of fungal skin infections in the same schools was found to be 9.3%; the difference to 1993 was not significant. Only tinea capitis, with a prevalence rate of 5.8%, showed a significant reduction (P < 0.05). Altogether, a distinctive improvement regarding the extent and the severity of dermatophytomycoses could be noticed. In the cultures from tinea capitis, Microsporum canis was not found to be present. Trained community health workers are capable of the diagnosis and treatment of fungal skin infections of children in rural areas, which leads to a reduction in the prevalence of tinea capitis.

Antifungal Agents↗
PubMed2001

Health effects of waste incineration: a review of epidemiologic studies.

There is an increasing trend toward using incineration to solve the problem of waste management; thus, there are concerns about the potential health impact of waste incineration. A critical review of epidemiologic studies will enhance understanding of the potential health effects of waste incineration and will provide important information regarding what needs to be investigated further. This study reviews the epidemiologic research on the potential health impact of waste incineration. Previous studies are discussed and presented according to their study population, incinerator workers or community residents, and health end points. Several studies showed significant associations between waste incineration and lower male-to-female ratio, twinning, lung cancer, laryngeal cancer, ischemic heart disease, urinary mutagens and promutagens, or blood levels of certain organic compounds and heavy metals. Other studies found no significant effects on respiratory symptoms, pulmonary function, twinning, cleft lip and palate, lung cancer, laryngeal cancer, or esophageal cancer. In conclusion, these epidemiologic studies consistently observed higher body levels of some organic chemicals and heavy metals, and no effects on respiratory symptoms or pulmonary function. The findings for cancer and reproductive outcomes were inconsistent. More hypothesis-testing epidemiologic studies are needed to investigate the potential health effects of waste incineration on incinerator workers and community residents.

Air Pollutants↗
PubMed2001

Ageing and mental health in a developing country: who cares? Qualitative studies from Goa, India.

BACKGROUND: While there is a growing body of epidemiological evidence on the prevalence of mental illnesses in late-life in developing countries, there is limited data on cultural perceptions of mental illnesses and care arrangement for older people. METHOD: This qualitative study used focus group discussions with older people and key informants to investigate the status of older people and concepts of late-life mental health conditions, particularly dementia and depression, in Goa, India. RESULTS: Vignettes of depression and dementia were widely recognized. However, neither condition was thought to constitute a health condition. Dementia was construed as a normal part of ageing and was not perceived as requiring medical care. Thus, primary health physicians rarely saw this condition in their clinical work, but community health workers frequently recognized individuals with dementia. Depression was a common presentation in primary care, but infrequently diagnosed. Both late-life mental disorders were attributed to abuse, neglect, or lack of love on the part of children towards a parent. There was evidence that the system of family care and support for older persons was less reliable than has been claimed. Care was often conditional upon the child's expectation of inheriting the parent's property. Care for those with dependency needs was almost entirely family-based with little or no formal services. Unsurprisingly, fear for the future, and in particular 'dependency anxiety' was commonplace among older Goans. CONCLUSIONS: There is a need to raise awareness about mental disorders in late-life in the community and among health professionals, and to improve access to appropriate health care for the elderly with mental illness. The study suggests directions for the future development of locally appropriate support services, such as involving the comprehensive network of community health workers.

Aged↗
PubMed1981

Approaches to primary health care in the Commonwealth Caribbean.

In this article, the authors present a brief review of the health problems of the Commonwealth Caribbean and of the primary care activities being implemented to solve them. Special attention is given to programs which develop new categories of health workers and direct health manpower toward learning a technology appropriate to the conditions in which they work. These programs enable the health worker and allied health personnel to adapt their roles and functions accordingly and thus provide quality health care within limited resources. The main programs are: development of new categories of health workers such as the community health aide and the nurse practitioner; education and training of allied health personnel; the training of primary health care physicians. An account is also given of primary health care in Jamaica and in the smaller territories of the Caribbean.

Allied Health Personnel↗
PubMed2001

Primary prevention of childhood lead poisoning through community outreach.

BACKGROUND: The prevalence of childhood lead poisoning has substantially decreased in Milwaukee, Wisconsin over the past decade. Nevertheless, by the mid 1990s, 30% of children were still found to have elevated blood levels. OBJECTIVE: To extend the reach of the Milwaukee Health Department (MHD) to previously underserved families in 1 inner city neighborhood with extremely old housing, the Sixteenth Street Community Health Center (SSCHC) implemented, in 1995, the Community Lead Outreach Project (CLOP). Going door-to-door, CLOP attempted to identify children 6 months to 6 years old with elevated blood lead levels (BLL), referring those > or = 20 micrograms/dL to MHD and enrolling those with BLLs 10-19 micrograms/dL in a program of prevention education and environmental clean-up with the specific aim of preventing BLLs increasing to 20 micrograms/dL and above. METHODS: A team of community outreach workers led by a nurse-coordinator visited, over a 4-year period, families in their homes in 13 census tracts surrounding the SSCHC. During the home visits, capillary blood samples for BLLs were drawn, environmental assessments and scoring were conducted, lead poisoning prevention education provided and repair and cleaning of household lead hazards demonstrated. For control and comparison, BLL data for the entire city by ZIP Code and provider were obtained from the Milwaukee Health Department. Odds ratios for changes in the proportions of children screened > or = 10 micrograms/dL were calculated and compared for the years 1996 through 1999. The odds ratios of changes for various populations were compared for significant differences using tests of homogeneity. To control for age confounding, proportions of elevated BBLs for all groups and for all years were age-standardized, using the direct method. RESULTS: Over the entire study, 20.9% of the children screened had BLLs > or = 10 micrograms/dL and 3.0% were > or = 20 micrograms/dL. For 395 children with BLLs 10-19 micrograms/dL enrolled in the CLOP follow-up program, the mean BLL was 12.9 micrograms/dL. Mean levels at the first, second and third follow-up visits were 10.8, 10.3 and 9.8 micrograms/dL respectively, showing an overall decline of 3.1 micrograms/dL or 24%. At the first follow-up visit, 97% of the children tested were < 20 micrograms/dL while 76% were < 10 micrograms/dL. By the second follow-up visit, 100% were < 20 micrograms/dL. Initial environmental scores averaged 24.7, declining to 19.0 at first, 17.8 at second and 14.8 at third follow-up visits. For the entire CLOP population, the proportion of children testing > 10 micrograms/dL declined each year from 46.3% in 1996 to 22.5% in 1999. The geographic area in which CLOP operated recorded the highest screening penetration rate in the city: 61%. The odds ratio for CLOP clients to have elevated blood lead levels at the end of the study period, in contrast with the beginning, was 0.34 compared to 0.55 for the entire city and 0.75 for private physicians serving the same general population. Comparison of odds ratios showed the CLOP target population enjoyed a decrease in rate of elevated BLL 1.6 times that of the city-wide average, p-value = 0.016 and more than double that of the patients of area private providers. CONCLUSIONS: We conclude that the Sixteenth Street Community Health Center Childhood Lead Outreach Project has successfully accessed populations of children with high rates of lead poisoning who had escaped more traditional screening venues and effectively intervened to reduce their BLLs to < 10 micrograms/dL. Moreover, CLOP produced impressive and unanticipated primary prevention benefits in the community at large. The demonstrated ability of community outreach workers to access high-risk populations and reduce exposure to lead hazards suggests the potential of this strategy for extension to other geographic areas, to the patients of private physicians and to address other prevalent, urban health problems like asthma, injuries and violence.

Child↗
PubMed1999

Training, skills and caseloads of community mental health support workers involved in case management: evaluation from the initial UK demonstration sites.

This paper describes phase one of a three phase, Department of Health funded project, led by the Mental Health Programme of the Royal College of Nursing Institute in collaboration with the Research Unit of the Royal College of Psychiatrists and the School of Social Work at the University of East Anglia. Its project aims were to establish whether the work of demonstration sites in mental health case management had developed beyond their original structure, to compare their current profile with the general literature on case management and assertive outreach and to use this data to reach consensus about issues affecting the work of those healthcare workers who currently see themselves working as case managers. Central to these aims were the experiences and narratives of the demonstration site case managers themselves. In 1995 data were collected from six fieldwork sites in England using semistructured interviews. Similarities and differences between the literature and the fieldwork data were used to inform a consensus conference. The main areas of investigation were organizational considerations, the nature of innovative projects and user involvement. The paper concludes that there are serious problems with the perceived role of case managers, their support and training and further difficulties attributed to interagency working. Finally, it is clear that the exact nature of the client group most suited to UK case management typology has not yet been resolved.

Case Management↗
PubMedDate not supplied

A community-based programme to provide prompt and adequate treatment of presumptive malaria in children.

A community-based programme to ensure prompt and adequate treatment of presumptive episodes of clinical malaria in children has been established in a rural province of Burkina Faso. The implementation strategy was based on training a core group of mothers in every village and supplying community health workers with essential antimalarial drugs specially packed in age-specific bags containing a full course of treatment. Drugs were sold under a cost-recovery scheme. The programme was run in 1994 by the national malaria control centre (CNLP), and in 1995 it was developed to the provincial health team (PHT). Knowledge and awareness of malaria increased with the intervention. Drug consumption by age group was compatible with the distribution of disease, and no major problem of misuse emerged. The actual implementation costs of the intervention were US$ 0.06 per child living in the province. An evaluation of the impact of the intervention on the severity of malaria, using routine data from the health information system and taking as an indicator the proportion of malaria cases which were recorded as severe in health centres, was performed. In 1994, when the intervention was implemented on a provincial scale by CNLP, this proportion was lower than the average of the 4 preceding years (3.7% vs. 4.9%). In 1995, when the programme was implemented by the PHT, the proportion of severe cases was lower in health centres achieving a programme coverage of > or = 50% in their catchment area compared with the others (4.2% vs. 6.1%). Our experience shows that a low-cost, community-based intervention aimed at providing children with prompt and adequate treatment of presumptive episodes of clinical malaria is feasible, and suggests that it may lead to a reduction in the morbidity from severe malaria.

Acetaminophen↗
PubMed1997

Sociocultural factors and the promotion of exclusive breastfeeding in rural Yoruba communities of Osun State, Nigeria.

Child survival strategies include prolonged and intensive breastfeeding, together with its early initiation, and breastmilk only for the first six months of life. This paper reports on local knowledge and attitudes of breastfeeding and the sociocultural factors that shape its practice in poor rural Yoruba communities of Southwestern Nigeria. The study has conducted 10 focus group discussions among homogeneous groups of grandmothers, pregnant women, lactating mothers, husbands, and community health workers, and a questionnaire survey of 256 third trimester pregnant women. All women in these communities breastfeed their infants on demand, and for up to two years, because breastmilk is universally accepted as the best food for babies, and breastfeeding spaces births. Prelacteal feedings of water herbal infusions and ritual fluids are the norm, and breastmilk is supplemented, from birth, with water and teas. Exclusive breastfeeding is considered dangerous to the infant: the baby has an obligatory requirement for supplementary water to quench its thirst and promote its normal development, and for herbal teas which serve as food and medicine. Colostrum is discarded because it is dirty, "like pus", and therefore potentially harmful to the infant, although 24% of the survey sample would give it to their babies. Expressed breastmilk is suspect as it can get contaminated, poisoned or bewitched. Complementary foods are introduced as early as two months because of perceived lactation insufficiency. The commonest supplement is a watery maize porridge of low nutrient density. Breastfeeding can also be dangerous, as toxins and contaminants can be passed to the infant through breastmilk. The most serious conflict with the WHO/UNICEF recommendations is the lack of local credibility of exclusive breastfeeding. According to local knowledge, the early introduction of water, herbal teas, and of complementary foods is designed to enhance child survival, while these are supposed to do the exact opposite by the WHO/UNICEF rationale, by exposing the infant to contaminants early, thereby increasing diarrheal morbidity and mortality. Child survival interventions need to address this conflict.

Attitude to Health↗
PubMed1991

Primary health care and immunisation in Iran.

The Primary Health Care (PHC) network of Iran consists of a rural and an urban branch. While the rural branch presently covers a sizeable portion of the rural population, the urban PHC project is in its early stages of implementation. The Expanded Programme on Immunisation (EPI) in Iran, which started as an independent and vertical project in early 1983, is being gradually integrated into the PHC network as the latter expands. Results of the second PHC programme review of Iran shows that immunisation coverage of children has improved appreciably since the first PHC review, especially for BCG which stands at 56.3%. Complete immunisation at first birthday in the rural areas with the PHC services is 44.1%, whereas for urban areas other than Teheran it is 28.1%. While the high coverage in the rural areas is attributed to the 'active' approach and vigilance of the providers of immunisation (i.e. the community health workers and the vaccinators of the mobile teams), the higher coverage in the capital city of Teheran is attributed to the involvement of private paediatricians and the generally higher social, economic, and educational status as well as higher interest of mothers. It is noticed that the results of cluster sampling for determination of immunisation coverage in large metropolitan areas of the developing world must be interpreted with much care. The reason is that in these areas extreme fluctuations in the crude birth rate are common and therefore results tend to over-represent the attributes of the segment of population with lower birth rate. It is also argued that complete immunisation might not be the best indicator for assessing the progress of the immunisation efforts. These and other findings are discussed in detail. are discussed in detail.

Attitude to Health↗
PubMed2003

Risk assessment and management of patients with self-neglect: a 'grey area' for mental health workers.

This study explores the perceptions and experiences of community mental health workers who assess and manage the risk of self-neglect and severe self-neglect in people with serious mental health problems. The initial literature review demonstrated a lack of material on this specific subject. Semi-structured interviews were undertaken with seven community mental health workers who met the criteria of being knowledgeable, skilled and credible practitioners. Data analysis was completed using thematic content analysis. Findings suggest that community mental health workers are operating in a number of areas where there is a distinct lack of clarity--'The Grey Areas'. The most important of these were the tolerance of workers to situations of self-neglect/severe self-neglect, policies, procedures and legislation, and definitions of self-neglect/severe self-neglect. The workers dealt with this lack of clarity by completing a detailed risk assessment, which then enabled them to manage the risk. However, the need to balance the safety needs of clients against their need to be treated as autonomous individuals presented a major dilemma for workers.

Anecdotes as Topic↗
PubMedDate not supplied

Patterns of partnership and condom use in two communities of female sex workers in Tanzania.

Two rapid ethnographic studies have found that commercial sex workers (CSWs) and other high-risk women in Tanzania have different categories of partners, ranging from single-time contacts to long and enduring relationships. Since the advent of HIV/AIDS prevention programs in Tanzania in the late 1980s, CSWs and their clients have been aware of the multiple benefits of condom use for the prevention of pregnancy and STDs including HIV. These women often use condoms for the single-time contact. However, since the HIV/AIDS epidemic, casual partners have decreased in number. These days, most of their sexual contacts occur within long-term partnerships, and within these relationships, condom use is rare. Although the message that condoms should be used during high-risk behavior has been largely accepted, the definition of a high-risk relationship needs to be extended from casual partnerships to include multiple long-term partnerships. In addition, men and women's empowerment through education, business, and equal rights needs to be addressed at all levels of society.

Adolescent↗
PubMed1992

Latinos and HIV disease: issues, practice and policy implications.

This paper examines critical issues faced by Latino PWAs and offers suggestions for meeting the needs for community support and care of Latino PWAs and their families. As HIV disease is shifting increasingly to minority communities, social workers need to consider new approaches to developing community care. Drawing on the strengths and informal support networks of the Latino community, the authors suggest ways in which these strengths can form the basis of service strategies that will effectively meet the needs of Latino PWAs.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Fetal alcohol syndrome prevention in American Indian communities of Michigan's upper peninsula.

Attitudes and knowledge about Fetal Alcohol Syndrome (FAS) were examined among American Indian communities of Michigan's Upper Peninsula. Indian health workers and community women were interviewed. Education about FAS was provided in each community. The results indicate that information on FAS is reaching many women in these communities and that traditional cultural patterns can support the development of a strong Indian women's health program. At the same time, more must be done in the near term to help those women who are at greatest risk.

Adolescent↗