scholarly journals Preparing to launch the ‘Thinking Healthy Programme’ perinatal depression intervention in Urban Lima, Peru: experiences from the field

2018 ◽  
Vol 5 ◽  
Author(s):  
B. S. Eappen ◽  
M. Aguilar ◽  
K. Ramos ◽  
C. Contreras ◽  
M. C. Prom ◽  
...  
Keyword(s):  
Perinatal Depression ◽  
Health Workers ◽  
World Health ◽  
Depression Care ◽  
Middle Income ◽  
Intervention Delivery ◽  
Implementation Team ◽  
Perinatal Women ◽  
And Training ◽  
Depression Intervention

Background.An estimated 19–25% of perinatal women in low- and middle-income countries are affected by depression which, untreated, is associated with multiple health problems for mothers and children. Nonetheless, few perinatal women have access to depression care. The Thinking Healthy Programme (THP), promoted by the World Health Organization (WHO), is an evidence-based, non-specialist delivered depression intervention that addresses this care gap. However, the WHO THP manual explains intervention delivery but not the antecedents to implementation. Here, we describe a principled, planned approach leading to the implementation of THP in Lima, Peru by the non-profit organization Socios En Salud with community health workers (CHW) to inform its implementation in other settings.Methods.The Replicating Effective Programs (REP) framework guided THP implementation, following four phases: (I) pre-conditions; (II) pre-implementation; (III) implementation; and (IV) maintenance and evolution. This paper centers on REP phases I and II, including (1) documented high perinatal depression rates in Peru; (2) designation of perinatal depression as a government priority; (3) THP Implementation Team orientation and training; (4) data collection plan development; (5) public health system coordination; (6) CHW selection and training; and (7) THP launch.Results.Between December 2016 and March 2017, a THP training program was developed and seven CHW were trained to deliver the intervention to 10 perinatal women, the first of whom was enrolled on 17 April 2017.Conclusions.THP was rapidly implemented by a community-based organization with no prior experience in delivering non-specialist perinatal depression care. The steps followed may inform the implementation of THP in other settings.

scholarly journals Scoping review assessing the evidence used to support the adoption of mobile health (mHealth) technologies for the education and training of community health workers (CHWs) in low-income and middle-income countries

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e019827 ◽  
Author(s):  
Niall Winters ◽  
Laurenz Langer ◽  
Anne Geniets
Keyword(s):  
Systematic Reviews ◽  
Scoping Review ◽  
Low Income ◽  
Health Workers ◽  
Education And Training ◽  
Evidence Base ◽  
Mobile Technologies ◽  
Middle Income ◽  
And Training ◽  
Formal Theories

ObjectivesUndertake a systematic scoping review to determine how a research evidence base, in the form of existing systematic reviews in the field of mobile health (mHealth), constitutes education and training for community health workers (CHWs) who use mobile technologies in everyday work. The review was informed by the following research questions: does educational theory inform the design of the education and training component of mHealth interventions? How is education and training with mobile technology by CHWs in low-income and middle-income countries categorised by existing systematic reviews? What is the basis for this categorisation?SettingThe review explored the literature from 2000 to 2017 to investigate how mHealth interventions have been positioned within the available evidence base in relation to their use of formal theories of learning.ResultsThe scoping review found 24 primary studies that were categorised by 16 systematic reviews as supporting CHWs’ education and training using mobile technologies. However, when formal theories of learning from educational research were used to recategorise these 24 primary studies, only four could be coded as such. This identifies a problem with how CHWs’ education and training using mobile technologies is understood and categorised within the existing evidence base. This is because there is no agreed on, theoretically informed understanding of what counts as learning.ConclusionThe claims made by mHealth researchers and practitioners regarding the learning benefits of mobile technology are not based on research results that are underpinned by formal theories of learning. mHealth suffers from a reductionist view of learning that underestimates the complexities of the relationship between pedagogy and technology. This has resulted in miscategorisations of what constitutes CHWs’ education and training within the existing evidence base. This can be overcome by informed collaboration between the health and education communities.

scholarly journals Edukasi dan Deteksi Dini Komplikasi Kehamilan dengan Pemeriksaan Laboratorium

2020 ◽  
Vol 1 (2) ◽  
pp. 43-49
Author(s):  
Rochany Septiyaningsih ◽  
Dhiah Dwi Kusumawati ◽  
Frisca Dewi Yunadi ◽  
Septiana Indratmoko
Keyword(s):  
Pregnant Women ◽  
Health Workers ◽  
World Health ◽  
Maternal Deaths ◽  
Middle Income ◽  
Pregnancy And Childbirth ◽  
Delivery Assistance ◽  
The World ◽  
Laboratory Examinations ◽  
Health Organization

The World Health Organization (WHO) states that maternal mortality worldwide due to complications during pregnancy and childbirth in 2017 is estimated at around 810 cases. Between 2000 and 2017 there was a decline in the ratio of MMR around the world by 38%. WHO also states that 94% of global maternal deaths occur in low and middle income countries. In Indonesia, maternal deaths due to complications from pregnancy or childbirth every year are estimated at 20,000 mothers died from five million births. Delivery assistance by trained health workers in health facilities can be an effort to reduce MMR and IMR. In addition, awareness of pregnant women is also important for the importance of having a pregnancy with a health worker. This community service aims to increase the knowledge of pregnant women about anemia and to detect early pregnancy complications by laboratory examinations. The target of this activity is 15 pregnant women. The dedication activity is conducting educational activities, laboratory examinations in Tambakreja Village, Cilacap Regency. Based on the results of this activity it was concluded that there was an increase in knowledge of pregnant women about anemia and found 2 pregnant women experiencing anemia from 15 pregnant women and urine examination found all negative pregnant women

scholarly journals Feasibility of a Mobile Health Tool for Mothers to Identify Neonatal Illness in Rural Uganda: Acceptability Study

10.2196/16426 ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e16426
Author(s):  
Shababa B Matin ◽  
Allison Wallingford ◽  
Shicheng Xu ◽  
Natalie Ng ◽  
Anthony Ho ◽  
...  
Keyword(s):  
Health Workers ◽  
Health Assessment ◽  
Care Seeking ◽  
Wearable Sensor ◽  
Middle Income ◽  
Neonatal Deaths ◽  
Danger Signs ◽  
Study Team ◽  
And Training ◽  
At Home

Background A shortage of community health workers to triage sick neonates and poor recognition of neonatal illness by mothers contribute significantly toward neonatal deaths in low- and middle-income countries. Providing low-resource communities with the tools and knowledge to recognize signs of neonatal distress can lead to early care-seeking behavior. To empower and educate mothers to recognize signs of neonatal illness, we developed a neonatal health assessment device consisting of a smartphone app and a wearable sensor (the NeMo system). Objective The aim of this study was to determine if mothers in rural Uganda were willing and able to use the NeMo system during the first week of their infant’s life. We also assessed mothers’ responses to the device’s recommendation to seek care. Methods A total of 20 mothers were enrolled in the study after giving birth in the Iganga District Hospital. Each mother was trained to use the NeMo system to assess her infant for signs of illness before leaving the hospital and was given the NeMo system to use at home for 1 week. Throughout the week, the smartphone tracked the mothers’ usage of NeMo, and the study team visited twice to observe mothers’ ability to use NeMo. Each mother was interviewed at the end of 1 week to gather qualitative feedback on her experience with the NeMo system. Results In total, 18 mothers completed the study; 2 mothers were withdrawn during the week because of extenuating health circumstances. Moreover, 1 day after enrollment and training, 75% (15/20) of mothers used NeMo properly with no mistakes. 3 days after enrollment and training, only 1 mother placed the wearable sensor improperly on her infant. On the final study day, only 1 mother connected the device improperly. Mothers used NeMo an average of 11.67 (SD 5.70) times on their own at home during the 5 full study days. Although the frequency of use per day decreased from day 1 to day 5 of the study (P=.04), 72% (13/18) of mothers used NeMo at least once per day. In total, 64% (9/14) of mothers who received an alert from the NeMo system to seek care for their infants either called the health care professional working with the study team or reused the system immediately and found no danger signs. All 18 mothers agreed or strongly agreed that the NeMo system was easy to use and helped them know when to seek care for their babies. Conclusions NeMo is a feasible and acceptable tool to aid mothers in rural Uganda to assess their infant’s health.

scholarly journals Human Resources in Healthcare and Health Outcomes in India

2020 ◽  
Vol 11 (2) ◽  
pp. 133-159
Author(s):  
Venkatanarayana Motkuri ◽  
Udaya S. Mishra
Keyword(s):  
Human Resources ◽  
Health Outcomes ◽  
Census Data ◽  
Health Workers ◽  
Human Resources For Health ◽  
Size Composition ◽  
Healthcare Services ◽  
World Health ◽  
Middle Income ◽  
Minimum Requirement

Human resources for health including health professionals and skilled health workers are crucial in shaping health outcomes. But the shortage of human resources in healthcare services is a reality and hence it has been a cause of concern in lower-middle income countries like India. The present exercise based on census data is a situation analysis of size, composition and distribution of human resources available in the Indian healthcare services. It also explores the relationship between educational development and health workers availability alongside the association between density of health workers and health outcomes across states of India. It is observed that despite the remarkable improvement in health workers density particularly during 2001–2011, the country is falling short of the World Health Organization’s (WHO) need-based minimum requirement (4.45 health workers per 1,000 population) of health workers. The exploratory verification asserts that there is a significant and strong positive relationship/association between the density of health workers and health outcomes.

scholarly journals Integrating Depression Care Within NCD Provision in Bangladesh and Pakistan: A Qualitative Study

2020 ◽  
Author(s):  
Jerome Wright ◽  
Papiya Mazumdar ◽  
Deepa Barua ◽  
Silwa Lina ◽  
Humaira Bibi ◽  
...  
Keyword(s):  
Health Workers ◽  
Psychological Intervention ◽  
Screening Tools ◽  
Hospital Environment ◽  
Depression Care ◽  
Framework Analysis ◽  
Healthcare Facilities ◽  
Motivation Factors ◽  
Co Morbidity ◽  
Depression Intervention

Abstract Background: Co-morbidity of depression with other non-communicable diseases (NCDs) worsens clinical outcomes for both conditions. Low- and middle-income countries need to strengthen mechanisms for detection and management of co-morbid depression within NCDs. The BEACON study explored the acceptability and feasibility of integrating a brief depression intervention (behavioural activation, BA) into NCD services in healthcare facilities in Bangladesh and Pakistan.Methods: Face-to-face qualitative interviews were conducted with 43 patients and 18 health workers attending or working in NCD centres in four healthcare facilities in Bangladesh and Pakistan, and with three policy makers in each country. The interviews addressed four research questions (1) how NCD care is delivered, (2) how NCD patients experience distress, (3) how depression care is integrated within NCD provision, and (4) the challenges and opportunities for integrating a brief depression intervention into usual NCD care. The data were analysed using framework analysis, organised by capability, opportunity and motivation factors, cross-synthesised across countries and participant groups.Results: Patients and health workers described NCD centres as crowded and time pressured, with waiting times as long as five hours, and consultation times as short as five minutes; resulting in some patient frustration. They did not perceive direct links between their distress and their NCD conditions, instead describing worries about family and finance including affordability of NCD services. Health worker and policy maker accounts suggested these NCD centres lacked preparedness for treating depression in the absence of specific guidelines, standard screening tools, recording systems or training. Barriers and drivers to integrating a brief depression intervention reflected capability, opportunity and motivation factors for all participant groups. While generally valuing the purpose, significant challenges included the busy hospital environment, skill deficits and different conceptions of depression.Conclusions: Given current resource constraints and priorities, integrating a brief psychological intervention at these NCD centres appears premature. An opportune first step calls for responding to patients’ expressed concerns on service gaps in provisioning steady and affordable NCD care. Acknowledging differences of conceptions of depression and strengthening psychologically informed NCD care will in turn be required before the introduction of a specific psychological intervention such as BA.

scholarly journals Defining hypoxemia from pulse oximeter measurements of oxygen saturation in well children at low altitude in Bangladesh: an observational study

2021 ◽  
Author(s):  
Eric D McCollum ◽  
Carina King ◽  
Salahuddin Ahmed ◽  
Abu AM Hanif ◽  
Arunangshu D Roy ◽  
...  
Keyword(s):  
Low Income ◽  
Pulse Oximeter ◽  
Health Workers ◽  
Respiratory Infections ◽  
Clinical Status ◽  
World Health ◽  
Older Children ◽  
Middle Income ◽  
Lower Altitude ◽  
Low Altitude

Background: The World Health Organization defines hypoxemia, a low peripheral oxyhemoglobin saturation (SpO2), as <90%. Although hypoxemia is an important risk factor for mortality of children with respiratory infections, the optimal SpO2 threshold for defining hypoxemia is uncertain in low-income and middle-income countries (LMICs). We derived a SpO2 threshold for hypoxemia from well children in Bangladesh residing at low altitude. Methods: We prospectively enrolled well, 3-35 month old children participating in a pneumococcal vaccine evaluation in Sylhet district, Bangladesh between June and August 2017. Trained health workers conducting community surveillance measured the SpO2 of children using a Masimo Rad-5 pulse oximeter with a wrap sensor. We used standard summary statistics to evaluate the SpO2 distribution, including whether the distribution differed by age or sex. We considered the 2.5th, 5th, and 10th percentiles of SpO2 as possible lower thresholds for hypoxemia. Results: Our primary analytical sample included 1,470 children (mean age 18.6 +/- 9.5 months). Median SpO2 was 98% (interquartile range, 96-99%), and the 2.5th, 5th, and 10th percentile SpO2 was 91%, 92%, and 94%. No child had a SpO2 <90%. Children 3-11 months old had a lower median SpO2 (97%) than 12-23 month olds (98%) and 24-35 month olds (98%) (p=0.039). The SpO2 distribution did not differ by sex (p=0.959). Conclusion: A SpO2 threshold for hypoxemia derived from the 2.5th, 5th, or 10th percentile of well children is higher than <90%. If a higher threshold than <90% is adopted into LMIC care algorithms then decision-making using SpO2 must also consider the childs clinical status to minimize misclassification of well children as hypoxemic. Younger children in lower altitude LMICs may require a different threshold for hypoxemia than older children. Evaluating the mortality risk of sick children using higher SpO2 thresholds for hypoxemia is a key next step.

scholarly journals Investigating Software Requirements for Systems Supporting Task-Shifted Interventions: Usability Study (Preprint)

2018 ◽  
Author(s):  
Pepijn Van de Ven ◽  
Ricardo Araya ◽  
Maria Clara P de Paula Couto ◽  
Maiara Garcia Henrique ◽  
Damien Meere ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Health Workers ◽  
World Health ◽  
Software Requirements ◽  
Usability Study ◽  
Web Interfaces ◽  
Low Middle Income Countries ◽  
System Usability Scale ◽  
Depression Intervention

BACKGROUND There is a considerable shortfall in specialized health care professionals worldwide to deliver health services, and this shortfall is especially pronounced in low-middle-income countries. This has led to the implementation of task-shifted interventions, in which specific tasks are moved away from highly qualified health workers to health workers with less training. The World Health Organization (WHO) has published recommendations for such interventions, but guidelines for software and systems supporting such interventions are not included. OBJECTIVE The objective of this study was to formulate a number of software requirements for computer systems supporting task-shifted interventions. As the treatment of mental health problems is generally considered to be a task for highly trained health care professionals, it poses interesting case studies for task-shifted interventions. Therefore, we illustrated the use of the identified software requirements in a mobile system created for a task-shifted depression intervention to be provided to older adults in deprived areas of São Paulo, Brazil. METHODS Using a set of recommendations based on the WHO’s guidance documentation for task-shifted interventions, we identified 9 software requirements that aim to support health workers in management and supervision, training, good relationship with other health workers, and community embeddedness of the intervention. These 9 software requirements were used to implement a system for the provision of a psychosocial depression intervention with mobile Android interfaces to structure interventions and collect data, and Web interfaces for supervision and support of the health care workers delivering the intervention. The system was tested in a 2-arm pilot study with 33 patients and 11 health workers. In all, 8 of these 11 health workers participated in a usability study subsequent to the pilot. RESULTS The qualitative and quantitative feedback obtained with the System Usability Scale suggest that the system was deemed to have a usability of between <italic>OK</italic> and <italic>Good</italic>. Nevertheless, some participants’ responses indicated that they felt they needed technical assistance to use the system. This was reinforced by answers obtained with perceived usefulness and ease of use questionnaires, which indicated some users felt that they had issues around correct use of the system and perceived ability to become skillful at using the system. CONCLUSIONS Overall, these high-level requirements adequately captured the functionality required to enable the health workers to provide the intervention successfully. Nevertheless, the analysis of results indicated that some improvements were required for the system to be useable in a task-shifted intervention. The most important of these were better access to a training environment, access for supervisors to metadata such as duration of sessions or exercises to identify issues, and a more robust and human-error–proof approach to the availability of patient data on the mobile devices used during the intervention.

Improving the uneven distribution of the health workforce worldwide: a perspective from the pharmacy workforce.

2021 ◽  
Author(s):  
Kayoko Takeda Mamiya ◽  
Ian Bates ◽  
Christopher John ◽  
Lina Bader ◽  
Saja A. Alnahar
Keyword(s):  
World Bank ◽  
Home Country ◽  
Health Workers ◽  
Pharmacy Education ◽  
World Health ◽  
Uneven Distribution ◽  
World Bank Group ◽  
Middle Income ◽  
The World

Abstract Background The World Health Organization (WHO) currently estimates a shortage of approximately 18 million health workers worldwide, potentially impacting the achievement of the United Nations (UN) Sustainable Development Goal on health. One of these goals is to stimulate and guide the creation of at least 40 million new jobs in the health and social sectors and reduce the projected shortage of 18 million health workers, primarily in low- and lower-middle-income countries, by 2030. However, since 2006, there have been few surveys conducted of internationally trained pharmacists worldwide, while surveys of internationally trained nurses and doctors are being conducted by the OECD, WHO and World Bank Group. Methods A global survey on intention to migrate was conducted through International Pharmacy Students’ Federation (IPSF), Young Pharmacists Group (YPG) at International Pharmaceutical Federation (FIP) members. The questionnaire was distributed via email with a cover letter to all IPSF and YPG members with a survey URL. Results This study showed some differences in “intention to migrate”, “the motivation to migrate”, “the length of stay in the host country”, “the satisfaction with initial pharmacy education, home country and home country pharmacists’ work” among the income levels as defined by the World Bank classification. Conclusion To improve the uneven distribution of pharmacists, an education system that connects initial pharmacy education and lifelong education might need to be created or altered to address the role of pharmacists in each country. To that end, we need to share knowledge and practices related the development and implementation of lifelong learning systems and the role of pharmacists in various countries worldwide through studies and the work of international organizations.

scholarly journals Building Global Capacity for COVID-19 Vaccination Through Interactive Virtual Learning

2021 ◽  
Author(s):  
Shoshanna Goldin ◽  
Nancy Hood ◽  
Alexandre Pascutto ◽  
Celine Bennett ◽  
Ana Carolina Barbosa de Lima ◽  
...  
Keyword(s):  
Best Practices ◽  
Information Needs ◽  
Health Workers ◽  
Interactive Learning ◽  
Virtual Learning ◽  
World Health ◽  
Chi Square ◽  
Middle Income ◽  
Vaccine Introduction ◽  
Global Capacity

Abstract Background To support the introduction of the COVID-19 vaccine, the World Health Organization and its partners developed an interactive virtual learning initiative through which vaccination stakeholders could receive the latest guidance, ask questions, and share their experiences. This initiative, implemented between 9 February 2021 and 15 June 2021, included virtual engagement between technical experts and participants during a 15-session interactive webinar series as well as web and SMS-messaging discussions in English and French. Methods This article uses a mixed-methods approach to analyze survey data collected following each webinar and a post-series survey conducted after the series had concluded. Participant data was tracked for each session and feedback surveys were conducted after each session to gauge experience quality and content usability. Chi-square tests were used to compare results across professions (health workers, public health practitioners, and other). Results The COVID-19 Vaccination: Building Global Capacity webinar series reached participants in 181 countries or 93% of the WHO Member States; 78% of participants were from low-and middle-income countries (LMICs). More than 60% of participants reported using the resources provided during the sessions and 47% reported sharing these resources with colleagues. More than 79% of participants stated that this initiative significantly improved their confidence in preparing for and rolling out COVID-19 vaccinations; an additional 20.3% stated that the initiative “somewhat” improved their confidence. In the post-series survey, 70% of participants reported that they will “definitely use” the knowledge derived from this learning series in their work; an additional 19.7% will “probably use” and 8.6% would “possibly use” this knowledge in their work. Conclusion The COVID-19 Vaccination: Building Global Capacity learning initiative used a digital model of dynamic, interactive learning at scale. The initiative enhanced the WHO’s ability to disseminate knowledge, normative guidance, and best practices to COVID-19 vaccination stakeholders in real-time. This approach allowed the WHO to hear the information needs of stakeholders and respond by developing guidance, tools, and trainings to support COVID-19 vaccine introduction. The WHO and its partners can learn from this capacity-building experience and apply best practices for digital interactive learning to other health programmes moving forward.

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