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PubMed1990

A mobile HIV education, counseling, and testing unit: a pilot initiative.

In May and June, 1989, the Hartford (CT) Health Department piloted a mobile educational unit, the "HIVan," which also included an HIV counseling and testing component. The intent of this initiative was to reach African-American and Latino communities, and intravenous drug users (IVDUs) and sex workers, all communities at demonstrated risk for HIV infection in Hartford. Results indicate a high degree of success in reaching the targeted communities with the HIVan with HIV counseling and testing: 95.2% of the HIVan clients were African-American or Latino, 59.2% were IVDUs. Of 79 persons tested on the HIVan seroprevalence was 26.5%, almost five times that of the primary clinic site. Return for posttest counseling and results is currently low (20.2%), but will be monitored over time, as the rate of return for results increases over time. A recommendation is made to find and implement similar mobile initiatives in communities where at-risk persons are reluctant to enter a clinical setting.

AIDS Serodiagnosis↗
PubMed2005

Are separate standards for occupational and environmental exposures good public health policy?

Occupational and environmental exposures are treated as distinct entities for the purpose of public health protection. Yet workers and community members may experience the same exposures simultaneously or within a very narrow time frame. Agricultural chemicals applied by workers in the field drift into residential communities. Chemicals may be carried from a work site, with or without physical boundaries, into the home and delivered to household members. Meteorological conditions transport agricultural chemicals or stored ashes to residential communities during and after the work day. Occupational standards generally allow a higher level of exposure to workers than environmental standards allow for community exposures. For some chemicals, standards exist for only one exposure group, thus leaving the other exposed group without protection. The distinction between occupational and environmental exposures assumes the identification of specific human activities as work or non-work. However, not all human activity falls clearly into one specific category. The strict separation of occupational and environmental exposures therefore renders public health protection of all exposed people difficult to achieve. An in-depth discussion about the factors and assumptions that are used when occupational and environmental standards are separately applied to exposed populations is needed to enhance the public health of all people.

Journal Article↗
PubMed2005

Scaling up integrated management of childhood illness to the national level: achievements and challenges in Peru.

This paper presents the first published report of a national-level effort to implement the Integrated Management of Childhood Illness (IMCI) strategy at scale. IMCI was introduced in Peru in late 1996, the early implementation phase started in 1997, with the expansion phase starting in 1998. Here we report on a retrospective evaluation designed to describe and analyze the process of taking IMCI to scale in Peru, conducted as one of five studies within the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE) coordinated by the World Health Organization. Trained surveyors visited each of Peru's 34 districts, interviewed district health staff and reviewed district records. Findings show that IMCI was not institutionalized in Peru: it was implemented parallel to existing programmes to address acute respiratory infections and diarrhoea, sharing budget lines and management staff. The number of health workers trained in IMCI case management increased until 1999 and then decreased in 2000 and 2001, with overall coverage levels among doctors and nurses calculated to be 10.3%. Efforts to implement the community component of IMCI began with the training of community health workers in 2000, but expected synergies between health facility and community interventions were not realized because districts where clinical training was most intense were not those where community IMCI training was strongest. We summarize the constraints to scaling up IMCI, and examine both the methodological and policy implications of the findings. Few monitoring data were available to document IMCI implementation in Peru, limiting the potential of retrospective evaluations to contribute to programme improvement. Even basic indicators recommended for national monitoring could not be calculated at either district or national levels. The findings document weaknesses in the policy and programme supports for IMCI that would cripple any intervention delivered through the health service delivery system. The Ministry of Health in Peru is now working to address these weaknesses; other countries working to achieve high and equitable coverage with essential child survival interventions can learn from their experience.

Child Health Services↗
PubMed2002

Community knowledge, attitude and practices regarding sexually transmitted infections in a rural district of Pakistan.

OBJECTIVE: To determine knowledge, attitude and practices regarding sexually transmitted infections in district Khairpur, Sindh, Pakistan. DESIGN AND METHODOLOGY: A needs assessment study employing a community based survey, key informant interviews and focus group discussions was conducted in all seven sub-districts of the district. This paper is based on the results of the key informant interviews and the focus group discussions. Thirty interviews and six group discussions were held with members of the community and with the health care providers. RESULTS: There was little awareness regarding causes and prevention of sexually transmitted infections in the community. The situation was slightly better among health care providers. While health care providers believed that the prevalence of sexually transmitted infections is high, the community did not consider themselves at risk. The community believed that these diseases are a problem among a sub-population of male adolescents, especially those who have homosexual relations. However, due to social norms, they rarely discussed such health problems with other family members or elders. Adolescents with any sexual health problems visit hakims and quacks. The community was aware about aetiology and some of the risk factors associated with AIDS and hepatitis, most probably due to the recent public health campaigns against both diseases. CONCLUSION: Considering the suspected high prevalence of sexually transmitted infections and the relative lack of knowledge, it is imperative that a public health intervention be initiated. This must include educating not only the community but also the health workers. The governments' initiative to train community workers in reproductive health is a step in the right direction.

Adolescent↗
PubMed2006

Community knowledge, attitude and practices regarding sexually transmitted infections in a rural district of Pakistan.

OBJECTIVE: To determine knowledge, attitude and practices regarding sexually transmitted infections in district Khairpur, Sindh, Pakistan. DESIGN AND METHODOLOGY: A needs assessment study employing a community based survey, key informant interviews and focus group discussions was conducted in all seven sub-districts of the district. This paper is based on the results of the key informant interviews and the focus group discussions. Thirty interviews and six group discussions were held with members of the community and with the health care providers. RESULTS: There was little awareness regarding causes and prevention of sexually transmitted infections in the community. The situation was slightly better among health care providers. While health care providers believed that the prevalence of sexually transmitted infections is high, the community did not consider themselves at risk. The community believed that these diseases are a problem among a sub-population of male adolescents, especially those who have homosexual relations. However, due to social norms, they rarely discussed such health problems with other family members or elders. Adolescents with any sexual health problems visit hakims and quacks. The community was aware about aetiology and some of the risk factors associated with AIDS and hepatitis, most probably due to the recent public health campaigns against both diseases. CONCLUSION: Considering the suspected high prevalence of sexually transmitted infections and the relative lack of knowledge, it is imperative that a public health intervention be initiated. This must include educating not only the community but also the health workers. The governments' initiative to train community workers in reproductive health is a step in the right direction (JPMA 52:21, 2002).

Journal Article↗
PubMed1990

Application of multiple methods to study the immunization programme in an urban area of Guinea.

During 1988-89, studies were conducted to evaluate the immunization system in Conakry, Guinea. The first, a health facility survey, found that health staff screened the vaccination status of only 30% of children who presented for curative care. A sterile syringe and needle were used for less than half of the injections. In the second survey, key informant interviews with vaccinators and health centre chiefs showed that there were minimal lines of communication between health workers and the community, but that health workers did not perceive this to be a problem. Focus group discussions in the community revealed a high level of general knowledge about vaccine-preventable diseases. However, mothers did not know how many vaccinations their children should receive or by what age they should be completed. They complained of long waiting times in health centres, the high costs of vaccination, poor rapport with health workers, and the occurrence of abscesses after vaccination. The final study, a "knowledge, attitudes, and practice" community survey, showed that missed immunization opportunities and inappropriately timed vaccinations reduced potential vaccine coverage by almost 30% among children with vaccination cards. Higher socioeconomic status, delivery in hospital, and whether mothers perceived the vaccinations to be affordable affected whether the child began the immunization series. Once a child had entered the immunization system, completion of the series was determined by the mother's education level, employment status, and experience with vaccination services.

Adult↗
PubMed1987

The effectiveness of parent aides in the tertiary prevention of child abuse in South Australia.

A parent aide program using volunteer experienced mothers to prevent reabuse of children (tertiary prevention) has been highly successful (97% prevention) in Southern Adelaide, South Australia. The program was modeled on that described by Kempe and widely used in North America. Only minor modifications have been required to establish the program in South Australia. The outcome of the first five years' experience indicates that, despite a work load of more than 20 hours per month per client, less than 10% of volunteer parent aides withdrew from their two-year commitment to the program. The cost-benefit ratio of the program appears very low and the prevention of reabuse by mothers involved was less than that for other clients assessed by the Southern Metropolitan Child Protection Panel, which referred all cases for a parent aide in the five-year period reviewed. Difficulties in maintaining the program did arise but were dealt with by close liaison between the parent aide, the program coordinators, and the primary care worker in the community who was usually a social worker in the Department for Community Welfare. The parent aide program has proved a cost-effective and successful method of tertiary prevention.

Child↗
PubMed1980

Community social work in a rural state.

This study of the social services offered in conjunction with a Veterans Administration facility in Maine clarifies the role of the community social worker in a rural state. The author discusses such factors as the objectives, methods, and duration of intervention as related to the residential status of the social worker's clients.

Community Health Services↗
PubMed2006

Cervical cancer services for Indigenous women: advocacy, community-based research and policy change in Australia.

Collaborative research undertaken in the state of Queensland, Australia, resulted in major changes in cervical cancer screening and treatment for Indigenous women. Guided by an Indigenous statewide reference group and with an Indigenous researcher playing a lead role, qualitative data were collected using interviews, focus groups, larger community meetings; and case studies were conducted with health workers and community members from diverse rural, remote and urban communities, to explore the different cultural and structural factors affecting understanding and awareness of cervical cancer and Indigenous women's use of and access to health services for screening, diagnosis and treatment. These data were supplemented by an analysis of clinical data and health service checklists. We discuss the methodology and summarize the key social and structural factors that discourage women from presenting for screening or returning for follow-up. These include women's misunderstanding of cervical cancer screening, fear of cancer, and distrust of health services, poor recall and follow-up systems, and the economic and social burden to women to presenting for treatment. We describe how the research process and subsequent activities provided Indigenous women with a vehicle for their own advocacy, resulting in important policy and program changes.

Community Health Planning↗
PubMedDate not supplied

[Training of community health aides in the subject of nutrition].

Struggling with nutritional diseases requires strategies to get through: the training of community health workers (C.H.W.) represents one among others. After strong arguments are made on whether or not these C.H.W. are relevant to support the community in an attempt to increase its nutritional status, some prerequisites are listed out according to certain criteria. In order to write down a complete training plan, an intervention model and a step by step approach are submitted. In developing technical and community organization skills, the C.H.W. is better off for being involved at the local level. Nevertheless information channel and the process of problem solving are keys important to consider for the C.H.W. in his social commitment, providing that concerned sectors and disciplines participate under health personnel initiatives.

Africa↗
PubMed1995

Yaws in Ecuador: impact of control measures on the disease in the Province of Esmeraldas.

OBJECTIVES: To determine the impact of a community-based programme of yaws control in Esmeraldas province in Ecuador. METHODS: Community health workers provided mass treatment and subsequent surveillance for the detection and treatment of new cases and their contacts over the period 1988 to 1993. Clinical and serological surveys were performed in the study area in 1988 and 1993. RESULTS: Over the 5 year observation period, the number of communities with active infections had decreased by 75%, from 20 communities in 1988 to 5 in 1993. In 1993, 4 communities were found free of clinical infections as well as latent infections. There was a corresponding decrease of 94.6% in the prevalence of dermal lesions (from 11.2% to 0.6%), and a reduction of 97.3% in latent infections (from 93.6% to 2.5%). CONCLUSIONS: The control of yaws using existing community-based health workers has proved very effective in Ecuador.

Adolescent↗