Health education and training of leprosy field workers.
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Community Health Workers↗
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Indian mental health: changes in the delivery of care in northwestern Ontario.
For ten years University of Toronto psychiatrists have made regular visits to isolated Indian villages in remote Northwestern Ontario, offering a clinical psychiatric program. Initially, two non-Indian social workers provided ongoing service between the psychiatric visits. Recognizing the difficulty in providing psychotherapy cross-culturally, the members of the treatment team developed the skills of local persons who were not formally trained in the treatment of mental health problems. The paper describes a significant shift in the psychiatric program beginning in 1981. At that time in certain communities local people took over the service, resulting in an increased ability to provide a preventative psychiatric program. Community based workers have dealt more with early marital difficulties, grief reactions, transitional depressive states, and less with major mental illnesses. In the areas which have community based treatment teams, the emphasis in psychiatric service is shifting from direct clinical work to formal teaching and case consultations with the indigenous counsellors. The evidence indicates optimism that the service is reaching more persons before the emergency stage than it did in previous years of the program.
Community Mental Health Services↗
Home management of childhood diarrhoea in southern Mali--implications for the introduction of zinc treatment.
Diarrhoea remains one of the leading killers of young children. A recent meta-analysis demonstrated that a two-week course of zinc tablets once daily significantly reduces the severity and duration of diarrhoea and mortality in young children (Bhutta et al., 2000. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: Pooled analysis of randomized controlled trials. American Journal of Clinical Nutrition, 72(6), 1516-1522). Formative research is being conducted in a number of countries to prepare for the large-scale promotion of this new treatment. In-depth and semi-structured interviews with parents, community health workers, and traditional healers were conducted to examine the household management of diarrhoea in the Sikasso region of southern Mali in preparation for the introduction of a short-course of daily zinc for childhood diarrhoea at the community level. Supporting data from a subsequent household survey are also presented. Although nearly all parents knew oral rehydration solution (ORS) could replace lost fluids, its inability to stop diarrhoea caused parents to seek antibiotics from local markets, traditional medicines or anti-malarials to cure the illness. The notion of combining multiple treatments to ensure the greatest therapeutic benefit was prevalent, and modern medicines were often administered simultaneously with traditional therapies. As parents often deem ORS insufficient and judge that an additional treatment should be combined with ORS to cure diarrhoea, the concept of joint therapy of zinc and ORS should be well accepted in the community. Mothers-in-law and fathers, who play a significant role in decisions to seek treatment for sick children, as well as traditional healers, should also be considered when designing new programs to promote zinc. Similarities with formative research conducted for a previous generation of diarrhoea control programmes are discussed.
Child Welfare↗
Dental health promotion in a group of children at high risk to dental disease.
Three hundred and ten children from three schools were examined before and after a dental health promotion program targeted at one of the schools. Parents of subjects at the experimental school were visited at home by a community health worker who provided individualized information on dental services and preventive strategies. Parents of subjects at the control school were provided with similar information by way of general written documentation, not tailored to specific needs, and distributed as part of the traditional school take home system. The experimental hypothesis proposed that, at re-examination, subjects from the experimental school would show a measurable improvement in caries increment, and a reduced plaque index over subjects from the control schools. Although the individualized social intervention strategy did not demonstrate a major shift in use of dental services or improvement in health status some improvement in caries experience was obtained in the target group. The multifactorial nature of dental disease and the limited contact of the health worker with the families involved would account for the low success rate of this strategy.
Australia↗
Acceptability of community and health facility-based directly observed treatment of tuberculosis in Tanzanian urban setting.
SETTING: An urban district in Dar es Salaam, Tanzania. OBJECTIVE: To assess the acceptability of community and health facility-based direct observation of treatment (DOT) of tuberculosis (TB) patients in Temeke district. DESIGN: Both quantitative and qualitative study methodologies were used. Eight focus group discussions were carried out with TB patients, treatment supporters, health workers and community members. Quantitative study was also carried out among TB patients and treatment supporters. RESULTS: A total of 268 patients and 103 treatment supporters were enrolled in the study. The majority of the patients (75%) were satisfied with the DOT options they received. Males were more satisfied with community-based DOT (84%) than females (67%) (OR 4.96, 95% CI 1.38-17.86). The majority (81%) were willing to supervise another TB patient. The results of the qualitative study demonstrated that community-based DOT was preferred because it was found to be convenient, reduced costs, saved time of the patients and reduced workload in health services. The main challenge of community-based DOT was to ensure effective supervision and monitoring of patients and treatment supporters in the community. CONCLUSION: The results from the quantitative and qualitative studies indicate that both DOT options were acceptable. The study has also identified key challenges and opportunities for effective implementation of community-based DOT interventions that are relevant, sensitive and acceptable to the population. Community-based DOT is a viable option and can complement and strengthen the existing health facility-based DOT, especially in countries like Tanzania where the health system is overwhelmed with increasing number of TB and HIV/AIDS patients.
Adult↗
The scope of guidelines to prevent healthcare-associated infections.
As care is increasingly delivered in the community rather than acute settings, there has been concern that this might be accompanied by a rise in healthcare-associated infection. Consequently, the National Institute for Clinical Excellence (NICE) has commissioned a set of infection prevention guidelines for healthcare workers in community and primary care. The guideline developers were anxious to concentrate this guidance on the areas of most concern to practitioners, particularly in relation to devices. This article describes how a survey and focus groups were employed to identify the areas for guideline development, namely standard principles, long-term indwelling urinary catheters, enteral feeds and central intravascular devices.
Community Health Services↗
Dental self-care and dietary characteristics of remote-living Indigenous children.
INTRODUCTION: Indigenous children in remote communities carry a disproportionate amount of the dental disease burden among Australian 4-12 year-olds. However, there have been no reports of dental service use, dental self-care or dietary characteristics among remote-living Indigenous children. This information may provide insight into behaviours linked with the high levels of dental disease observed. The purpose of this study was to examine such behaviours among Indigenous children in three remote communities in the Top End of the Northern Territory of Australia. The study is part of a wider investigation involving the implementation and monitoring of water fluoridation plants in two of the communities, and the collection of clinical dental data from children in these three and other remote communities. METHODS: In 2003, small-scale fluoridation plants were installed in two remote communities (Communities A and B) in the Top End of the Northern Territory with naturally low fluoride levels in the water and with a high prevalence of child dental disease. Another community (Community C) was selected as a comparison site (natural levels of water fluoride low). A convenience sample of carers of children from all communities completed a questionnaire that sought information on carer education and their children's age, sex, use of dental services, dental self-care behaviours, dietary characteristics, household water source and water consumption. The questionnaires were administered by a project worker and community residents once consent had been obtained. Data were analysed using SPSS version vers.13.0 (SPSS Inc; Chicago, IL, USA). RESULTS: Some 214 carers completed the questionnaire for 409 children aged 4-12 years; 131 (32.0%) from Community A, 158 (38.6%) from Community B and 120 (29.3%) from Community C. The response rates for the child survey based on Census data (generally regarded as an undercount) was 55% across the three communities. Approximately one-third of carers had had no secondary schooling or could not recall their level of educational attainment. Child age was reasonably spread over the target age-range and there were no significant differences between communities by sex. Approximately one-third of children were reported to have had their teeth checked every year by a dental therapist and most children were reported to use a toothbrush. While most children were also reported to use toothpaste, only 20% of such children reportedly used it every day. Time of toothpaste use was evenly distributed between morning and evening, with a small proportion of children reportedly using it twice a day. The most common age that toothpaste use began was 4 years and most children had never taken fluoride supplements. Over three-quarters of children who reportedly consumed softdrinks, cordial, milk or flavoured milk in the evenings drank such beverages at least a few evenings each week. Over 90% of children across the three communities who reportedly drank tea, and approximately three-quarters of those who consumed sweet snacks, did so at least a few evenings each week. Almost all houses were connected to the community water supply. Most children sourced their drinking water from a tap and approximately two-thirds were reported to drink more than 4 cups of water a day. CONCLUSIONS: Our study showed there were low levels of preventive dental care, irregular use of dentrifices, negligible implementation of alternative fluoride sources, high consumption of sweetened snacks and drinks in the evenings, and almost universal connection of houses to the public water supply among remote-dwelling Indigenous children. The findings provide some insights into factors contributing to the poor and declining state of such children's dental health, and should aid in the planning and implementation of oral health promotion initiatives.
Adolescent↗
Overview of biomedical waste management in selected Governorates in Egypt: a pilot study.
Inadequate management of biomedical waste can be associated with risks to healthcare workers, patients, communities and their environment. This study was conducted to assess the handling and treatment of biomedical waste in different healthcare settings in Egypt. Five hospitals and ten primary healthcare settings were surveyed using a modified survey questionnaire for waste management. This questionnaire was obtained from the World Health Organization (WHO), with the aim of assessing the processing systems for biomedical waste disposal. Researchers found that biomedical waste is inadequately processed in hospitals and primary healthcare settings due to the absence of written policies and protocols. Accordingly, healthcare staff, patients, the community and the environment may be negatively affected by exposure to the hazards of biomedical waste. The development of waste management policies, plans, and protocols are strongly recommended, in addition to establishing training programs on proper waste management for all healthcare workers.
Egypt↗
[Maquiladoras and women on the US-Mexican border: a benefit or a detriment to occupational health?].
This article examines the impact of work conditions on the health of women working in assembly plants known as "maquiladoras". A sample of 480 women residing in Tijuana and with similar low socioeconomic conditions was studied. The sample included 120 electronics workers, 120 textile workers, 120 service workers and 120 women with no history of labor-force participation. These groups were compared on physical and psychosocial health outcomes, including depression, nervousness, functional impediments and sense of control over life. Data were obtained from interviews conducted in the communities where workers reside. Although high levels of depression and a low sense of control over life was observed, maquiladora workers--particularly in the electronics industry--suffered less functional impediments and nervousness than service workers. However, maquiladora workers were at higher risk of delivering infants of low birthweight.
Adolescent↗
Role of community programs in controlling blood pressure.
Despite more than 30 years of intense activity to improve control--and more recently prevention--high blood pressure continues to be a major public health problem. Evidence-based reviews have identified best practices and quality improvement strategies to address prevention and control. Since the 1970s, community-based programs have been instrumental in raising awareness, increasing knowledge, and promoting changes in health behavior to improve blood pressure control. Most of these programs have emphasized the use of partnerships and involvement of community residents in conducting screening and referral activities, implementing clinical practice guidelines, and increasing healthy eating and physical activity. Many also have used health care team approaches, including the use of trained community health workers to deliver targeted, culturally sensitive heart health education, particularly related to the prevention of cardiovascular disease risk factors in general and high blood pressure in particular. Increased focus on implementation of evidence-based lifestyle and clinical management strategies coupled with community-based approaches may help increase blood pressure control rates within communities.
Blood Pressure↗
Role of traditional health workers in prevention and control of AIDS in Africa.
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Acquired Immunodeficiency Syndrome↗
A preliminary study of reproductive outcomes of female maquiladora workers in Tijuana, Mexico.
Maquiladoras are plants on the Mexican side of the United States-Mexico border which are used largely by U.S. manufacturers to assemble premanufactured parts. We examined reproductive outcomes of women employed in electronics (N = 120) and garment (N = 121) maquiladora work compared to women employed in the service sector (N = 119) in Tijuana, Mexico. Women recruited by community health workers were interviewed about their reproductive history, sociodemographic characteristics, health behaviors, and characteristics of their current job. Length of regular menstrual cycle in the past year as well as time of conception and rates of fetal loss in the most recent pregnancy were similar across occupational groups. However, infants of garment maquiladora workers were 653 g lighter (95% confidence interval [CI]: -1,041 g, -265 g) and infants of electronic maquiladora workers were 337 g lighter (95% CI: -682 g, 9 g) than infants of service workers after adjusting for potential confounders. The cause of these differences remains unclear.
Abortion, Spontaneous↗
Family dynamics and child abuse and neglect in three Finnish communities.
The purpose of this study was to describe family dynamics of Finnish families in which there is abuse or neglect of a child in that family. One adult from 41 families with recognized child abuse/neglect completed the Family Dynamics Measure II (FDM II) consisting of six dimensions of family life, and answered questions about problems, changes and illnesses. Nurses and social workers in community health care and social agencies identified potential subjects in their agencies and collected data. Four of the six dimensions of the FDM II reached statistical significance (p =.05) with child age and number of children, education, marital status, and age of respondent. They are: Flexibility vs. rigidity, Stability vs. disorganization, Clear vs. distorted communication, and Role reciprocity vs. role conflict. FDM II is useful in identifying several of the less positive family dynamics dimensions in abuse:neglect families. Conclusions for clinical management cannot be drawn at this time.
Adolescent↗
Integrating health and social care: implications for joint working and community care outcomes for older people.
In England, the theme of promoting collaborative working between social and primary health care remains high on the policy agenda. The underlying assumption, largely untested, is that a greater degree of structural integration benefits service users. This paper reports the findings from a feasibility study comparing two models of joint working and examining the relative impact of personal characteristics, service use and co-location on the likelihood of older people remaining in the community. Baseline standardised interviews with 79 older people aged 75 + with complex needs in two social services departments were carried out following referral, covering social circumstances, physical and mental health and services received, with follow-up interviews after six months. Contacts between social workers and primary care were tracked. The findings suggest that co-location does not necessarily lead to substantially closer interprofessional working in terms of greater contact between social workers and GPs or social workers and community nurses. Factors affecting outcome were degree of cognitive impairment, intensity of home care received and whether the older person lived alone. Whatever the model of collaborative working, its effects on remaining in the community must be assessed in the wider context of the characteristics and services received by older people.
Aged↗
Support for teenage mothers: a qualitative study into the views of women about the support they received as teenage mothers.
AIM OF THE STUDY: To gain insight into the support teenage mothers received during pregnancy, birth and their child's pre-school years and young women's perceptions of the usefulness of a support group for teenage mothers. BACKGROUND: Most qualitative studies have focused on teenage mothers around the time of the birth of their first child. For this study, women were recruited several years after the birth (median 8.5 years), so that they would have had time to reflect on the support they had received. DESIGN: The qualitative method of semi-structured interviews was chosen to obtain in-depth information and to allow teenage mothers' own views to be heard. Ten individual interviews and one paired interview were undertaken. FINDINGS: Recruitment was difficult because taking part in research was not a priority for many of the women. The study confirmed the strong link between deprivation and teenage pregnancy found in other studies, and suggested that mental health problems in teenage mothers may be more difficult to detect. Teenage women need more information on mental health and on services available to them. The fear, expressed by some of the women in this study, of becoming different from other women in their social network should be considered by health workers when establishing intervention programmes. CONCLUSIONS: Professional bodies of health workers should lobby government to provide a minimum standard of living and sufficient child-care to combat deprivation. Former teenage mothers should be involved in the recruitment, planning and implementation stages of research and interventions. Health professionals should be aware that mental health problems in teenage mothers may be particularly difficult to detect. Key community health workers or a support group may provide information on services, mental health and education facilities available that would benefit teenage mothers. A support group may also give emotional support.
Adolescent↗
A neighborly way to reduce Medicaid costs.
One of the keys to controlling the costs of Medicaid managed care patients is to treat them before they become ill. Richard Frye, Ph.D., profiles the Community Health Worker Outreach Program in Baltimore, which trains residents of neighborhoods with high numbers of Medicaid beneficiaries how to teach their chronically ill neighbors about improving their health.
Baltimore↗
Measles outbreak in a northern Pakistani village: epidemiology and vaccine effectiveness.
In the spring of 1990, local community health workers reported a measles outbreak in several partially vaccinated villages in the Punial Valley in northern Pakistan. The authors conducted an investigation in one of these villages to assess vaccine coverage and vaccine efficacy and to describe the patterns of measles outbreaks that prevailed in this community. The results of a survey of the entire village revealed two major gaps in vaccine coverage: the small minority Sunni community and children over 3 years of age. Vaccine efficacy was estimated to range from 73 to 90% but was markedly reduced in children who were vaccinated under 12 months of age. The occurrence of an outbreak in a community in which a relatively new vaccination program is primarily directed at younger children has been predicted by theoretical models of measles dynamics and is consistent with the experience of other vaccination programs in the developing world. These observations suggest that, in some areas of the developing world, the age groups targeted to receive measles vaccinations may need to be broadened to ensure adequate coverage to prevent recurrent outbreaks.
Adolescent↗
Setting standards for monitoring the performance of primary care personnel--outreach workers.
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Child↗