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PubMed2000

Formal handling routines in Jamaican infants. Knowledge, attitudes and behaviour.

This study aimed to determine the frequency of use and the knowledge, attitudes and behaviour regarding the Formal Handling Routines (FHR) in rural and urban Jamaican infants. Analysis was made of the area of residence and educational level of the caregivers. The study included 194 caregivers, thirty-three community rehabilitation workers (CRWs) and 30 health care workers (HCWs). Depending on the level of understanding of the respondents, questionnaires were either self-administered or a personal interview was conducted. Caregivers with tertiary education differed significantly from the other caregivers both in frequency of use of the FHR and knowledge, attitudes and behaviour. Caregivers with tertiary education used the routine much less and had more negative attitudes towards it. This might be due to their better financial position, which allowed them to have helpers who cared for their children. HCWs also had significantly more negative beliefs about the FHR than CRWs and caregivers. It is possible that HCWs carried over their knowledge, attitudes and behaviour to the caregivers but if they did, it did not influence the majority of caregivers.

Analysis of Variance↗
PubMed2000

Ex post and ex ante willingness to pay (WTP) for the ICT Malaria Pf/Pv test kit in Myanmar.

Willingness to pay (WTP) for the ICT Malaria Pf/Pv test kit was assessed by the contingent valuation method using a bidding game approach in two villages in Myanmar. Kankone (KK) village has a rural health center (RHC) and Yae-Aye-Sann (YAS) is serviced by community health worker (CHW). The objectives were to assess WTP for the ICT Malaria Pf/Pv test kit and to determine factors affecting the WTP. In both villages WTP was assessed in two different conditions, ex post and ex ante. The ex post WTP was assessed at an RHC in the KK village and at the residence of a CHW in the YAS village on patients immediately following diagnosis of malaria. The ex ante WTP was assessed by household interviews in both villages on people with a prior history of malaria. Ordinary least squares (OLS) multiple regression analysis was used to analyze factors affecting WTP. The WTP was higher in ex post conditions than ex ante in both villages. WTP was significantly positively associated with the average monthly income of the respondents and severity of illness in both ex post and ex ante conditions (p < 0.001). Distance between the residence of the respondents and the health center was significantly positively associated (p < 0.05) in the ex ante condition in a household survey of YAS village. Traveling time to RHC had a negative relationship with WTP (p < 0.05) in the ex post condition in the RHC survey in KK village.

Adult↗
PubMed2001

Skin diseases in children in rural Kenya: long-term results of a dermatology project within the primary health care system.

BACKGROUND: Following an epidemiological study on skin diseases in 5780 pupils from 13 schools in rural western Kenya in 1993, a dermatology project within the primary health care system was established in 1994 by the German non-government organization (NGO) 'Doctors in Aid of Children with Skin Diseases in Africa'. Within this project trained community health workers carried out regular visits to schools and nurseries and treated children with hydrocortisone acetate 1% cream for dermatitis, gentian violet 1% solution for bacterial skin infections, Whitfield's ointment for dermatophytoses and benzylbenzoate emulsion 25% for scabies. OBJECTIVES: To assess the impact of this intervention. METHODS: In 1999, after a 5-year period, 4961 pupils from the same 13 schools were re-examined and the prevalence rates were compared. RESULTS: Non-infective dermatitis had a prevalence of 1.7% in 1993 as well as in 1999; among the communicable diseases bacterial infections declined from 12.7% to 11.3% (not significant), fungal infections rose from 10.1% to 13.9% (P < 0.05) and arthropod infections (mainly scabies) remained at similar levels of 8.3% in 1993 and 8.0% in 1999. A distinctive reduction could only be found for tropical ulcers (0.1% in 1999 compared with 1.2% in 1993). CONCLUSIONS: The prevalence of dermatoses in children in rural Africa does not only depend on treatment schemes within the primary health care system, but on the socio-economic conditions available.

Adolescent↗
PubMed1975

Reduction of gastroenteritis morbidity in high-risk infants.

A method of predicting infants at high risk for developing gastroenteritis was validated in a prospective study. The ability to predict a high-risk subset of the population is particularly important if risk can be reduced with preventive measures. Performance of a preventive educational task in the field by community health workers was associated with a significantly lower rate of morbidity from gastroenteritis among high-risk infants, while achieving no significant reduction among the average-risk group.

Arizona↗
PubMed2002

Prevalence of childhood disability in rural KwaZulu-Natal.

OBJECTIVE: To determine the prevalence of disability in children under 10 years of age in the Manguzi subdistrict, in order to inform the development of an appropriate rehabilitation service. SETTING: Twelve areas within the rural Manguzi subdistrict of the Jozini-Uthungulu district in the far north-east of KwaZulu-Natal. DESIGN: A descriptive study in two stages. The first stage identified children under the age of 10 years reported with a disability. For this stage, 12 community health workers (CHWs) were trained to use a validated '10-question' screening tool with probes, adapted to include the under-2-year age group. The second stage involved confirmation of actual disability by the Manguzi rehabilitation team. RESULTS: A total of 2,036 children were screened. Of these children, 168 were reported with a disability giving an overall rate of 83/1,000 (95% confidence interval (CI): 71-95). The overall confirmed prevalence rate for children with disabilities under 10 years was 60/1,000 (95% CI: 50-71). The most prevalent disabilities were mild perceptual or learning disability (17/1,000), followed by cerebral palsy (10/1,000), hearing loss (10/1,000), moderate to severe perceptual disability (6/1,000) and seizure disorders (4/1,000). CONCLUSION: The prevalence of disabilities among children aged under 10 years is high. This has major implications for health, rehabilitation, welfare and educational services in rural areas. These implications must be addressed in order to develop appropriate rehabilitation services for children in rural areas.

Age Distribution↗
PubMed2003

Self-treatment of malaria in rural communities, Butajira, southern Ethiopia.

OBJECTIVES: To quantify the use of self-treatment and to determine the actions taken to manage malaria illness. METHODS: A cross-sectional study was undertaken in six peasant associations in Butajira district, southern Ethiopia, between January and September 1999. Simple random sampling was used to select a sample of 630 households with malaria cases within the last six months. FINDINGS: Overall, 616 (>97%) of the study households acted to manage malaria, including the use of antimalarial drugs at home (112, 17.8%), visiting health services after taking medication at home (294, 46.7%), and taking malaria patients to health care facilities without home treatment (210, 33.3%). Although 406 (64.5%) of the households initiated treatment at home, the use of modern drugs was higher (579, 92%) than that of traditional medicine (51, 8%). Modern drugs used included chloroquine (457, 73.5%) and sulfadoxine-pyrimethamine (377, 60.6%). Malaria control programmes were the main sources of antimalarials. In most cases of malaria, treatment was started (322, 52.3%) or health services visited (175, 34.7%) within two days of the onset of symptoms. Cases of malaria in the lowland areas started treatment and visited health services longer after the onset of malaria than those in the midland areas (adjusted odds ratio, 0.44; 95% confidence interval (CI), 0.30-0.64; and adjusted odds ratio, 0.37; 95% CI, 0.25-0.56, respectively). Similarly, those further than one hour's walk from the nearest health care facility initiated treatment later than those with less than one hour's walk (adjusted odds ratio, 0.62; 95% CI 0.43-0.87). This might be because of inaccessibility to antimalarial drugs and distant health care facilities in the lowland areas; however, statistically insignificant associations were found for sex, age, and religion. CONCLUSION: Self-treatment at home is the major action taken to manage malaria. Efforts should be made to improve the availability of effective antimalarials to communities in rural areas with malaria, particularly through the use of community health workers, mother coordinators, drug sellers, and shop owners.

Adolescent↗
PubMed2002

[Iron deficiency and anemia in pregnant women from Chaco, Argentina].

Aiming at their prevention, to determine the prevalence of gestational iron deficiency and anemia, considering access to health care and associations with social and biological variables in the Province of el Chaco, Argentina. Three hundred and sixty four, randomly selected pregnant women from the whole province participated. Mean Hemoglobin (Hb) +/- SD dropped progressively from 118.4 +/- 11.0 to 112.1 +/- 11.5 g/L (p = 0.015) between the 1st and the 3rd gestational trimesters. Anemia prevalence (Hb < 110 g/L) was 17.4, 26.5 and 35.8%. From the 1st to the 3rd trimesters. Second trimester prevalence was 14.1% using Hb < 105 g/L as recently suggested. The ferritin geometric mean during the progressive gestational trimesters were 28.9; 16.0 and 11.1 micrograms/L. 21.7, 40.5 and 60.5% had ferritins < 12 micrograms/L, and 39.1, 58.9 and 83.2% had ferritins < 20 micrograms/L in these respective trimesters (p < 0.004 between trimesters in both cases). Both iron deficiency and anemia were significantly greater in women with unfinished primary education and with interpregnancy interval < 1 year. Seventy five percent of women had adequate number of antenatal visits but only 23% were taking iron supplements and 10% had stopped taking them. The prevention and correction of gestational iron deficiency and anemia must focus on the preconceptional period (inter-pregnancy spacing and increasing iron intake using all available means) as well as during pregnancy improving adherence to iron supplements by means of motivation of health workers and community.

Adult↗
PubMedDate not supplied

Emergency care of the trauma patient in remote regions of Papua New Guinea.

The purpose of this article is to discuss 'best practice' regarding the management of a trauma victim's upper airway in a remote region of Papua New Guinea (PNG). This article has been written with the trauma patient in mind; however, much of the information would be equally relevant to the acute and chronically ill patient. Therefore the management described should be of use to aid post orderlies, community health workers, nurses and doctors alike who work or patrol in remote regions of PNG. The article is designed to take the reader through a step by step approach. Commentaries to further clarify or expand the text are placed at the end of the article under specific addendum headings, so as not to disrupt the main flow of the subject matter. In addition to upper airway management, this article also details 'ideal' emergency trauma equipment and drug requirements for bush use.

Airway Obstruction↗
PubMed1992

The use of diarrhoeal management counselling cards for community health volunteer training in Indonesia: the HealthCom Project.

The Indonesian Ministry of Health relies on a network of over a million kader (community health volunteers) to bring primary health care to the village level. In West Java, the Department of Health's Control of Diarrhoeal Disease (CDD) Program recently carried out an extensive research and development effort to produce effective job aids for the kader in CDD and a training programme to teach their use. A set of counselling cards was produced to provide kader with a tool to diagnose and treat diarrhoea and teach the proper use of ORS. Researchers conducted a controlled evaluation in which they measured the cards' effectiveness through observations of kader performance and interviews with mothers they had counselled. In the intervention group, 15 kader underwent two days training in the use of the cards when diagnosing and advising treatment for cases of diarrhoea in their villages. The 16 control kader received comparable CDD training without the cards. Each group provided lists of local mothers they pledged to counsel during the coming weeks. Follow-up interviews were held with these mothers to test their level of knowledge on CDD and to observe their ability to mix ORS properly. Significant performance differences between the intervention kader and mothers, and the control kader and mothers, were demonstrated. The intervention kader were consistently more accurate in their diagnoses and recommendations for treatment with a mean of 83% accuracy vs 68% for the control kader. Mothers counselled by the intervention kader also prepared ORS significantly better than the mothers counselled by the control kader, with 97 vs 74% accuracy.

Community Health Services↗
PubMed1992

Cancer in socioeconomically disadvantaged populations.

This article presents a summary of the health status of the disadvantaged populations in the United States, with specific regard to the incidence, treatment, and mortality of cancer. It begins with an historical overview of health care for the poor in this country, and continues with an explanation of the risk factors prevalent, if not inherent, in the life-style associated with low socioeconomic status, such as poor diet, cigarette smoking, and ignorance of preventive health measures and screening techniques. It includes a discussion of the different types that are overrepresented in this population and of the barriers to preventive care and treatment that still exist. The most important of these is decreased access to continuous medical care because of a lack of health insurance and an overdependence on emergency room treatment for all health care. The final section reviews solutions that have been preferred by physicians, nurses, lawmakers, public health workers, and community advocates for the poor. The most important parts of the solution are patient education for preventive health care, disease warning signs, and screening techniques and an overhaul of the present system of providing health care to ensure equal access and treatment for all members of the society.

Health Services Accessibility↗
PubMed2003

Knowledge, perceptions and prevention of malaria among women in Sistan va Baluchestan, Islamic Republic of Iran.

A questionnaire about malaria knowledge, beliefs and practices was given to a random sample of 2168 married women from rural and urban areas of Sistan va Baluchestan, Islamic Republic of Iran. The mean knowledge score of subjects was low at 5.5 (maximum 15.0). Few respondents (37.6%) knew that malaria was an important disease in the area and only 58.4% knew that malaria was transmitted by mosquitoes. Most subjects (69.4%) never used a mosquito net. Only 49.9% of rural and 73.8% of urban residents would seek care for fever and chills from the local health centre. Community health workers (behvarz) were the main source of information (29.5%) for rural women; the role of physicians in education was minimal. Subsequent health education must be tailored to the educational needs of the target population in this area.

Adolescent↗
PubMed2005

The spectrum of beta-globin gene mutations in children with beta-thalassaemia major from Kota Kinabalu, Sabah, Malaysia.

INTRODUCTION: Beta-thalassaemia major is one of the commonest genetic disorders in South East Asia. The strategy for the community control of beta-thalassaemia major requires the characterisation of the spectrum of beta-globin gene mutations in any multi-ethnic population. There is only a single report of mutation analyses of the beta-globin gene in an isolated Kadazandusun community in Kota Belud, Sabah, Malaysia, which showed the presence of a common 45 kb deletion. METHODS: To confirm the observation that this large deletion is the commonest beta-globin gene mutation among the Kadazandusun and other indigenous populations in Sabah, Malaysia, we performed polymerase chain reaction (PCR) analysis of the beta-globin gene in ten children with beta-thalassaemia major attending the Thalassaemia Centre, Queen Elizabeth Hospital, the major paediatric referral centre in Kota Kinabalu, Sabah. RESULTS: The 45 kb deletion was confirmed to be the commonest mutation found in the Kadazandusun, Bajau and Murut populations, whereby it was detected in 19 out of the 20 (95 percent) alleles analysed. The other mutation was due to an IVS-1 position 1 G > T mutation. CONCLUSION: This finding confirmed the deletion in the homozygous state was associated with a severe phenotype. The reason for the predominance of this mutation in Kota Kinabalu is most likely to be due to founder effects and possibly intermarriages between the various ethnic groups. Prenatal diagnosis using PCR for this common mutation is feasible in this community. Medical workers and scientists at molecular diagnostic centres serving large South East Asian populations should incorporate a diagnostic strategy for this deletion in the appropriate population. Future studies on these indigenous ethnic groups in other areas and other groups in Sabah are required.

Beta-Globulins↗
PubMed1992

A case of fatal methyl bromide poisoning.

A case of preventable fatality and a nearly greater disaster as a result of methyl bromide fumigation of a restaurant is presented. Methyl bromide is a nearly odorless, volatile hydrocarbon used as a fumigant in the food industry. As a result of this episode, recommendations are made for worker and community notification of the hazards involved whenever fumigation takes place. Addition of a mucosal irritant or olfactory stimulant is recommended to provide warning for methyl bromide exposure.

Fumigation↗
PubMed1992

[Pneumonia in children in Latin America: morbidity, predisposing causes, mortality and costs].

The paper refers to pneumonia in children under five years of age in Latin America, and covers the following toplos: morbidity, predisposing and risk factors, mortality and costs. It emphasizes the magnitude, tendency and advances in the control of the problem. High pneumonia morbidity and mortality rates are observed, with slow tendency to decrease in the majority of the countries of the Region, with some exceptions. The paper points out the importance of the National Programs of Control of Acute Respiratory Infections (ARI), specifically of pneumonia, following the guide lines of the PAHO/WHO. Special mention is made of the diagnosis, ambulatory standardized treatment and cost-effectiveness under the strategy of the Primary Health Care. The preventive measures are important, including the health education of parents and the training of the community health workers. The principal goal is to obtain a decrease of one third in the mortality of pneumonia in children, within the present.

Child, Preschool↗
PubMedDate not supplied

The National Rural Health Mission (NRHM): a critical overview.

This paper explores the forces that led to the conceptualisation of the National Rural Health Mission (NRHM) including the role of the Common Minimum Programme and the Structural Adjustment Programme. The paper analyses the key components of the NRHM in terms of the theoretical frameworks of decentralisation, integration of programmes, primary health care, community health workers and standards.

Humans↗
PubMedDate not supplied

African American community breast health education: a pilot project.

This paper reports the results of a project designed to examine the effectiveness of a Train the Trainer breast health education and screening program for African American, elderly and underserved women residing in the greater Nashville area. The project aimed to identify a cadre of women from the community willing to serve as leaders advocated and peer breast health educators. Data collected from the community leaders and the women from the local community during the course of the project suggest that the Train the Trainer model was well suited to provide education, support and breast cancer resource referral to women residing within this rural Tennessee community.

Black or African American↗