scholarly journals ASHA Kirana: when digital technology empowered front-line health workers

2021 ◽  
Vol 6 (Suppl 5) ◽  
pp. e005039
Author(s):  
V Srinidhi ◽  
Baneen Karachiwala ◽  
Aditi Iyer ◽  
Bhavya Reddy ◽  
Vinalini Mathrani ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Digital Technology ◽  
Assessment Tool ◽  
Health Workers ◽  
Health Centre ◽  
Home Visits ◽  
Front Line ◽  
Contributing Factors ◽  
Individual Level ◽  
Maternal Risks

This practice paper describes our experience of implementing accredited social health activists (ASHA) Kirana, a digital technology-enabled Maternal Clinical Assessment Tool (M-CAT) and how the ASHAs felt empowered in the process. M-CAT aimed to train ASHAs to collect data that assists doctors in identifying maternal risks, in Karnataka, India. Systematic clinical assessment is not common in rural public health institutions. High caseloads, a tendency to ‘normalise’ maternal risks, varied competence of doctors and task shifting to insufficiently trained cadres may be some contributing factors. M-CAT was a response to this challenge. ASHAs asked a set symptom-cluster-based questions during home visits that were analysed by software algorithms to generate reports for doctors. M-CAT was implemented in one primary health centre with a group of 14 ASHAs, 2 auxiliary nurse midwives and 349 pregnant and postpartum women over 4 months. Our team worked with the ASHAs to refine the tool and supported them with training, hands-on assistance and regular debrief meetings. By learning how to collect individual-level data that they could interpret and act on, the ASHAs felt empowered with new knowledge on maternal risks. Their perfunctory data collection at home visits changed to substantive interactions with women and families, during which they captured pertinent qualitative information. The information asymmetry between doctors and ASHAs reduced. ASHAs started taking proactive steps on early indications of maternal risks. They changed from being mere transmitters of information to active users of it. Thus, technology-driven initiatives that include empowerment as an objective can strengthen the role of front-line workers in health systems.

scholarly journals Perceived sources of occupational burn-out and embitterment among front-line health workers for COVID-19 control in Gyeonggi province, South Korea: a qualitative study

2021 ◽  
pp. oemed-2021-107635
Author(s):  
Bee-Ah Kang ◽  
Sijoung Kwon ◽  
Myoungsoon You ◽  
Heeyoung Lee
Keyword(s):  
Mental Health ◽  
South Korea ◽  
Mental Health Problems ◽  
Health Workers ◽  
Health Centre ◽  
Social Recognition ◽  
Contact Tracing ◽  
Front Line ◽  
Organisational Support ◽  
Burn Out

ObjectivesFront-line health workers (FHWs) for COVID-19 control in South Korea have implemented a labour-intensive contact tracing programme, which places them at high risk for mental health problems. However, a few studies have examined mental health conditions in this population. We employed a qualitative approach to understand the factors perceived as causes of burn-out and embitterment among temporary FHWs to provide recommendations for supporting the workforce.MethodsWe recruited 20 FHWs to participate in semistructured focus group interviews through purposive sampling. The sample size was determined on the basis of data saturation. We collected data from October to November 2020, audiorecording and transcribing the interviews. Data analysis was conducted manually, applying the principles of grounded theory.ResultsFive levels of perceived sources of occupational burn-out and embitterment emerged. FHWs showed considerable mistrust of patients and faced ethical dilemmas in accessing and disclosing personal information. Poor collaboration with community health centre workers and interested parties as well as inadequate organisational support aggravated their conditions. Lack of social recognition and employment instability also presented challenges for FHWs’ mental health.ConclusionsThe current pandemic response system imposes great moral and emotional burdens on the workforce, prompting the need for initiatives to safeguard the values and needs of those who represent the backbone of the system. This study suggests that multilevel strategies, including providing organisational support and establishing contingency plans for workforce management and resource distribution, may improve FHWs’ mental health outcomes as well as the health system for emergency preparedness.

scholarly journals Working conditions and health status of 6,317 front line public health workers across five provinces in China during the COVID-19 epidemic: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jinghua Li ◽  
Jingdong Xu ◽  
Huan Zhou ◽  
Hua You ◽  
Xiaohui Wang ◽  
...  
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Health Status ◽  
Health Outcomes ◽  
Working Conditions ◽  
Health Workers ◽  
Front Line ◽  
Cross Sectional ◽  
Self Rated Health ◽  
Public Health Workers

ABSTRACT Background Public health workers at the Chinese Centre for Disease Control and Prevention (China CDC) and primary health care institutes (PHIs) were among the main workers who implemented prevention, control, and containment measures. However, their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of front line public health workers in China during the COVID-19 epidemic. Methods Between 18 February and 1 March 2020, we conducted an online cross-sectional survey of 2,313 CDC workers and 4,004 PHI workers in five provinces across China experiencing different scales of COVID-19 epidemic. We surveyed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health using a self-constructed questionnaire and standardised measurements (i.e., Patient Health Questionnaire and General Anxiety Disorder scale). To examine the independent associations between working conditions and health outcomes, we used multivariate regression models controlling for potential confounders. Results The prevalence of depression, anxiety, and poor self-rated health was 21.3, 19.0, and 9.8%, respectively, among public health workers (27.1, 20.6, and 15.0% among CDC workers and 17.5, 17.9, and 6.8% among PHI workers). The majority (71.6%) made immense efforts in both field and non-field work. Nearly 20.0% have worked all night for more than 3 days, and 45.3% had worked throughout the Chinese New Year holiday. Three risk factors and two protective factors were found to be independently associated with all three health outcomes in our final multivariate models: working all night for >3 days (multivariate odds ratio [ORm]=1.67~1.75, p<0.001), concerns about infection at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p<0.001), initiating COVID-19 prevention work after January 23 (ORm=0.78~0.82, p=0.002~0.008), and ability to persist for > 1 month at the current work intensity (ORm=0.44~0.55, p<0.001). Conclusions Chinese public health workers made immense efforts and personal sacrifices to control the COVID-19 epidemic and faced the risk of mental health problems. Efforts are needed to improve the working conditions and health status of public health workers and thus maintain their morale and effectiveness during the fight against COVID-19.

scholarly journals Knowledge and practices regarding malaria and the National Treatment Guidelines among public health workers in Equatorial Guinea

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Marta Blanco ◽  
Pablo Suárez-Sanchez ◽  
Belén García ◽  
Jesús Nzang ◽  
Policarpo Ncogo ◽  
...  
Keyword(s):  
Public Health ◽  
Treatment Guidelines ◽  
Health Workers ◽  
Health Centre ◽  
Regional Hospital ◽  
Malaria Treatment ◽  
Diagnosis And Treatment ◽  
Equatorial Guinea ◽  
Public Health Facilities ◽  
Health Centres

Abstract Background In 2018, an estimated 228 million cases of malaria occurred worldwide. Countries are far from having achieved reasonable levels of national protocol compliance among health workers. Lack of awareness of treatment protocols and treatment resistance by prescribers threatens to undermine progress when it comes to reducing the prevalence of this disease. This study sought to evaluate the degree of knowledge and practices regarding malaria diagnosis and treatment amongst prescribers working at the public health facilities of Bata, Equatorial Guinea. Methods A cross-sectional survey was conducted in October-December 2017 amongst all public health professionals who attended patients under the age of 15 years, with suspected malaria in the Bata District of Equatorial Guinea. Practitioners were asked about their practices and knowledge of malaria and the National Malaria Treatment Guidelines. A bivariate analysis and a logistic regression model were used to determine factors associated with their knowledge. Results Among the 44 practitioners interviewed, 59.1% worked at a Health Centre and 40.9% at the District Hospital of Bata. Important differences in knowledge and practices between hospital and health centre workers were found. Clinical diagnosis was more frequently by practitioners at the health centres (p = 0.059), while microscopy confirmation was more frequent at regional hospital (100%). Intramuscular artemether was the anti-malarial most administrated at the health centres (50.0%), while artemether-lumefantrine was the treatment most used at the regional hospital (66.7%). Most practitioners working at public health facilities (63.6%) have a low level of knowledge regarding the National Malaria Treatment Guidelines. While knowledge regarding malaria, the National Malaria Treatment Guidelines and treatment resistances is low, it was higher amongst hospital workers than amongst practitioners at health centres. Conclusions It is essential to reinforce practitioners’ knowledge, treatment and diagnosis practices and use of the National Malaria Treatment Guidelines in order to improve malaria case management and disease control in the region. A specific malaria training programme ensuring ongoing updates training is necessary in order to ensure that greater experience does not entail obsolete knowledge and, consequently, inadequate diagnosis and treatment practices.

scholarly journals Clinical diagnosis in paediatric patients at urban primary health care facilities in southern Malawi: a longitudinal observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mtisunge Joshua Gondwe ◽  
Marc Y. R. Henrion ◽  
Thomasena O’Byrne ◽  
Clemens Masesa ◽  
Norman Lufesi ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Health Workers ◽  
Health Centre ◽  
Treatment Algorithm ◽  
Secondary Level ◽  
Support Staff ◽  
Health Care Facilities ◽  
Severe Illness ◽  
Primary Health ◽  
Sick Children

Abstract Background Despite health centres being the first point of contact of care, there are challenges faced in providing care to patients at this level. In Malawi, service provision barriers reported at this level included long waiting times, high numbers of patients and erratic consultation systems which lead to mis-diagnosis and delayed referrals. Proper case management at this level of care is critical to prevent severe disease and deaths in children. We aimed to adopt Emergency, Triage, Assessment and Treatment algorithm (ETAT) to improve ability to identify severe illness in children at primary health centre (PHC) through comparison with secondary level diagnoses. Methods We implemented ETAT mobile Health (mHealth) at eight urban PHCs in Blantyre, Malawi between April 2017 and September 2018. Health workers and support staff were trained in mHealth ETAT. Stabilisation rooms were established and equipped with emergency equipment. All PHCs used an electronic tracking system to triage and track sick children on referral to secondary care, facilitated by a unique barcode. Support staff at PHC triaged sick children using ETAT Emergency (E), Priority (P) and Queue (Q) symptoms and clinician gave clinical diagnosis. The secondary level diagnosis was considered as a gold standard. We used statistical computing software R (v3.5.1) and used exact 95% binomial confidence intervals when estimating diagnosis agreement proportions. Results Eight-five percentage of all cases where assigned to E (9.0%) and P (75.5%) groups. Pneumonia was the most common PHC level diagnosis across all three triage groups (E, P, Q). The PHC level diagnosis of trauma was the most commonly confirmed diagnosis at secondary level facility (85.0%), while a PHC diagnosis of pneumonia was least likely to be confirmed at secondary level (39.6%). The secondary level diagnosis least likely to have been identified at PHC level was bronchiolitis 3 (5.2%). The majority of bronchiolitis cases (n = 50; (86.2%) were classified as pneumonia at the PHC level facility. Conclusions Implementing a sustainable and consistent ETAT approach with stabilisation and treatment capacity at PHC level reinforce staff capacity to diagnose and has the potential to reduce other health system costs through fewer, timely and appropriate referrals.

scholarly journals Cutaneous anthrax outbreak associated with handling dead animals, Rhino Camp sub-county: Arua District, Uganda, January–May 2018

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Vivian Ntono ◽  
Daniel Eurien ◽  
Lilian Bulage ◽  
Daniel Kadobera ◽  
Julie Harris ◽  
...  
Keyword(s):  
Health Workers ◽  
Clinical Sample ◽  
Health Centre ◽  
Skin Lesions ◽  
Suspected Case ◽  
Prevention Measures ◽  
Multiple Exposures ◽  
Increased Risk ◽  
Control And Prevention ◽  
Cutaneous Anthrax

Abstract Background On 18 January 2018 a 40 year old man presented with skin lesions at Rhino Camp Health Centre. A skin lesion swab was collected on 20 January 2018 and was confirmed by PCR at Uganda Virus Research Institute on 21 January 2018. Subsequently, about 9 persons were reported to have fallen ill after reporting contact with livestock that died suddenly. On 9 February 2018, Arua District notified Uganda Ministry of Health of a confirmed anthrax outbreak among humans in Rhino Camp sub-county. We investigated to determine the scope and mode of transmission and exposures associated with identified anthrax to guide control and prevention measures. Methods We defined a suspected cutaneous anthrax case as onset of skin lesions (e.g., papule, vesicle, or eschar) in a person residing in Rhino Camp sub-county, Arua District from 25 December 2017 to 31 May 2018. A confirmed case was a suspected case with PCR-positivity for Bacillus anthracis from a clinical sample. We identified cases by reviewing medical records at Rhino Camp Health Centre. We also conducted additional case searches in the affected community with support from Community Health Workers. In a retrospective cohort study, we interviewed all members of households in which at least one person had contact with the carcasses of or meat from animals suspected to have died of anthrax. We collected and tested hides of implicated animals using an anthrax rapid diagnostic test. Results We identified 14 case-patients (1 confirmed, 13 suspected); none died. Only males were affected (affected proportion: 12/10,000). Mean age of case-persons was 33 years (SD: 22). The outbreak lasted for 5 months, from January 2018–May 2018, peaking in February. Skinning (risk ratio = 2.7, 95% CI = 1.1–6.7), dissecting (RR = 3.0, 95% CI = 1.2–7.6), and carrying dead animals (RR = 2.7, 95% CI = 1.1–6.7) were associated with increased risk of illness, as were carrying dissected parts of animals (RR = 2.9, 95% CI 1.3–6.5) and preparing and cooking the meat (RR = 2.3, 95% CI 0.9–5.9). We found evidence of animal remains on pastureland. Conclusion Multiple exposures to the hides and meat of animals that died suddenly were associated with this cutaneous anthrax outbreak in Arua District. We recommended public education about safe disposal of carcasses of livestock that die suddenly.

scholarly journals Knochengesundheit und Hochleistungssport

2021 ◽  
Author(s):  
Lisa-Maria Wallwiener ◽  
Barbara Kapfer ◽  
Vanadin Seifert-Klauss
Keyword(s):  
Clinical Assessment ◽  
Medikamentöse Therapie ◽  
Assessment Tool ◽  
Relative Energy ◽  
Sich Eine ◽  
Energy Deficiency ◽  
Körperliche Betätigung

ZusammenfassungRegelmäßige körperliche Betätigung trägt zu einer gesunden Knochendichte bei, Leistungssportlerinnen in einigen Sportarten weisen jedoch eine erhöhte Prävalenz erniedrigter Knochendichte sowie vermehrt Stressfrakturen auf. Häufig liegt dem ein relatives Energiedefizit (RED), verbunden mit hoher mechanischer Belastung und intensivem Trainingsalltag, zugrunde. Das Vorliegen eines RED im Sport ist oft unterdiagnostiziert, daher hat sich eine systematische multidisziplinäre Zusammenarbeit unter Zuhilfenahme standardisierter Tests, z. B. des RED‑S CAT (Relative Energy Deficiency in Sport Clinical Assessment Tool) als hilfreich erwiesen. Therapieansätze zielen primär auf eine Behebung der negativen Energiebilanz der Patientin als auch auf psychotherapeutische Interventionen ab. Darüber hinaus kann in schweren Fällen eine medikamentöse Therapie zur Unterstützung sowohl einer ausgeglichenen hormonellen Situation als auch des Knochenstoffwechsels notwendig sein.

Vicarious trauma: Strategies for legal practice and law schools

2021 ◽  
pp. 1037969X2199985
Author(s):  
Kelley Burton ◽  
Amanda Paton
Keyword(s):  
Mental Health ◽  
Vicarious Trauma ◽  
Health Workers ◽  
Mental Health Workers ◽  
Future Research ◽  
First Year ◽  
Helping Professionals ◽  
Legal Practice ◽  
Law Schools ◽  
Individual Level

We examine the effect of vicarious trauma on various stakeholders in the legal profession. Criminal lawyers are likely to experience higher levels of vicarious trauma than other lawyers. Additionally, lawyers are at a heightened risk of vicarious trauma compared to other helping professionals such as mental health workers. We identify a range of strategies that can be implemented at an organisational or individual level to address vicarious trauma. Future research should evaluate the effectiveness of vicarious trauma strategies and initiatives. Importantly, we argue that vicarious trauma initiatives should begin in first-year law courses and continue over a career.

Can digital technology help reduce smoke exposure and protect health in extreme air quality events?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S L Campbell ◽  
P J Jones ◽  
A J Wheeler ◽  
C Lucani ◽  
G J Williamson ◽  
...  
Keyword(s):  
Air Quality ◽  
Digital Technology ◽  
Online Survey ◽  
Quality Standard ◽  
Environmental Hazards ◽  
Smoke Exposure ◽  
Smartphone Apps ◽  
Individual Level ◽  
Health Authorities ◽  
Public Health Authorities

Abstract Background In the southern hemisphere summer of 2019-2020, Australia experienced its most severe bushfire season on record. Smoke from fires affected 80% of the population, with large exceedances of the Australian National Air Quality Standard for particulate air pollution recorded in all major population centres during this period. We examined if emerging and innovative digital technology can assist extreme smoke-affected populations to reduce their exposure and protect their health. Methods AirRater is a free smartphone app that tracks air quality and user symptoms in near real-time. We distributed an online survey to over 13,000 app users to assess how they used this information during the 2019-20 bushfire season, and if the app was helpful in decision-making around reducing personal smoke exposure. Results We received responses from 1732 users (13.3%). Respondents reported that the app was highly useful, supporting informed decisions regarding daily activities during the smoke-affected period. Commonly reported activities supported by information provided through the app were staying inside (76%), rescheduling or planning outdoor activities (64%), changing locations to less affected areas (29%) and informing decisions on medication use (15%). Conclusions Smartphone apps enable users to reduce smoke exposure and protect their health by providing individual-level and location-specific data. Furthermore, digital technology such as AirRater provides the potential to provide insight into the community impacts of environmental hazards such as bushfire smoke. Key messages Smartphone apps enable users to reduce their smoke exposure and protect their health. These emerging technologies can help public health authorities to understand the community impact of environmental hazards.

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