scholarly journals Treatment-seeking for children with suspected severe malaria attending community health workers and primary health centres in Adamawa State, Nigeria

2021 ◽  
Author(s):  
Tristan T. Lee ◽  
Elizabeth Omoluabi ◽  
Kazeem Ayodeji ◽  
Ocheche Yusuf ◽  
Charles Okon ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Case Fatality Rate ◽  
Health Workers ◽  
Case Fatality ◽  
Treatment Seeking ◽  
Community Based ◽  
Danger Signs ◽  
Primary Health ◽  
Primary Health Centres ◽  
Rectal Artesunate

AbstractBackgroundThe Community Access to Rectal Artesunate for Malaria project investigated the feasibility of introducing pre-referral rectal artesunate into existing community-based health services. In that study, the case fatality rate of children visiting primary health centres (PHCs) was 19% compared to 6% in children first visiting community health workers, locally called Community Oriented Resource Persons (CORPs). As case management practices did not fully explain this finding, this publication investigates other reasons underlying the observed difference in case fatality.MethodsThe observational study enrolled 589 children under the age of five years with fever and danger signs indicative of severe malaria attending CORPs and PHCs in Adamawa State, Nigeria, between June 2018 and July 2020. After 28 days, follow-up visits were conducted with caregivers to understand background characteristics, severity of symptoms, home treatment administration, and treatment seeking practices during the child’s illness. These factors were compared between children visiting CORPs versus those visiting PHCs as their first health provider.ResultsChildren visiting PHCs were more likely to display danger signs indicative of central nervous system involvement (90% vs. 74%, p < 0.01) and have four or more danger signs (50% vs. 39%, p = 0.02). The delay between illness onset and visiting the community-based provider did not differ between children attending a CORP and children attending a PHC. PHC attendances more often lived in urban areas (16% vs 4%, p=0.01) and travelled farther to their first health provider, which was usually a community-based provider. Although practicing home treatment was common, especially among children attending PHCs (42% vs 33%, p=0.04), almost none of the children were given an antimalarial. PHCs were visited for their professionalism and experience while CORPs were visited for their low cost and because caregivers personally knew and trusted the provider.ConclusionsOur comparison of children with suspected severe malaria seeking care from two kinds of community-based health care providers in Nigeria suggest that illness severity may be the primary driver behind the observed difference in case fatality rate.

Neonatal tetanus at the close of the 20th century in Nigeria

2007 ◽  
Vol 37 (3) ◽  
pp. 165-167 ◽  
Author(s):  
Tinuade A Ogunlesi ◽  
John A O Okeniyi ◽  
Joshua A Owa ◽  
Gabriel A Oyedeji
Keyword(s):  
Odds Ratio ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Neonatal Tetanus ◽  
World Health ◽  
Preventive Strategies ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Organization ◽  
Year 2000

The year 2000 marked another failed World Health Organization deadline for neonatal tetanus (NNT) eradication. Existing preventive strategies can be enhanced by exploring factors involved in the persistence of the scourge. Thus, records of neonates admitted between 1996 and 2000 into the Wesley Guild Hospital, Ilesa, were analysed. Of 3051 total neonatal admissions,162 (5.3%) had NNT. Eighty-nine (54.9%) mothers had clinic-based antenatal care (ANC), but only 59 (36.4%) had tetanus toxoid (TT) vaccines. The majority (66.7%) of them delivered at home or churches and others at either private clinics or primary health centres. Overall, the case fatality rate was 43.8%, though it was significantly higher among babies whose mothers had neither clinic-based ANC (odds ratio [OR] = 2.62; 95% confidence interval [CI] = 1.33-5.18) nor antenatal TT vaccination (OR = 2.41; 95% CI = 1.17-5.03). Thus, improvement on ANC, anti-tetanus immunization and ensuring hygienic deliveries are crucial for eliminating NNT in the 21st century.

scholarly journals Effectiveness of rectal artesunate as pre-referral treatment for severe malaria in children <5 years of age

2021 ◽  
Author(s):  
Manuel W Hetzel ◽  
Jean Okitawutshu ◽  
Antoinette Tshefu ◽  
Elizabeth Omoluabi ◽  
Phyllis Awor ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Rural Areas ◽  
Health Care Systems ◽  
Controlled Trial ◽  
Child Survival ◽  
Case Fatality ◽  
Community Based ◽  
Rectal Artesunate ◽  
Roll Out

Background To prevent child deaths from severe malaria, early parenteral treatment is essential. Yet, in remote rural areas, higher-level facilities offering parenteral antimalarials are often difficult to access. A randomised controlled trial found pre-referral rectal artesunate (RAS) to reduce death and disability in children who delay arriving at a referral facility. This study examined the effectiveness of pre-referral RAS treatment in established community-based health care systems. Methods An observational study accompanied the roll-out of RAS in the Democratic Republic of the Congo, Nigeria and Uganda. Children < 5 years presenting to a community-based health provider with a positive malaria test and signs of severe malaria were followed-up during admission and after 28 days to assess their health status and treatment history. The primary outcome was death; covariates of interest included RAS use, referral completion, and post-referral treatment. Findings Post-roll-out, RAS was administered to 88% of patients in DRC, 52% in Nigeria, and 70% in Uganda. The overall case fatality rate (CFR) was 6.7% (135/2011) in DRC, 11.7% (69/589) in Nigeria, and 0.5% (19/3686) in Uganda; 865/6286 patients were sick at follow-up. In all countries, the CFR was higher after RAS-roll-out (6.7 vs. 6.6% in DRC, 16.1 vs. 4.2% in Nigeria, 0.7 vs. 0.3% in Uganda). In DRC and Nigeria, children receiving RAS were more likely to die than those not receiving RAS (aOR = 3.31, 95% CI 1.43-7.65 and aOR = 2.42, 95% CI 1.25-4.70, respectively). In Uganda, RAS users were less likely to be dead or sick at follow-up (aOR = 0.61, 95% CI 0.46-0.80). Post-referral parenteral antimalarials were protective in all countries; however, the effect of ACT administration was inconsistent. Interpretation RAS pre-referral treatment had no beneficial effect on child survival in three highly malaria endemic settings. RAS is unlikely to reduce malaria deaths unless health system shortfalls such as referral and post-referral treatment are addressed.

scholarly journals Pre-referral rectal artesunate and referral completion among children with suspected severe malaria in the Democratic Republic of the Congo, Nigeria and Uganda

2021 ◽  
Author(s):  
Nina C Brunner ◽  
Elizabeth Omoluabi ◽  
Phyllis Awor ◽  
Jean Okitawutshu ◽  
Antoinette Tshefu ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Democratic Republic ◽  
Health Workers ◽  
Health Centre ◽  
Rapid Improvement ◽  
Primary Health ◽  
Republic Of The Congo ◽  
Referral Completion ◽  
Rectal Artesunate ◽  
Roll Out

Background: Children who receive pre-referral rectal artesunate (RAS) require urgent referral to a health facility where appropriate treatment for severe malaria can be provided. However, the rapid improvement of a child's condition after RAS administration may influence a caregiver's decision to follow this recommendation. Currently, the evidence on the effect of RAS on referral completion is limited. In this study, we investigated the relationship between RAS implementation and administration and referral completion. Methods and Findings: An observational study accompanied the roll-out of RAS in three malaria endemic settings in the Democratic Republic of the Congo (DRC), Nigeria and Uganda. Community health workers and primary health centres enrolled children under five years with suspected severe malaria before and after the roll-out of RAS. All children were followed up 28 days after enrolment to assess their treatment seeking pathways, treatments received, and their health outcome. In total, 8,365 children were enrolled, 77% of whom fulfilled all inclusion criteria and had a known referral completion status. Referral completion was 67% (1,408/2,104) in DRC, 48% (287/600) in Nigeria and 58% (2,170/3,745) in Uganda. In DRC and Uganda, RAS users were less likely to complete referral than RAS non-users in the pre-roll-out phase (adjusted odds ratio [aOR] = 0.48, 95% CI 0.30-0.77 and aOR = 0.72, 95% CI 0.58-0.88, respectively). Among children seeking care from a primary health centre in Nigeria, RAS users were less likely to complete referral compared to RAS non-users in the post-roll-out phase (aOR = 0.18, 95% CI 0.05-0.71). In Uganda, among children who completed referral, RAS users were significantly more likely to complete referral on time than RAS non-users enrolled in the pre-roll-out phase (aOR = 1.81, 95% CI 1.17-2.79). Conclusions: The findings of this study raise legitimate concerns that the roll-out of RAS may lead to lower referral completion in children who were administered pre-referral RAS. To ensure that community-based programmes are effectively implemented, barriers to referral completion need to be addressed at all levels. Alternative effective treatment options should be provided to children unable to complete referral.

scholarly journals Can public sector community health workers deliver a nurturing care intervention in South Africa? The Amagugu Asakhula feasibility study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Sonja Klingberg ◽  
Esther M. F. van Sluijs ◽  
Stephanie T. Jong ◽  
Catherine E. Draper
Keyword(s):  
South Africa ◽  
Health Care ◽  
Public Sector ◽  
Health Workers ◽  
Care Facility ◽  
Health Care Facility ◽  
Preschool Age ◽  
Primary Health Care Facility ◽  
Community Based ◽  
Primary Health

Abstract Background Nurturing care interventions have the potential to promote health and development in early childhood. Amagugu Asakhula was designed to promote developmentally important dietary and movement behaviours among children of preschool age (3–5 years) in South Africa. An initial formative study in Cape Town found the intervention to be feasible and acceptable when delivered by community health workers (CHWs) linked to a community-based organisation. This study evaluated the delivery of the Amagugu Asakhula intervention by CHWs linked to a public sector primary health care facility in Soweto, as this mode of delivery could have more potential for sustainability and scalability. Methods A qualitative design was utilised to assess feasibility, acceptability, adoption, appropriateness, implementation, fidelity and context. CHWs (n = 14) delivered the intervention to caregivers (n = 23) of preschool-age children in Soweto over 6 weeks. Following the completion of the intervention, focus group discussions were held with CHWs and caregivers. Further data were obtained through observations, study records and key informant interviews (n = 5). Data were analysed using deductive thematic analysis guided by a process evaluation framework. Results The delivery of the Amagugu Asakhula intervention through CHWs linked to a primary health care facility in Soweto was not found to be feasible due to contextual challenges such as late payment of salaries influencing CHW performance and willingness to deliver the intervention. CHWs expressed dissatisfaction with their general working conditions and were thus reluctant to take on new tasks. Despite barriers to successful delivery, the intervention was well received by both CHWs and caregivers and was considered a good fit with the CHWs’ scope of work. Conclusions Based on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector CHWs in South Africa. This feasibility study informs the optimisation of implementation and supports further testing of the intervention’s effectiveness when delivered by CHWs linked to community-based organisations. The present study further demonstrates how implementation challenges can be identified through qualitative feasibility studies and subsequently addressed prior to large-scale trials, avoiding the wasting of research and resources.

scholarly journals HOME VISIT FOR APPLYING FAMILY NURSING: A PERSPECTIVE

2019 ◽  
Vol 8 (2) ◽  
pp. 69-71
Author(s):  
Kusuma Wijaya Ridi Putra
Keyword(s):  
Paradigm Shift ◽  
Home Visit ◽  
Health Workers ◽  
Public Awareness ◽  
Public Welfare ◽  
Community Nurse ◽  
Community Based ◽  
Family Nursing ◽  
Primary Health

The paradigm shift from hospital-based care to community-based care lead role of health workers in Primary Health Care became an important part in improving public welfare through the field of health. A community nurse is required to be able to make approaches to the community, including conducting a home visit, in order to increase public awareness and concern for their health level.Keywords: Home visit, family empowering, family nursing

Supervising Community Health Workers in Community-Based Delivery of Primary Health/Family Planning Services: Experiences in Mexico, 1977–1982

1986 ◽  
Vol 6 (4) ◽  
pp. 309-322 ◽  
Author(s):  
Michele G. Shedlin ◽  
Joe D. Wray ◽  
Sergio Correu
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Program ◽  
Health Workers ◽  
Community Based ◽  
Family Planning Services ◽  
Roles And Responsibilities ◽  
Primary Health ◽  
Wide Range

The supervision of CHWs in the Mexican Rural Health Program (1977–82) illustrates a wide range of problems and strengths because it was developed within a program based on a strong political mandate to deliver services to an extremely large, as well as culturally and geographically diverse population. This article presents an in-depth perspective on the issues involved in the supervision of community health workers with a focus on the myriad roles and responsibilities which are expected from supervisory personnel. The information and observations which are offered come from program evaluation materials as well as the long-term, first hand experience of the authors with the program discussed.

Incidence, 30-day case-fatality rate, and prognosis of stroke in Iquique, Chile: a 2-year community-based prospective study (PISCIS project)

The Lancet ◽  
2005 ◽  
Vol 365 (9478) ◽  
pp. 2206-2215 ◽  
Author(s):  
Pablo M Lavados ◽  
Claudio Sacks ◽  
Liliana Prina ◽  
Arturo Escobar ◽  
Claudia Tossi ◽  
...  
Keyword(s):  
Prospective Study ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Fatality Rate ◽  
Day Case ◽  
Community Based

scholarly journals Starting at the community: Treatment seeking pathways of children with suspected severe malaria in Uganda

2021 ◽  
Author(s):  
Nina C. Brunner ◽  
Aliya Karim ◽  
Proscovia Athieno ◽  
Joseph Kimera ◽  
Gloria Tumukunde ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Health Facility ◽  
Health Workers ◽  
Local Treatment ◽  
Public Health Facility ◽  
Private Clinic ◽  
Community Treatment ◽  
Treatment Seeking ◽  
Antimalarial Treatment ◽  
To Receive

AbstractIntroductionCommunity health workers (CHW) usually refer children with suspected severe malaria to the nearest public health facility or a designated public referral health facility (RHF). Caregivers do not always follow this recommendation. This study aimed at identifying post-referral treatment-seeking pathways that lead to appropriate antimalarial treatment for children less than five years with suspected severe malaria.MethodsAn observational study in Uganda enrolled children below five years presenting to CHWs with signs of severe malaria. Children were followed up 28 days after enrolment to assess their condition and treatment-seeking history, including referral advice and provision of antimalarial treatment from visited providers.ResultsOf 2211 children included in the analysis, 96% visited a second provider after attending a CHW. The majority of CHWs recommended caregivers to take their child to a designated RHF (65%); however, only 59% followed this recommendation. Many children were brought to a private clinic (33%), even though CHWs rarely recommended this type of provider (3%). Children who were brought to a private clinic were more likely to receive an injection than children brought to a RHF (78% vs 51%, p<0.001) and more likely to receive the second or third-line injectable antimalarial (artemether: 22% vs. 2%, p<0.001, quinine: 12% vs. 3%, p<0.001). Children who only went to non-RHF providers were less likely to receive an artemisinin-based combination therapy (ACT) than children who attended a RHF (odds ratio [OR] = 0.64, 95% CI 0.51–0.79, p<0.001). Children who did not go to any provider after seeing a CHW were the least likely to receive an ACT (OR = 0.21, 95% CI 0.14–0.34, p<0.001).ConclusionsHealth policies should recognise local treatment-seeking practices and ensure adequate quality of care at the various public and private sector providers where caregivers of children with suspected severe malaria actually seek care.

scholarly journals Current Aspect of Severe Malaria at the Infectious and Tropical Disease Service in Fann (Dakar)

2018 ◽  
Vol 2 (2) ◽  
Keyword(s):  
Multiple Organ Failure ◽  
Organ Failure ◽  
Severe Malaria ◽  
Poor Prognosis ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Multiple Organ ◽  
Current Profile ◽  
Who Criteria ◽  
Life Threatening

Background: Severe malaria occupies a significant place in Senegal. It is characterized by a multiple organ failure that is related to a very poor prognosis. The objective of this study was to determine the Current profile of severe malaria in the service of Tropical and Infectious Diseases of Fann Hospital in Dakar. Methods: A retrospective study was conducted regarding patients hospitalized between 2014 and 2016 for whom the diagnosis of severe malaria was established using WHO criteria of severity. Results: The number of cases of severe malaria was 176 cases, ie a hospital prevalence of 6%. The majority of patients were admitted between September and December. The median age averages 33 years [range: 11-86]. Nearly three-quarters of the patients were male (73.9%), a sex ratio of 2.8. Cerebral malaria was the most common (69.9%) and the most frequent signs of gravity were coma (68.2%), followed by jaundice (58.5%) and renal failure (29.6%). Hyperparasitaemia was noted in 13 cases. In all cases Plasmodium falciparum was the responsible parasite. Ninety-nine patients received quinine and 75 artesunate. Almost three quarters of patients (111 cases) had been hospitalized for up to 7 days. Case fatality rate reached 18.8%. Conclusion: Severe malaria is still responsible of multiple organ failure and a life-threatening disease. The most frequent sign of severity is coma but jaundice and renal impairment are increasingly high. Parenteral artesunate’s use is becoming consistent. Patients’ surviving artesunate should be investigated.

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