scholarly journals Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?

2019 ◽  
Vol 4 (4) ◽  
pp. e001529 ◽  
Author(s):  
Sarah L Dalglish ◽  
Sarah Straubinger ◽  
Justine A Kavle ◽  
Lacey Gibson ◽  
Evariste Mbombeshayi ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Community Health ◽  
Democratic Republic ◽  
Health Workers ◽  
Traditional Healers ◽  
Child Health Services ◽  
Health Providers ◽  
Community Members ◽  
Republic Of The Congo

Recent years have seen increasing momentum towards task shifting of basic health services, including using community health workers (CHW) to diagnose and treat common childhood illnesses. Yet few studies have examined the role of traditional healers in meeting families’ and communities’ health needs and liaising with the formal health system. We examine these issues in Tshopo Province in the Democratic Republic of the Congo, a country with high rates of child mortality (104 deaths per 1000 live births). We conducted 127 in-depth interviews and eight focus group discussions with a range of community members (mothers, fathers and grandmothers of children under 5 years of age) and health providers (CHWs, traditional healers, doctors and nurses) on topics related to care seeking and case management for childhood illness and malnutrition, and analysed them iteratively using thematic content analysis. We find significant divergence between biomedical descriptions of child illness and concepts held by community members, who distinguished between local illnesses and so-called ‘white man’s diseases.’ Traditional healers were far less costly and more geographically accessible to families than were biomedical health providers, and usually served as families’ first recourse after home care. Services provided by traditional healers were also more comprehensive than services provided by CHWs, as the traditional medicine sphere recognised and encompassed care for ‘modern’ diseases (but not vice versa). Meanwhile, CHWs did not receive adequate training, supervision or supplies to provide child health services. Considering their accessibility, acceptability, affordability and ability to recognise all domains of illness (biomedical and spiritual), traditional healers can be seen as the de facto CHWs in Tshopo Province. National and international health policymakers should account for and involve this cadre of health workers when planning child health services and seeking to implement policies and programmes that genuinely engage with community health systems.

scholarly journals Assessing Access and Healthcare Quality of Maternal and Child Health Services in Facilities of Kasai Province in the Democratic Republic of the Congo (DRC)

2021 ◽  
Author(s):  
Britou Ndela ◽  
Philippe Ngwala ◽  
Adrien N’siala ◽  
Albert Kalonji ◽  
Felix Minuku ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Democratic Republic ◽  
Maternal Mortality Ratio ◽  
Child Health Services ◽  
Geographical Access ◽  
Republic Of The Congo ◽  
And Child Health

Abstract Background: The Democratic Republic of the Congo (DRC) is classified among the 5 countries with the highest global maternal mortality ratio (MMR) and highest under-five mortality rate (U5MR) in the world. Kasai is one of 14 provinces of the DRC, which have a high U5MR and MMR. Despite this overriding concern, almost no studies have been conducted to assess maternal et child situation in this province. The aim of this study was to assess access, availability, and quality of maternal and child health services in Kasai Province in the DRC. Methods: A cross-sectional survey of 49 Health Facilities (HFs) integrating quantitative and qualitative data collection was conducted in 18 Health Zones in Kasai Province in the DRC. Documentary review, interviews and direct observation of HFs were performed to collect data. Pearson’s chi-squared test was performed to establish the relation between variables.Results: Nearly 54 % of visited HFs population had a geographical access to maternal and child health services and the majority of medical acts were unaffordable. Basic and comprehensive emergency obstetric care (EmOC) were offered respectively by only 11.8% and 7.6% of HF and none provided high quality basic or comprehensive EmOC. This low availability and quality of EmOC are due to the insufficiency of necessary inputs and personal for maternal and child health services in the majority of HFs. Conclusion: The situation of maternal and child health services is very precarious in Kasai Province. The improvement of EmOC coverage will require rehabilitation of infrastructure, dotation of equipment, regular supply of medicines and strengthening of human resource capacity.

scholarly journals Assessment of gaps of knowledge and practices of frontline community workers in Chandragiri Mandal, Chittoor district, Andhra Pradesh: maternal and child health services

2021 ◽  
Vol 8 (3) ◽  
pp. 1299
Author(s):  
Shankar Reddy Dudala ◽  
Sathyendra Nath Ponna ◽  
Venkata Prasad Upadrasta ◽  
Hemalatha Bathina ◽  
Renuka Sadasivuni ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Vitamin A ◽  
Community Health ◽  
Maternal And Child Health ◽  
Andhra Pradesh ◽  
Health Workers ◽  
Child Health Services ◽  
Frontline Workers ◽  
And Child Health

Background: The undernutrition status among the vulnerable groups in rural areas still persists, despite provision of Anganwadi services in villages. Assessment knowledge and practices about maternal and child health services of frontline workers, will identify knowledge and implementation gaps. Objective was to assess the knowledge, attitude and practices of community health workers of maternal and child health services for identifying gaps for designing and implementing intervention.Methods: In this community based prospective, pre and post intervention-based study, Knowledge, Attitude and Practices (KAP) of the community health workers, in 16 villages and 13 Anganwadi centres of Chandragiri Mandal, Chittoor district, Andhra Pradesh about maternal and child health services were collected. The basic infrastructure of the anganwadis and health centres of Auxiliary nurse midwifes were assessed using a prevalidated survey instrument. Descriptive analysis was used.Results: The knowledge of antenatal and postnatal care was least among Anganwadi workers. Awareness regarding need of colostrum feeding was high in AWW compared to ASHA. ANM and AWW had lesser knowledge about duration of the exclusive breast feeding to the infant. Only 57.1% of ANM had sufficient knowledge about protein energy malnutrition consequences. AWW, ASHA did not have knowledge of vitamin A deficiency signs and symptoms although providing massive dose of vitamin A to children. ASHAs did not have awareness about anaemia and the knowledge was below 50% in ANMs.Conclusions: The study emphasizes the need for proper training with interactive sessions to these frontline workers, which will enhance their knowledge and skills for provision of quality services.

scholarly journals Trust of community health workers influences the acceptance of community-based maternal and child health services

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Merridy Grant ◽  
Aurene Wilford ◽  
Lyn Haskins ◽  
Sifiso Phakathi ◽  
Ntokozo Mntambo ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Health System ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Child Health Services ◽  
Community Members ◽  
Community Based ◽  
Complex Relationships ◽  
And Child Health

Background: Community health workers (CHWs) are a component of the health system in many countries, providing effective community-based services to mothers and infants. However, implementation of CHW programmes at scale has been challenging in many settings.Aim: To explore the acceptability of CHWs conducting household visits to mothers and infants during pregnancy and after delivery, from the perspective of community members, professional nurses and CHWs themselves.Setting: Primary health care clinics in five rural districts in KwaZulu-Natal, South Africa.Methods: A qualitative exploratory study was conducted where participants were purposively selected to participate in 19 focus group discussions based on their experience with CHWs or child rearing.Results: Poor confidentiality and trust emerged as key barriers to CHW acceptability in delivering maternal and child health services in the home. Most community members felt that CHWs could not be trusted because of their lack of professionalism and inability to maintain confidentiality. Familiarity and the complex relationships between household members and CHWs caused difficulties in developing and maintaining a relationship of trust, particularly in high HIV prevalence settings. Professional staff at the clinic were crucial in supporting the CHW’s role; if they appeared to question the CHW’s competency or trustworthiness, this seriously undermined CHW credibility in the eyes of the community.Conclusion: Understanding the complex contextual challenges faced by CHWs and community members can strengthen community-based interventions. CHWs require training, support and supervision to develop competencies navigating complex relationships within the community and the health system to provide effective care in communities.

scholarly journals Resolution of Resilience: Empirical Findings on the Challenges Faced and the Mitigation Strategies Adopted by Community Health Workers (CHWs) to Provide Maternal and Child Health (MCH) Services during the COVID-19 Pandemic in the Context of Odisha, India

Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 88
Author(s):  
Bijaya Kumar Mishra ◽  
Srikanta Kanungo ◽  
Kripalini Patel ◽  
Swagatika Swain ◽  
Subhralaxmi Dwivedy ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Community Health ◽  
Community Health Workers ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Community Support ◽  
Mitigation Strategies ◽  
Child Health Services ◽  
And Child Health

Community health workers (CHW) faced increased challenges in delivering maternal and child health services during the current COVID-19 pandemic. In addition to routine services, they were also engaged in pandemic management. In view of a dearth of evidence, the current study explores the challenges faced by CHWs while rendering maternal and child health services. A qualitative study through in-depth interviews (IDI) and focus group discussions (FGD) in six districts of Odisha was conducted from February to April 2021. Data were analyzed using MAXQDA software. Personal-level challenges, like lack of family support, stress, and fear of contracting COVID-19; facility-level challenges, like transportation problems and inadequate personal protective measures; and community-level challenges, like stigma, resistance, and lack of community support were major hindrances in provisioning routine MCH services. Prevailing myths and misconceptions concerning COVID-19 were factors behind stigma and resistance. Sharing experiences with family, practicing yoga and pranayam, engaging ambulance bikes, financial assistance to mothers, counseling people, and involving community leaders were some effective strategies to address these challenges. Development and implementation of appropriate strategy guidelines for addressing the challenges of frontline warriors will improve their work performance and achieve uninterrupted MCH services during pandemics or similar health emergencies.

scholarly journals 1666. Community Beliefs about Ebola and Implications for Disease Control in Eastern Democratic Republic of the Congo

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S609-S609
Author(s):  
Qaasim Mian ◽  
Kasereka Masumbuko Claude ◽  
Michael Hawkes
Keyword(s):  
Ebola Virus ◽  
Democratic Republic ◽  
Traditional Healers ◽  
Control Measures ◽  
Community Members ◽  
Group Discussions ◽  
Major Barrier ◽  
Modes Of Transmission ◽  
Infection Control Measures ◽  
Republic Of The Congo

Abstract Background The current Ebola epidemic in Eastern Democratic Republic of the Congo (DRC) has surpassed 1,300 cases and 800 deaths. Social resistance is a major barrier to control efforts, and invites an exploration of community beliefs around Ebola and its origins. Methods Mixed-methods study, using focus group discussions (FGDs) with key community informants and a 19-item survey questionnaire broadly sampling the outbreak zone. Results Between 4 to 17 August, 2018, we conducted 4 FGDs (20 participants) and surveyed 286 community members across Eastern DRC. FGDs revealed a widespread rumor in Mangina early in the epidemic of two twins bewitched by their aunt after eating her cat, who developed bleeding symptoms and triggered the epidemic. However, this myth appeared to dissipate as the epidemic progressed and biomedical transmission became generally accepted (medical syncretism). In our survey, 6% of respondents endorsed supernatural origins of Ebola. This subgroup did not differ from other respondents in terms of knowledge of biomedical modes of transmission or resistant attitudes toward infection control measures, but was more likely to believe that traditional healers could cure Ebola. Wild animals of the forest were recognized as sources of the Ebola virus by 53% of survey respondents. Our findings suggest that skepticism and/or denial of the biomedical discourse, coupled with and mistrust and fear of ETUs may fuel “underground” transmission of Ebola outside western-style medical facilities, as patients seek care from traditional healers, who are ill-equipped to deal with a highly contagious biohazard. Conclusion A deeper understanding of beliefs around Ebola origins may illuminate strategies to engage communities in control efforts. Disclosures All authors: No reported disclosures.

scholarly journals Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: A theory-driven scoping review

2019 ◽  
Author(s):  
Eveline Muika Kabongo ◽  
Ferdinand Mukumbang ◽  
Peter N/A Delobelle ◽  
Edward N/A Nicol
Keyword(s):  
Health Care ◽  
Child Health ◽  
Community Health ◽  
Community Health Workers ◽  
Health Care Providers ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Child Health Services ◽  
Care Providers ◽  
And Child Health

Abstract Introduction Despite the growing global application of mobile health (mHealth) technology in maternal and child health, the contextual factors and mechanisms by which interventional outcomes are generated have not been subjected to extensive review. In this study, we sought to identify context, mechanisms and outcome elements from implementation and evaluation studies of mHealth interventions to formulate theories or models explicating how mHealth interventions work (or not) both for health care providers and for pregnant women and new mothers.Method An electronic search of six online databases (Medline, Pubmed, Google Scholar, Scopus, Academic Search Premier and Health Systems Evidence) was performed. Using appropriate MeSH terms and selection procedure, 32 articles were considered for analysis. A theory-driven approach, narrative synthesis, was applied to synthesise the data. Thematic content analysis was used to delineate the elements of the intervention, including its context, actors, mechanism and outcomes. Retroduction was applied to link these elements using a realist evaluation heuristic to form generative theories.Results Mechanisms that promote the implementation of mHealth by community health workers/health care providers include motivation, perceived skill and knowledge improvement, improved self-efficacy, improved confidence, improved relationship between community health workers and clients, perceived support of community health workers, perceived ease of use and usefulness of mHealth, For pregnant women and new mothers, mechanisms that trigger the uptake of mHealth and use of maternal and child health services included: perceived service satisfaction, perceived knowledge acquisition, support and confidence, improved self-efficacy, encouragement, empowerment and motivation. Information overload was identified as a potential negative mechanism for the uptake of maternal and child health services.Conclusion The models developed in this study provide a detailed understanding of the implementation and uptake of mHealth interventions and how they improve maternal and child health services in low and middle income countries. These models provide a foundation for the ‘white box’ or theory-driven evaluation of mHealth intervention and can improve the rollout and implementation where required.

scholarly journals Lessons for responding to COVID-19, from Exemplars in Under-five Mortality Reduction

2020 ◽  
Vol 4 ◽  
pp. 120
Author(s):  
Lisa R Hirschhorn ◽  
Nathaniel Gerthe ◽  
David E Phillips ◽  
Oliver Rothschild ◽  
Manpreet Singh ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Health Systems ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Child Health Services ◽  
Data Systems ◽  
Under Five ◽  
Success Stories ◽  
And Child Health

COVID-19 may not have the same direct effects on children as it does on older adults, but its indirect effects still pose a threat to child health, by disrupting delivery of routine health services like immunizations. This has happened during previous crises, and early indications point towards similar disruptions due to the coronavirus pandemic. To mitigate this, countries need to build resilient health systems capable of maintaining essential maternal and child health interventions, while also responding to COVID. How can this be accomplished? To find some answers, we can learn from countries in the past who improved health outcomes in the face of challenging circumstances. Specific to child health, countries with positive-outlier performance in reducing under-five mortality provide helpful strategies. These lessons include a clear national plan that drives rapid response, leveraging existing data systems to inform decision-making, engaging communities via community health workers, and focusing on equity. Today, countries around the world are facing the challenge of responding to the pandemic while building resilient health systems that continue to deliver invaluable maternal and child health services. Studying lessons from previous success stories can help inform the road ahead.

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