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PubMed2006

Community outreach, training, and research: the Hawai'i/Pacific Basin area Health Education Center of the University of Hawai'i, John A. Burns SChool of Medicine.

The Hawai'i/Pacific Basin AHEC is a federal grant program that utilizes academic/community partnerships to recruit students to health careers, train students in rural and underserved areas, and assist with workforce development across the region. Ongoing activities and programs include 1) Outreach for recruitment to health careers for students from kindergarten through adulthood; 2) Individual and interdisciplinary health professions student training in rural and underserved areas; 3) Community health education using distance learning; 4) Assessment of and efforts to improve recruitment and retention of providers in rural areas including continuing education; and 5) Health disparities research. The AHEC programs reach more than 4,000 individuals annually, helps to train more than 1,000 individuals a year and assist with placement of up to 20 providers a year in rural and underserved healthcare practices. This article describes the existing AHEC programs that are community based, community driven and inclusive of all who choose to participate. Collaboration is invited and necessary for success and future program development. Future areas for collaboration activities include increased statewide community health worker training, an expanded health careers pipeline, ongoing rural and underserved health needs assessments and an expanded training network for students in healthcare. Additional information is available at www.ahec.hawaii.edu.

Community-Institutional Relations↗
PubMed2004

Critical incidents of nonadherence with standard precautions guidelines among community hospital-based health care workers.

OBJECTIVE: To identify, categorize, and assess critical incidents of nonadherence to standard precautions. DESIGN: Qualitative and quantitative analysis of a written, mail-out survey. SETTING: Community hospitals. PARTICIPANTS: Statewide stratified random sample of community hospital-based health care workers at risk for blood exposure. MAIN VARIABLE: Responses to the question: "Think of an incident during the past year when you didn't adhere to universal precautions. Please describe the situation and why you didn't adhere." RESULTS: Reasons given for not using precautions included: belief that stopping to use standard precautions would have put the patient at risk (22%); using precautions would have interfered with patient care (20%); precautions were not warranted in a specific situation (14%); did not anticipate the potential for exposure (14%); and high job demands that had caused respondent to be in a hurry (11%). Less often, equipment was not available (7%), respondent forgot (6%), respondent thought that the patient did not pose a risk (4%), or the available equipment was not effective (3%). In terms of overall exposure rates, 34% of those who described an incident had experienced a sharps injury during the previous 3 months and 42% had experienced a mucocutaneous exposure. In terms of overall nonadherence, 44% wore gloves less than 100% of the time, while 61% washed their hands less than 100% of the time. Needlestick injuries were lowest among those who had forgotten to use precautions, while mucocutaneous exposures were highest among those who had not anticipated potential exposure while performing the task. Failure to wear gloves routinely was highest among those who said that following precautions interfered with their ability to provide care and among those who believed a particular patient to be low risk; failure to wash hands routinely was also highest among the latter group and lowest among those who said necessary equipment was not available. CONCLUSIONS: Using specific information about local incidents of nonadherence to standard precautions may enhance training, especially if the program identifies incidents of unanticipated exposure and helps workers plan for them in the future. Closer examination of job demands and responsibilities that interfere with standard precautions may increase the likelihood of adherence.

Blood-Borne Pathogens↗
PubMed1999

Community-based malaria control in Tigray, northern Ethiopia.

Community-based control activities have been a major component of the Tigray regional malaria control programme since 1992. A team of 735 volunteer community health workers treat on average 60,000 clinical malaria cases monthly during the high malaria transmission season. Ensuring access for the rural population to early diagnosis and treatment has contributed to a significant decrease in death rate in under-five children at the village level from 1994 to 1996. Mapping and geographic information system (GIS) technologies have been introduced to support planning for control by assessment of community-based coverage. With further development, GIS will be used in stratification, and to assess the impact of water resources development on malaria transmission and intensity.

Adult↗
PubMed2004

Acceptability and utilisation of services for voluntary counselling [corrected] and testing and sexually transmitted infections in Kahsey Abera Hospital, Humera, Tigray, Ethiopia.

OBJECTIVES: A study was conducted to assess the acceptability and utilization of voluntary counselling and testing (VCT) and sexually transmitted infection (STI) services in Kahsey Abera Hospital, Humera. METHODS: Retrospective data was taken from hospital consultation logbooks from January 2002 to February 2003, and focus group discussions were conducted in March 2003 in the community. RESULTS: While the services were known and utilization is increasing, important misconceptions about the medical services, disease transmission, and STI treatment persist. Although hospital care was generally considered of high quality, persons often go to pharmacies to self-treat for STIs due to concerns about confidentiality, and the stigma of HIV deters many from wanting to know their serostatus. CONCLUSIONS: Additional education is needed on HIV/AIDS, STIs, and the medical services provided. Education may make use of community health workers or outreach workers in a small group where participants can feel comfortable to ask sensitive questions. HIV/AIDS treatment is planned for the near future and may be significant in reducing HIV/AIDS stigma.

Adolescent↗
PubMed1995

Perception of sickle cell haemoglobinopathy among 'would-be' counsellors.

Fifty-six paramedical personnel in training as Community Health Officers (CHO) and Nurse Tutors were interviewed by a self administered questionnaire as to personal information and what they know and believed about sickle cell haemoglobinopathy. Even after the normal course of lectures on the haemoglobinopathies as given for their training as CHO's, many of them still did not fully understand the topic as shown by mixed up and confusing answers given to questions. As a result of the maturity and exposure as community health workers, they are being proposed for retraining as counsellors with regards to the haemoglobinopathies. From our findings to this study it appears that using a formal lecture schedule would not be adequate in intimating this group with the problems they would likely encounter as CHO's in practice. A training programme should also include organised group discussions designed to detect biases and prejudices and correct them before certification as community health officers.

Adult↗
PubMed2005

Listening to those on the frontline: lessons for community-based tuberculosis programmes from a qualitative study in Swaziland.

This study explored the experience of people involved in a new community-based tuberculosis (TB) programme in rural Swaziland. Patients have their treatment observed in the community after choosing a treatment supporter (either community health worker or family member) in dialogue with the TB nurse. Interviews were conducted with TB patients, treatment supporters, clinic nurses, nurses working in the hospital-based TB team and medical staff. The study generated two main themes: (1) issues relating to the TB programme and (2) wider societal issues. Both are important, however this paper reports only the issues directly related to the TB programme. The study found that community-based care is preferred to hospital care, which should be retained only for the very ill patients. The importance of selecting suitable patients and ensuring individualised and flexible arrangements was highlighted. Although treatment outcomes are known to have improved since introducing the new TB programme a number of issues require further attention. Communication between different levels of the health service needs to be improved and consultation communication skills, taught prior to introducing the programme, need to be refreshed. All relevant staff must be trained on the TB programme and patient education (on TB, HIV and treatment adherence) needs to be reinforced throughout TB treatment. Health education of the wider community is also needed. Ongoing support of treatment supporters must recognise that their role is not simply treatment observation. In this context, where the large majority of TB patients are HIV positive, better co-ordination with the HIV/AIDS services is required, including treatment of other HIV-related infections and home-based care for TB patients who deteriorate. Although the findings and recommendations of this study are context specific they are likely to be of relevance to other programmes.

Community Health Services↗
PubMed2006

Health systems and access to antiretroviral drugs for HIV in Southern Africa: service delivery and human resources challenges.

Without strengthened health systems, significant access to antiretroviral (ARV) therapy in many developing countries is unlikely to be achieved. This paper reflects on systemic challenges to scaling up ARV access in countries with both massive epidemics and weak health systems. It draws on the authors' experience in southern Africa and the World Health Organization's framework on health system performance. Whilst acknowledging the still significant gap in financing, the paper focuses on the challenges of reorienting service delivery towards chronic disease care and the human resource crisis in health systems. Inadequate supply, poor distribution, low remuneration and accelerated migration of skilled health workers are increasingly regarded as key systems constraints to scaling up of HIV treatment. Problems, however, go beyond the issue of numbers to include productivity and cultures of service delivery. As more countries receive funds for antiretroviral access programmes, strong national stewardship of these programmes becomes increasingly necessary. The paper proposes a set of short- and long-term stewardship tasks, which include resisting the verticalisation of HIV treatment, the evaluation of community health workers and their potential role in HIV treatment access, international action on the brain drain, and greater investment in national human resource functions of planning, production, remuneration and management.

Africa South of the Sahara↗
PubMed1994

Factors affecting desired family size in Bangladesh.

Factors affecting desired family size in rural Bangladesh are examined using data from contraceptive prevalence surveys conducted between 1983 and 1991. The analysis suggests that mothers having two sons and one daughter are more inclined to perceive their family as complete than those having three sons and no daughter. Logistic regression analysis indicates that important determinants of desire for more children are age of woman, current contraceptive use status, work status, and family planning worker's visit. The policy implications of these findings are discussed.

Adolescent↗
PubMed1993

Evaluation of the home-based maternal record: a WHO collaborative study.

Thirteen centres in eight countries (Egypt, India, Pakistan, Philippines, Senegal, Sri Lanka, Democratic Yemen and Zambia) participated in the WHO collaborative study to evaluate the home-based maternal record (HBMR). The evaluation showed that use of the HBMR had a favourable impact on utilization of health care services and continuity of the health care of women during their reproductive period. When adapted to local risk conditions, their cut-off points and the available resources, the HBMR succeeded in promoting self-care by mothers and their families and in enhancing the timely identification of at-risk cases that needed referral and special care. The introduction of the HBMR increased the diagnosis and referral of at-risk pregnant women and newborn infants, improved family planning and health education, led to an increase in tetanus toxoid immunization, and provided a means of collecting health information in the community. The HBMR was liked by mothers, community health workers and other health care personnel because, by using it, the mothers became more involved in looking after their own health and that of their babies. Apart from local adaptation of the HBMR, the training and involvement of health personnel (including those at the second and tertiary levels) from the start of the HBMR scheme influenced its success in promoting maternal and child health care. It also improved the collection of community-based data and the linking of referral networks.

Continuity of Patient Care↗
PubMed1991

HIV seroprevalence surveys: impetus for preventive activities.

Seroprevalence determinations of human immunodeficiency virus are essential for design and implementation of preventive strategies. By demonstrating the severity of HIV infections within communities, New York State surveys have spurred preventive interventions, including information to the public and health care providers and increased counseling and testing of women of reproductive age. In high-prevalence areas the community health workers have been employed in preventive activities. Specific information has been provided to county health departments on zip code areas with high HIV seroprevalence rates. Serosurveys revealed that the magnitude of HIV infection in adolescents is much larger than indicated by case reports. Various seroprevalence studies confirmed higher rates of infection with increasing age and minority status and a strong association with intravenous drug use. Combining data provided by seroprevalence studies in a given community enables planners to assess the extent of infection in that community and in groups important to transmission of the virus.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Who fails to complete tuberculosis treatment? Temporal trends and risk factors for treatment interruption in a community-based directly observed therapy programme in a rural district of South Africa.

SETTING: Hlabisa Tuberculosis Programme, Hlabisa, South Africa. OBJECTIVE: To determine trends in and risk factors for interruption of tuberculosis treatment. METHODS: Data were extracted from the control programme database starting in 1991. Temporal trends in treatment interruption are described; independent risk factors for treatment interruption were determined with a multiple logistic regression model, and Kaplan-Meier survival curves for treatment interruption were constructed for patients treated in 1994-1995. RESULTS: Overall 629 of 3,610 surviving patients (17%) failed to complete treatment; this proportion increased from 11% (n = 79) in 1991/1992 to 22% (n = 201) in 1996. Independent risk factors for treatment interruption were diagnosis between 1994-1996 compared with 1991-1993 (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.6-2.4); human immunodeficiency virus (HIV) positivity compared with HIV negativity (OR 1.8, 95%CI 1.4-2.4); supervised by village clinic compared with community health worker (OR 1.9, 95%CI 1.4-2.6); and male versus female sex (OR 1.3, 95%CI 1.1-1.6). Few patients interrupted treatment during the first 2 weeks, and the treatment interruption rate thereafter was constant at 1% per 14 days. CONCLUSIONS: Frequency of treatment interruption from this programme has increased recently. The strongest risk factor was year of diagnosis, perhaps reflecting the impact of an increased caseload on programme performance. Ensuring adherence to therapy in communities with a high level of migration remains a challenge even within community-based directly observed therapy programmes.

Adolescent↗
PubMed1994

High-risk pregnancies in urban and rural communities in central part of Ethiopia.

A survey was conducted in 13 urban kebeles and 13 rural villages to assess the magnitude of high risk pregnancies. A total of 567 pregnant women were included in the study. Of these, 28.6% were younger than 20 or older than 34 years. Early marriage below the age of 20 were reported by 85%. 21.7% and 22.2% were nulliparous and multiparous women, respectively. 39.2% were illiterate and 42.9% with a very low income. 14.6% gave a history of abortion, 13.1% of infant deaths, 6.3% of postpartum haemorrhage and 1.1% of antepartum haemorrhage. Abnormal height was recorded in 18.5%, Albuminuria in 11.5% and abnormal diastolic blood pressure in 12.2%, where 2.9% and 9.2% were classified as pre-eclamptic and gestational hypertensive. 52.3% were not receiving antenatal care services. Those who had at least one of the risk factors were 85%. The results from this study indicate the need for increased Family Planning services and appropriate training, and use of community health workers.

Abortion, Spontaneous↗
PubMed2026

Ten years on, still out of reach: barriers to PrEP access and retention in France according to frontline actors (QualiPrEP Study).

Pre-exposure prophylaxis (PrEP) for HIV has been available in France since 2014, and reimbursed since 2016, with general practitioners allowed to prescribe it since 2021. Despite these policy advances, uptake remains low among some of the most affected populations. This community-based qualitative study explored barriers to PrEP access and retention ten years into its implementation.Interviews were conducted with 28 PrEP frontline actors (healthcare professionals and community-based workers involved in promoting, prescribing, or supporting PrEP). The sample included one group discussion (n = 5), two triads (n = 6), two dyads (n = 4), and nine individual interviews (n = 13). Thematic analysis was inductive, with barriers classified across four main domains.Participants were mostly cisgender men, median age 48, born in France and abroad, and employed by NGOs in Paris. Thirteen barriers and four major themes emerged: (1) Internal psychosocial barriers: lack of knowledge, negative health-related reactions; HIV stigma; STI risk perception, taboos; (2) Internal pragmatic barriers: perceived limits of protection, usage and follow-up constraints; (3) External psychosocial barriers: limited physician knowledge and reluctance; (4) External pragmatic barriers: communication failures; structural constraints, lack of human and financial resources.Findings call for more targeted messaging, simplified care models and provider training. They highlight the need to address social and symbolic dimensions of PrEP, with insights from those supporting users to ensure more equitable implementation.

Humans↗
PubMedDate not supplied

Alternative models in the delivery of primary and secondary prevention programs.

Despite the strong scientific evidence supporting the effectiveness of cardiovascular risk reduction interventions, their application is inconsistent across medical care settings and patient groups. Traditional approaches have been largely ineffective. Thus, there is an urgent need to develop and implement innovative approaches that provide persons with or at risk for coronary heart disease effective risk reduction interventions that are accessible and affordable. Advanced practice nurses and community health workers providing care as members of multidisciplinary teams have been successful strategies for improving outcomes. This paper describes the evidence supporting these alternative models and suggests strategies for the delivery of such programs for the primary and secondary prevention of coronary heart disease.

Cardiovascular Diseases↗
PubMed1984

Economic evaluation in primary health care: the case of Western Kenya community based health care project.

This paper describes the methodology and presents preliminary results of an economic appraisal of a community based health care project in Kenya. Community health workers, trained for 12 weeks and deployed in two locations in Kenya's Western Province, act as first contact providers of basic health care and promoters of selected health, sanitation and nutrition practices. A Cost Benefit Analysis has been undertaken using the Willingness to Pay approach to compare the costs of the project and its benefits. The benefits are in the form of more easily accessible basic health care and are measured as consumer surplus accruing to the community. Gain in consumer surplus is consequent on the fall of average user costs and rise in utilisation of the project established points of first contact with primary health care. The argument for the economic viability of the project is validated by the large Net Present Value and Benefit Cost Ratio obtained for the whole of the project area and for the two locations separately. Although the evaluation technique used faces the problem of valuation of community time, aggregation of health care services at all points of first contact and the partial nature of cost benefit analysis evaluations, the results are strongly in favour of decentralisation of primary health care on similar lines in the rest of the country.

Community Health Services↗
PubMed2006

Tungiasis in rural Haiti: a community-based response.

Tungiasis is a disease endemic to poor communities in Latin America, the Caribbean and Africa. It is caused by the female flea, Tunga penetrans, which burrows into the skin of its host to feed while producing and extruding eggs. Consequent lesions may be painful and even crippling with damage ranging from mild erythema and swelling to necrosis. Superinfection of lesions can be serious and may result in auto-amputation or death from tetanus. We describe an outbreak of tungiasis in rural Haiti and a community-based intervention used to address it. Of 177 patients assessed, 132 (47 female, 85 male, 23 children) had tungiasis lesions. Forty-four patients had clinical signs of superinfection; 15 had ectopic lesions. Community health workers cleaned and disinfected patients' feet and any parts of the body with ectopic lesions, and then extracted fleas from existing lesions. Patients with superinfections were treated with appropriate antibiotics. Over 1000 pairs of shoes were distributed in the villages. Over 400 adults were given tetanus vaccinations during follow-up visits. Patients who had been treated reported feeling better and those who had received shoes indicated they had not developed new lesions. All superinfections were resolved. We concluded that community-based care can treat tungiasis effectively.

Adolescent↗