Immunization Drop-Outs and Maternal Behavior: Evaluation of Reasons Given and Strategies for Maintaining Gains Made in the National Vaccination Campaign in Liberia

Through annual National Vaccination Weeks, Liberia, one of thirteen African countries participating in the CCCD program, has achieved good rates of initial vaccination coverage against childhood diseases. However, rates of completion have been disappointing. Described is a community-based operations research methodology for a.) identifying reasons for non-completion of the vaccination series according to groups of mothers, front-line health workers and country level administrators, b.) for making recommendations for alternatives in the delivery system, and c.) for critiquing the focus group methodology as a tool for increasing commitment to program goals.

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Determinants of knowledge, attitudes, and practices of front-line health workers during the first wave of COVID-19 in Africa: a multi-center online cross-sectional study

10.21203/rs.3.rs-1164116/v1 ◽

2021 ◽

Author(s):

Larrey Kasereka Kamabu ◽

Hervé Monka Lekuya ◽

Richard Newton Iranya ◽

Bienvenu Muhindo Kasusula ◽

Franck Katembo Sikakulya ◽

...

Keyword(s):

Health Workers ◽

Cross Sectional Study ◽

Sub Saharan Africa ◽

Sectional Study ◽

Front Line ◽

African Countries ◽

Cross Sectional ◽

Poor Knowledge ◽

Attitude And Practice ◽

Good Attitude

Abstract Background: During its first wave of COVID-19 infection in sub-Saharan Africa, there was insufficient understanding of the pandemic among front-line health care professionals that has led to a misidentification, and mistreatment of affected patients, with a potential risk of contracting and spreading the disease. This study was carried out to determine the Knowledge, attitude, and practices (KAP) of front-line health workers (HWs) towards COVID-19 in Africa and their related factors.Methods: This was a multi-centers online cross-sectional study conducted over a 3-months study-period using a google survey link among front lines HWs involved in the COVID-19 response in 26 African countries. Chi-square test & logistic regression were used in the bivariate and multivariate analysis respectively to assess determinants of KAP. Statistical analysis was done using STATA version 16; all tests were two-sided with 95% confidence interval. Results: Five hundred and seventeen (517, 96.3%) consented to participate in this study from 26 African countries; 289 (55.9%) were male and 228 (44.1%) female. Overall, most of HWs, 379 (73.3%) showed poor knowledge about COVID-19 infection and preventive measures. In contrast, majority of them showed good attitude (89%) and practice (90.3%) towards prevention of COVID-19 infections. Knowledge varied among countries; Uganda had the greatest number of HWs with good knowledge. (OR = 28.09, p <0.0001) followed by Ghana (OR=10.92, p=0.001) and DRC (OR: 4.59, p=0.015). The cadre of HWs also influenced knowledge; doctors were the most knowledgeable as compared to other cadres (OR: 3.4, p= 0.005). Additionally, knowledge increased with increasing HWs’ education level (p=0.011).Attitude and practice were both influenced by HWs country of workplace (p=0.05 & p< 0.0001 respectively) and their cadre (p = 0.025 & p < 0.0001 respectively).Conclusions: Majority of the front-line HWs in the African region had an overall good attitude and practice towards COVID-19 infection and practice measures despite relatively poor Knowledge. The KAP is influenced by HWs country of workplace, their cadre and level of education.

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A review of studies on community based early warning systems

Jàmbá Journal of Disaster Risk Studies ◽

10.4102/jamba.v8i1.206 ◽

2016 ◽

Vol 8 (1) ◽

Cited By ~ 17

Author(s):

Margaret Macherera ◽

Moses J. Chimbari

Keyword(s):

Early Warning ◽

Weather Conditions ◽

Early Warning Systems ◽

Warning Systems ◽

African Countries ◽

Community Based ◽

Warning Messages ◽

Specific Community ◽

Risk Knowledge ◽

Made In

Community-based early warning systems involve community driven collection and analysis of information that enable warning messages to help a community to react to a hazard and reduce the resulting loss or harm. Most early warning systems are designed at the national or global level. Local communities’ capacity to predict weather conditions using indigenous knowledge has been demonstrated in studies focusing on climate change and agriculture in some African countries. This review was motivated by successes made in non-disease specific community-based early warning systems with a view to identify opportunities for developing similar systems for malaria. This article reviewed the existing community-based early warning systems documented in literature. The types of disasters that are addressed by these systems and the methodologies utilised in the development of the systems were identified. The review showed that most of the documented community-based early warning systems focus on natural disasters such as floods, drought, and landslides. Community-based early warning systems for human diseases are very few, even though such systems exist at national and regional and global levels. There is a clear gap in terms of community-based malaria early warning systems. The methodologies for the development of the community-based early warning systems reviewed mainly derive from the four elements of early warning systems; namely risk knowledge, monitoring, warning communication and response capability. The review indicated the need for the development of community based early warning systems for human diseases.Keywords: community; early warning; disaster; hazards

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Towards Sustainable Community-Based Systems for Infectious Disease and Disaster Response; Lessons from Local Initiatives in Four African Countries

Sustainability ◽

10.3390/su131810083 ◽

2021 ◽

Vol 13 (18) ◽

pp. 10083

Author(s):

Harro Maat ◽

Dina Balabanova ◽

Esther Mokuwa ◽

Paul Richards ◽

Vik Mohan ◽

...

Keyword(s):

Case Studies ◽

Disaster Response ◽

Health Workers ◽

Systems Of Care ◽

Extreme Weather Events ◽

African Countries ◽

Community Based ◽

Holistic View ◽

Sustainable Community ◽

Response Planning

This paper explores the role of decentralised community-based care systems in achieving sustainable healthcare in resource-poor areas. Based on case studies from Sierra Leone, Madagascar, Uganda and Ethiopia, the paper argues that a community-based system of healthcare is more effective in the prevention, early diagnosis, and primary care in response to the zoonotic and infectious diseases associated with extreme weather events as well as their direct health impacts. Community-based systems of care have a more holistic view of the determinants of health and can integrate responses to health challenges, social wellbeing, ecological and economic viability. The case studies profiled in this paper reveal the importance of expanding notions of health to encompass the whole environment (physical and social, across time and space) in which people live, including the explicit recognition of ecological interests and their interconnections with health. While much work still needs to be done in defining and measuring successful community responses to health and other crises, we identify two potentially core criteria: the inclusion and integration of local knowledge in response planning and actions, and the involvement of researchers and practitioners, e.g., community-embedded health workers and NGO staff, as trusted key interlocuters in brokering knowledge and devising sustainable community systems of care.

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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

BMC Public Health ◽

10.1186/s12889-020-10146-0 ◽

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.

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The Costs of Introducing the Hepatitis B Birth Dose Vaccine into the National Immunization Programme in Senegal (NéoVac Study)

Vaccines ◽

10.3390/vaccines9050521 ◽

2021 ◽

Vol 9 (5) ◽

pp. 521

Author(s):

Andréa Gosset ◽

Marie Libérée Nishimwe ◽

Mamadou Yaya Diallo ◽

Lucas Deroo ◽

Aldiouma Diallo ◽

...

Keyword(s):

Hepatitis B ◽

Weighted Average ◽

Structured Interviews ◽

Cost Information ◽

African Countries ◽

Training Costs ◽

Country Level ◽

Immunization Programme ◽

Financial Costs ◽

Birth Dose

Some African countries are still reluctant to introduce the hepatitis B vaccine birth dose (HepB-BD) into their expanded program of immunization (EPI), partly because of logistical, economic, and cost information constraints. To assist decision-makers in these countries, we assessed the economic and financial costs of HepB-BD introduction in Senegal in 2016. We performed a micro-costing study in a representative sample of Senegal’s EPI sites at all levels in 2018. Information on EPI and HepB-BD activity-related inputs and costs was collected using standardized questionnaires and semi-structured interviews. Using inverse probability weighting, we computed weighted average costs associated with HepB-BD introduction for each EPI level, country-level aggregated costs and estimated costs per newborn. Economic and financial costs from a government perspective were estimated in US dollars for 2015, 2016 and 2017. Total economic costs were USD 143,364 in 2015, USD 759,406 in 2016 and USD 867,311 in 2017, while financial costs were USD 127,745, USD 82,519 and USD 29,853, respectively. When annualizing pre-introduction and initial training costs, the economic (financial) cost per vaccinated newborn was USD 2.10 (USD 0.30) in 2016 and USD 1.90 (USD 0.20) in 2017. Our estimates provide valuable information to implement HepB-BD in Sub-Saharan African countries that have not yet integrated this vaccine.

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

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00802-6 ◽

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.

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The implementation of a mobile application to support community-based health workers

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.051 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A C F Martins ◽

P L Pereira ◽

A C C N Mafra ◽

J L Miraglia ◽

C N Monteiro ◽

...

Keyword(s):

Health Care ◽

Mobile Application ◽

Total Population ◽

Health Workers ◽

Data Entry ◽

Population Data ◽

Administrative Staff ◽

Economic Data ◽

Process Change ◽

Community Based

Abstract Issue Real-time access to up-to-date population information is essential to the strategic planning of primary health care (PHC). In the Brazilian public health system community-based health workers (CHWs), working as part of PHC teams, collect health, demographic and socio-economic data from individuals mainly through paper-based forms that are later entered manually into electronic information systems. Mobile applications could help to improve the quality and speed of this process facilitating the CHWs day-to-day work while improving the access to the collected information. Description of the Problem During September of 2019, a mobile application installed in tablets for the collection of health, demographic and socio-economic data was deployed for 432 CHWs of 87 PHC teams in the southern region of São Paulo, Brazil, serving a total population of 283,324 individuals. During implementation, the acceptability and challenges faced by CHWs were evaluated and the time taken to complete data entry. Results Seventy-two hours of training were offered to CHWs and other 139 professionals including managers, nurses and administrative staff (AS). Some CHWs reported concerns about the process change and fear of not being able to operate the application, especially those unfamiliar to the technology. With training and team support, fear was transformed into satisfaction with the realization of the benefits of the system. The main infrastructure challenge was the need for installation of Wi-Fi routers in some health care units, in addition to the replacement 4.4% of damaged tablets. In four months 97.6% of the total population was registered in the application. Lessons A WhatsApp group was created to clarify AS doubts, receive suggestions and disseminate guidelines. AS remained as the reference point at healthcare units and data completeness still needs to be reinforced. Key messages A mobile application was well-accepted by CHWs and could facilitate the collection of population data. A tablet app proved to be a useful tool to generate information for the PHC teams.

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Financial constraint, trust, and export performances: firm-level evidence from Africa

Journal of Institutional Economics ◽

10.1017/s1744137421000059 ◽

2021 ◽

pp. 1-23

Author(s):

Maty Konte ◽

Gideon Ndubuisi

Keyword(s):

Financial Constraints ◽

Interpersonal Trust ◽

Negative Relationship ◽

Financial Constraint ◽

African Countries ◽

Firm Level ◽

Country Level ◽

The World Bank ◽

Negative Effect ◽

Enterprise Surveys

Abstract Several existing studies have documented a negative relationship between firm financial constraint and export activities but do not attempt to examine factors that could attenuate this relationship in Africa. In this paper, we examine the effect of financial constraint on exports in Africa and explore how the level of trust in countries where firms are located shapes this relationship. We combine the World Bank Enterprise Surveys with different measures of country-level personal and interpersonal trust computed from the Afrobarometer surveys of 19 African countries. Our results show that financial constraints negatively affect export activities. However, this negative effect is attenuated for firms that are located in trust-intensive societies. These findings are robust to different specifications. Interestingly, we find that small and medium-sized enterprises in Africa are more likely to be affected by financial constraints but also more likely to benefit from a higher level of both personal and interpersonal trust, while for larger firms only interpersonal trust matters.

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Umbilical cord care through community-based distribution of chlorhexidine in rural Sindh, Pakistan

European Journal of Public Health ◽

10.1093/eurpub/ckz186.162 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Shah ◽

Q Jamali ◽

F Aisha

Keyword(s):

Rural Communities ◽

Data Collection ◽

Umbilical Cord ◽

Rural Areas ◽

Health Workers ◽

High Rate ◽

Cord Care ◽

Community Based ◽

Sindh Province ◽

At Home

Abstract Background Unsafe practices such as cutting umbilical cord with unsterilized instruments and application of harmful substances, are in practice in many rural areas of Pakistan, and associated with high risk of neonatal sepsis and mortality. Methods We conducted an implementation research in 2015 in Tharparkar district, in Sindh province of Pakistan to understand the feasibility and acceptability of community-based distribution of chlorhexidine (CHX) in rural Pakistan. For this cohort group-only study, 225 lady health workers (LHWs) enrolled 495 pregnant women. Enrolled women received 4% CHX gel and user’s instructions for newborn cord care. The LHWs also counseled women on the benefits and correct use of CHX. Study enumerators collected data from CHX receiving women 3 times: at around 2 weeks before delivery, within 24 hours after delivery, and on the 8th day after delivery. We implemented this study jointly in collaboration with Ministry of Health in Sindh province, Pakistan. Results Among enrolled participants, 399 women (81%) received only the first visit, 295 women (60%) received first two visits and 261 women (53%) received all three visits by enumerators. Among 399 women, who received CHX gel, counseling on its use and were respondent to the first round data collection, 78% remembered that the CHX gel to be applied to cord stump and surrounding areas immediately after birth; but less than a third (29%) forgot the need to keep the cord clean and dry. Among 295 respondents in the first two rounds of data collection, who delivered at home, 97% applied CHX to cord stump on the first day. Conclusions Community-based CHX distribution by LHWs, along with counseling to recipient women, resulted in a high rate of cord care with CHX among newborn delivered at home. Results from this study may help program implementers to consider expanding this intervention for improving newborn cord care on the first day of life in Pakistan. Key messages Community-based distribution of chlorhexidine for newborn cord care appears as highly acceptable and feasible in rural communities in Pakistan. Relevant program policy supporting community-based CHX distribution along with counseling by LHW may help expanding coverage of newborn cord care in rural communities in Pakistan.

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Postscript: prescribing for acute diarrhea (30 December 1983, p 101–4)

Drug and Therapeutics Bulletin ◽

10.1136/dtb.22.16.64 ◽

1984 ◽

Vol 22 (16) ◽

pp. 64-64

Keyword(s):

Acute Diarrhea ◽

Clinical Presentation ◽

Health Workers ◽

Teaching Tool ◽

London School ◽

Infectious Agents ◽

Basic Information ◽

Professional Health ◽

And Control ◽

Made In

A CHART – Most of the points made in our article are also summarised in an information chart “Coping with Diarrhoea”, produced last year by the Ross Institute. It is intended as a teaching tool for professional health workers involved in the clinical management of diarrhoea, and gives basic information on clinical presentation, treatment, epidemiology and control of the most common agents of diarrhoea. A second chart summarises scientific knowledge of the major infectious agents of diarrhoea, and is intended for reference. The charts can be obtained from Miss S. O’Driscoll, Ross Institute, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT (cost £1 for the first and £2 for the second chart).

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