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PubMedDate not supplied

Assessment of the effect of training on management of acute diarrhoea in a primary health care setting.

Health care providers were trained to treat patients with acute diarrhoea using WHO-recommended oral rehydration therapy (ORT) in a rural area of Haryana, India. One year after the completion of the training programme, the diarrhoea management practices of these trainees were observed while they were treating 240 children with acute diarrhoea. The patients were treated by 12 Multipurpose Health Workers (MPHW), 12 Community Health Guides (CHG), and 11 childcare volunteers, called Anganwadi Workers (AWW), in 12 randomly selected villages. In addition, 9 doctors practising in Primary Health Centres and in a 50-bed hospital were also studied. The assessment of patients on the basis of the history of illness taken and the results of physical examinations varied significantly between the various health functionaries. Doctors assessed dehydration in 80% of patients, MPHWs in 65%, CHGs in 60% and AWWs in only 45% of patients (p less than 0.05). Oral rehydration solution (ORS) was given to every case. However, anti-microbial and anti-diarrhoeal drugs were used at a significantly higher rate by doctors than by other functionaries (p less than 0.05). The method of ORS preparation was explained to most (85-90%) of the parents by all types of functionaries but the quantity to be given to the child was told by doctors to 67%, MPHWs to 60%, CHGs to 63% and AWWs to only 43% of patients. Advice on feeding normal food during diarrhoea was either not given or restrictions to food intake were suggested by all types of functionaries. However, continuation of breast feeding during treatment was advised by all types of functionaries for the majority of patients.

Acute Disease↗
PubMed1998

Socioeconomics of a global leprosy eradication programme.

In the absence of evidence in the literature on cost factors in the management of leprosy, a reference is made to the sporadic attempts to study costs of case detection and treatment. Such studies indicate that in the currently declining phase of leprosy endemicity, employing a conventionally trained, salaried class of paramedical staff for field surveys is prohibitively expensive if cost per case detected is computed. Involving primary healthcare and community derived workers is cost effective. Likewise, short course chemotherapy with newer drugs under trial, administered under supervision by community volunteers, reduces the expenses considerably. Community-based disability services using inexpensive tools may cut costs by 90%. Operational research on cost effectiveness of rehabilitation comparing 'integrated' with 'vertical' approaches is, unfortunately, still in a primitive stage. It is urged that in view of the changing logistics, manpower costs and financial implications should be given serious consideration by health planners. Post-elimination problems such as: (i) unearthing hidden cases; (ii) community-based supervised treatment with highly promising newer drugs; (iii) identification of reactions and relapses; and (iv) field management of disabilities resulting from acute and silent neuritis etc could be solved in a much cheaper manner. Integration of leprosy into general healthcare services and community-based rehabilitation of leprosy patients along with those disabled by other diseases will be the major task in future as these procedures are expected to reduce management costs and eliminate stigma.

Animals↗
PubMedDate not supplied

Fatal dysentery in rural Bangladesh.

The purpose of this study was to find out the actual circumstances which lead to dysentery-related deaths in the rural Bangladesh. The Community Health Workers of the International Centre for Diarrhoeal Disease Research, Bangladesh have been collecting records of all deaths at the rural area of Matlab through a surveillance system since 1963. A review of existing data on dysentery-related deaths from this area during 1976-1981 suggests that deaths in children followed a recurring seasonal pattern with an increase during the post-monsoon season of August-November of each year. This seasonal pattern of death was not evident among adults. The overall dysenteric death rate during 1978-1981 was 13.3 per 10,000 population per year. The highest rates were in patients of the two extreme age groups. Deaths reported recently by the health workers were re-investigated. Although the causal agents producing fatal dysentery in most patients in the community remained unidentified, it was likely to be species of Shigella in childhood deaths. To identify clinical determinants of a fatal outcome, a case-control analysis was done with patients hospitalised with dysentery in 1980. The risk factors shown to be significantly associated with deaths were: longer median duration of illness (p = less than 0.001), female sex (p = 0.039), signs of respiratory infection (p = less than 0.001) and severe malnutrition (p = 0.002).

Bangladesh↗
PubMed2005

The role of the social worker in the face of terrorism: Israeli community-based experience.

Terrorism and its aftermath have become part of the Western way of life, and social workers have a central role to play in helping affected families and their communities. Drawing on community-based experience in Israeli communities, the authors examine the planning of multidisciplinary teams and how their planning was put into effect in their communities in several terrorist attacks. The authors use reports of social workers, community volunteers, and clients to map the phases of the activity, the roles and goals of the social workers with different focal systems during the phase stages, and the tasks that the social workers carried out.

Community Health Planning↗
PubMed2007

Bringing the community in: partnerships for aging enrichment.

Aging enrichment of undergraduate social work curricula ensures that program graduates will be prepared to practice with older adults. This article reports the results of focus group research that was designed to engage social workers from community agencies serving older adults in preparing students to become "aging-savvy" social workers. The workers highlighted the importance of wide-ranging exposure to older adults, the changing needs of older adults, and the importance of increasing students' comfort with self-determination. These findings informed the program's ongoing curricular transformation process through the incorporation of new assignments that enabled increased contact with older adults in a variety of settings.

Aged↗
PubMed1999

Stimulating community participation in a group of farm workers using action research.

This study assessed whether community participation in health related activity was a reality or just popular development rhetoric. Using action research methodology, focus group discussions and informal contacts were made with farm workers consisting of twelve families in Umkomaas, south of Durban in the province of Kwa Zulu Natal. The aim was to establish whether this community could be actively involved in all aspects of community participation. The level of participation was described using Rifkin's model (Rifkin et al, 1988). Results of this study revealed that the community was able to identify their own health problems, prioritize them and plan appropriate strategies to meet the needs identified.

Aged↗
PubMed2005

Gender and snow crab occupational asthma in Newfoundland and Labrador, Canada.

Fish and shellfish processing employs many thousands of people globally, with shellfish processing becoming more important in recent years. Shellfish processing is associated with multiple occupational health and safety (OHS) risks. Snow crab occupational asthma (OA) is work-related asthma associated with processing snow crab. We present a gender analysis of findings from a 3-year multifaceted study of snow crab OA in Newfoundland and Labrador, Canada. The study was carried out in four snow crab processing communities between 2001 and 2004. An anonymous survey questionnaire on knowledge, beliefs, and concerns related to processing snow crab administered to 158 workers attending community meetings at the start of the research found that women were significantly more likely than men to associate certain health problems, especially chest tightness, difficulty breathing, and cough, with crab processing (P<0.001). Worker health assessments carried out with 215 processing workers (187 current/28 former; 120 female/95 male) found that female participants were more likely to be diagnosed as almost certain/highly probable snow crab OA and allergy (P=0.001) and to be sensitized to snow crab (P=0.01) than male participants. Work histories from the health assessments were used to classify processing jobs as male or female. Allergen sampling (211 allergen samples: 115 area, 96 personal breathing zone) indicated that the plant areas where these male jobs were concentrated were associated with lower levels of aerosolized crab allergens (the agents responsible for OA to snow crab) than areas associated with female jobs. This difference was statistically significant in the two plants with poor ventilation (p<0.001 and P=0.017 for these plants). A gender analysis of work history data showed that female health assessment participants were likely to have worked longer processing snow crab than males (5 years versus 3.5 years, respectively). Cross-referencing of work history results with allergen sampling data for male and female job areas showed a gender difference in median cumulative exposures (duration of exposure x level of exposures) for health assessment participants. Health assessment participants with estimated higher median cumulative exposures were more likely to receive a diagnosis of almost certain/highly probable OA and allergy. Semistructured interviews with 27 health assessment participants (24 female/ 3 male) with a diagnosis of almost certain/highly probable or possible snow crab OA indicated that these workers can experience substantial quality of life impacts while working and that they seek to reduce the economic impact of their illness by remaining at their jobs as long as possible. Indications of selection bias and other study limitations point to the need for more research exploring the relationship between the gender division of labor and knowledge, beliefs, and concerns about snow crab processing, as well as gender differences in prevalence, quality of life, and socioeconomic impact.

Animals↗
PubMed2002

Training peer counselors to promote and support exclusive breastfeeding in Bangladesh.

Exclusive breastfeeding is rare in Bangladesh. About 90% of women have home deliveries, so the Baby-Friendly Hospital Initiative has no mechanism to reach them. Mother support groups do not exist, and community health workers do not have time to promote and support exclusive breastfeeding. To provide this kind of support at the community level, an area in Dhaka was selected for a peer-counseling intervention program. Using certain selection criteria, 1 woman from each community was trained as a peer counselor. The training was based on the World Health Organization/United Nations International Children's Emergency Fund 40-hour breastfeeding counseling course and related books. Counseling skills were taught using demonstrations and role play, followed by practical training in the project area. The intervention was very successful, as 70% of the mothers in the project area breastfed their infants exclusively for 5 months compared to only 6% in the control area. The authors describe the peer counseling training, strategies used for peer counseling visits, and lessons learned.

Bangladesh↗
PubMed1997

Pesticide use, exposure, and risk: A joint Israeli-Palestinian perspective.

The major predictors of health risk from pesticide exposure are quantity and toxicity of pesticides reaching end-users, field workers, and persons (including children) with casual and indirect exposures to field and food residues, drift, and contaminated groundwater. Past work in Israel and the Palestinian National Authority has documented risks for acute poisoning, daily illness, transient neurotoxic effects, and potential cancer hazards in workers, populations exposed to pesticide drift, and the general population. Risk assessment predicts that reduction in use of agents with high toxicity and pesticide substitution are desired strategies for achieving the largest reductions in risk, but successful implementation and program sustainability depend on maintaining crop yield and increasing farmer earnings. A joint pilot Israeli-Palestinian-NGO program aims to determine whether crop yields and profits can be sustained while reducing pesticide use, promoting integrated pest management, and restricting ecosystem damage. The project involves six components: (1) assessments of health risk and crop yield in relation to pesticide use and exposure; (2) training health-agricultural teams to introduce and evaluate crop growth and managements with reduced pesticide use; (3) tracing and stopping import and trade in banned or restricted pesticides; (4) restricting child labor; (5) promoting information delivery and worker and community right-to-know and right-to-act; and (6) establishing a uniform regional standard for protection of workers and the general public. Preliminary evidence (organochlorines and breast cancer, organophosphates and illness in field workers) indicates that (1) a reduction of use is the foremost determinant of a reduction in health risk; (2) cotton yield can be increased despite a reduction in pesticide use (organophosphates); and (3) a reduction in pesticide use (organophosphates and organochlorines) has to be part of a crop rotation program for food crops timed to seasonal fluctuations in supply, demand, and crop price.

Agricultural Workers' Diseases↗
PubMed2004

Community genetic services in Latin America and regional network of medical genetics. Recommendations of a World Health Organization consultation.

The World Health Organization sponsored a Consultation on Community Genetic Services and a Regional Network of Medical Genetics in Latin America in Porto Alegre, Brazil, on June 19, 2003. The main recommendations of the meeting included: (a) the call for government funding of services, research and education in medical genetics; (b) the conduct of epidemiological research on the prevalence and types of birth defects, genetic disorders and genetic predispositions to common diseases; (c) the education of health professionals in genetics; (d) the education of genetic professionals in community health and public health genetics; (e) the fostering of interactions between clinical geneticists, public health personnel, primary health care workers and community organizations, and (f) a better planning of regionalized services to avoid duplication and inefficiency.

Community Networks↗
PubMed2002

Exploring the community response to a randomized controlled HIV/AIDS intervention trial in rural Uganda.

Investigators need, both for ethical and methodological reasons, to consider the acceptability of their intervention to the study population. We explored the response to a community-based randomized controlled trial (RCT) of an HIV/AIDS behavioral change intervention in rural Uganda. The views of field-workers, trial community, nongovernment organization representatives, and religious leaders were explored via focus groups (13) and interviews (45). The results suggest that the components of the intervention valued by the community are not necessarily those prioritised by trial implementers. Specifically, prevention activities appear to be valued less than material assistance. Furthermore, universal acceptance of the trial is probably unattainable. For these reasons, sensitive mobilization, respect for community members and their appointed leaders, and ongoing communication is essential. We suggest that evaluations of process be regarded as essential to the conduct of community-based RCTs and highlight the need for appropriate evaluation indicators to facilitate this.

Attitude of Health Personnel↗
PubMed1996

Training to meet the needs of the communicatively impaired population of South Africa: a project of the University of the Witwatersrand.

At a time when South Africa is in the throes of transition, ideologies in the educational, medical, economic and social spheres are being redefined and redirected. The field of speech pathology and audiology is no exception. The Department of Speech Pathology and Audiology, University of the Witwatersrand has acknowledged an urgent need to address the requirements of a multilingual and multicultural South Africa and extend training beyond the white middle-class population. It is the responsibility of the training institutions to redirect the objectives of their curricula in order to meet these needs. This paper describes the changes introduced by the Department. These include teaching of community work principles and primary health care to the speech and hearing therapist, and the training of personnel for an alternative form of service, such as the community speech and hearing worker (CSHW) and the community-based rehabilitation worker (CBRW).

Community Health Services↗
PubMed1999

Health professionals' perspectives on service delivery in two Northern Ireland communities.

This research builds on the findings of an ethnographic study of health inequalities in two small, rural communities in Northern Ireland. Through further analysis of existing data, this second study aimed to explore health professionals' perspectives on issues of service delivery relevant to government policy on primary care. Anthropological fieldwork was conducted for two consecutive 4-month periods during 1995 and 1996 in one predominantly Catholic and one predominantly Protestant town. To preserve confidentiality, the locations have been given the pseudonyms, respectively, of Ballymacross and Hunterstown. Research tools included fieldwork journals and a fieldwork diary, meetings with key informants, tape-recorded interviews, group discussions, participant observation and use of secondary material such as census data, local newspapers and community health profiles. Interviews with 15 health workers revealed that there was not a coherent approach to achieving health gain, little collaborative enterprise and minimal interaction between the different professional groups. The National Health Service (NHS)-employed primary care professionals, more than local community workers, appeared to be demoralized, exhausted and suspicious of the business-orientated health service. In this respect, the primary care-led NHS appeared not to be working. It is concluded that a shared health agenda should be developed by NHS-employed primary care professionals and local community workers to create a health-inducing environment at community level. This needs to be complemented by the establishment of formal mechanisms for inter-agency working at local, professional and government levels.

Community Participation↗
PubMedDate not supplied

Beyond supply: the importance of female family planning workers in rural Bangladesh.

Using participant observation data on worker-client exchanges from Bangladesh, this article examines the interface between a government family planning program and the rural women it serves. Case material focuses first on the program function typically identified in the literature: meeting unmet demand for contraception by providing convenient supply. Functions that have been less recognized are then illustrated: (1) the worker's role in reducing fear of contraceptive technology; (2) her effort to address religious barriers, child mortality risks, and high fertility preferences; and (3) her role in mobilizing male support. The range of functions performed by the female family planning worker in the cases discussed here demonstrates that her role transcends the boundaries of what is conventionally implied by the concept of supply. She acts as an agent of change whose presence helps to shift reproductive decision-making away from passivity, exposing women long secluded by the tradition of purdah to the modern notion of deliberate choice.

Bangladesh↗
PubMed1999

Growth monitoring: family participation: effective community development.

Growth monitoring was introduced into most developing countries in the 1970s with the aim of combating under nutrition in infancy and childhood. Ten years later analysis showed weight charts were not completed satisfactorily and not used in decision making. Although growth monitoring is now seldom mentioned in nutrition studies, the authors of this study are convinced of its value. With new technology using the direct recording scales (DRS), illiterate or semi-literate mothers are able to complete the growth curve on the weight chart and acquire understanding about the process and its significance for their infant. This study investigates the understanding of the growth curve by the rest of the family. The mother, their daughters and significantly, the grandmothers were shown to have comprehended the meaning of the growth curve. In families where mothers weighed their infant using the DRS, a smaller proportion were found to be suffering from periods of growth failure compared with families where the infant was weighed by community health workers with a dial scale. There are obvious gains if technologies are moved from the clinic into the family and the community. The weighing and charting of children by DRS may be a further step in the fight to overcome undernutrition in developing countries.

Adolescent↗
PubMed2000

[Concentration of serum vitamin C in workers exposed to selected physical and chemical risk factors].

Determination of the serum vitamin C levels may yield the information on the nutritional status of workers. Increasing community awareness of the health-enhancing nutrition patterns as an element of the promotion of lifestyles conducive to health among workers may limit a negative impact of risk factors on workers' health. The aim of this study was to analyse the levels of serum vitamin C in workers exposed to selected physical (noise, electromagnetic fields) and chemical risk factors present in the work environment. Two randomised groups of male workers, one exposed to physical factors (n = 43; mean age 39.5 +/- 8.6 yr.), and the other to chemical factors (n = 40; mean age 38.3 +/- 8.0 yr.) were included in the study. The control group was composed of male workers (n = 36; mean age 40.4 +/- 10.1 yr.) exposed neither to physical nor to chemical factors. In all subjects, the serum vitamin C levels were measured using the spectrophotometric method by Kyaw. The mean serum vitamin C levels in the workers exposed to physical and chemical factors were 30.1 (mumol/l) and 30.9 (mumol/l), respectively, and their statistical significance was lower (p < 0.01) as compared with the mean serum vitamin C levels of 39.7 (mumol/l) in the control group.

Adult↗
PubMed2002

HIV counselling and testing in rural Uganda: communities' attitudes and perceptions towards an HIV counselling and testing programme.

Study results on the assessment of a community-wide HIV counselling and testing programme are presented. The aim of this qualitative study was to elucidate whether HIV counselling and testing (HIV CT) was acceptable to a rural community and whether they expressed a need for it. From a total of 2,267 persons of Kigoyera Parish, western Uganda, who were HIV tested and counselled, 171 persons participated in 17 focus group discussions. Most participants expressed a strong need for HIV counselling and testing services. The counsellors were seen as competent and confidential. Community health workers were favoured as the preferred provider of HIV CT services. However, participants stressed that they should not come from the same community. Most participants felt that a HIV CT programme available only once is not enough and did not induce a change in sexual behaviour, e.g. increased condom use. They requested counselling services that are continuously offered. The study results also showed that there is a demand for HIV counselling services without being HIV tested.

Adult↗