Engaging Female Community Health Volunteers (FCHVs) for cardiovascular diseases risk screening in Nepal

Introduction Non-Communicable Diseases (NCDs) have become the leading public health problems worldwide and the cardiovascular diseases (CVDs) is one of the major NCDs. Female Community Health Volunteers (FCHVs) in Nepal are the key drivers to implementing frontline health services. We explored the potential for engaging FCHVs for CVD risk screening at the community level in Nepal. Methods We used multiple approaches (quantitative and qualitative) for data collection. The trained FCHVs administered CVD risk screening questionnaire among 491 adults in rural and urban areas and calculated the CVD risk scores. To maintain consistency and quality, a registered medical doctor also, using the same risk scoring chart, independently calculated the CVD risk scores. Kappa statistics and concordance coefficient were used to compare these two sets of risk screening results. Sensitivity and specificity analyses were conducted. Two focus group discussions among the FCHVs were conducted to determine their experiences with CVD risk screening and willingness to engage with CVD prevention and control efforts. Results The mean level of agreement between two sets of risk screening results was 94.5% (Kappa = 0.77, P<0.05). Sensitivity of FCHV screening was 90.3% (95% CI: 0.801–0.964); and the specificity was 97% (95% CI: 0.948, 0.984). FCHVs who participated in the FGDs expressed a strong enthusiasm and readiness to using the CVD risk screening tools. Despite their busy workload, all FCHVs showed high level of motivation and willingness in using CVD risk screening tools and contribute to the prevention and control efforts of NCDs. The FCHVs recommended needs for providing additional training and capacity building opportunities. Conclusion We conclude that there is a potential for engaging FCHVs to use simple CVD risk screening tools at the community level. The findings are promising, however, further studies engaging larger number of FCHVs and larger population would warrant feasibility of such tools within the existing healthcare systems in Nepal.

Participatory health research under COVID-19 restrictions in Bauchi State, Nigeria: Feasibility of cellular teleconferencing for virtual discussions with community groups in a low-resource setting

Introduction During the COVID-19 pandemic, researchers have used Internet-based applications to conduct virtual group meetings, but this is not feasible in low-resource settings. In a community health research project in Bauchi State, Nigeria, COVID-19 restrictions precluded planned face-to-face meetings with community groups. We tested the feasibility of using cellular teleconferencing for these meetings. Methods In an initial exercise, we used cellular teleconferencing to conduct six male and six female community focus group discussions. Informed by this experience, we conducted cellular teleconferences with 10 male and 10 female groups of community leaders, in different communities, to discuss progress with previously formulated action plans. Ahead of each teleconference call, a call coordinator contacted individual participants to seek consent and confirm availability. The coordinator connected the facilitator, the reporter, and the participants on each conference call, and audio-recorded the call. Each call lasted less than 1 h. Field notes and debriefing meetings with field teams supported the assessment of feasibility of the teleconference meetings. Results Cellular teleconferencing was feasible and inexpensive. Using multiple handsets at the base allowed more participants in a call. Guidelines for facilitators and participants developed after the initial meetings were helpful, as were reminder calls ahead of the meeting. Connecting women participants was challenging. Facilitators needed extra practice to support group interactions without eye contact and body language signals. Conclusions With careful preparation and training, cellular teleconferencing can be a feasible and inexpensive method of conducting group discussions in a low-resource setting.

Gonadotropins at Advanced Age - Perhaps They Are Not So Bad? Correlations Between Gonadotropins and Sarcopenia Indicators in Older Adults

Many hormones fluctuate during the aging process. It has been suggested that gonadotropins, which increase with age, contribute to the occurrence of many diseases and syndromes in older life, such as cardiovascular diseases, obesity, frailty syndrome and osteoporosis. This study aims to assess the relationship between circulating gonadotropins and other hormones potentially contributing to age-related functional decline and sarcopenia indicators in 39 male and 61 female community-dwelling seniors, mean age 80 years. According to the definition developed by the second European Working Group on Sarcopenia in Older People (EWGSOP2), the following indicators of the sarcopenia were assessed: bioimpedance-measured body composition, gait speed, handgrip strength, timed up and go test (TUG), chair stand test, Short Physical Performance Battery (SPPB). Blood levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, dehydroepiandrosterone sulphate (DHEAS) and cortisol were also measured. In the men, FSH and partially LH correlated positively with muscle mass percentage, gait speed, handgrip strength and SPPB, and negatively with percent body fat. Additionally, testosterone and DHEAS correlated negatively with the percentage of fat mass in men. Whereas in the women, FSH and LH were mainly negatively associated with body mass and adipose tissue measures. Cortisol did not show any relationship with the examined indicators. The study shows that the indicators of sarcopenia are strongly associated with levels of gonadotropins, sex hormones and DHEAS, especially in older men. The obtained results, after being confirmed in a larger group, may modify prevention and treatment strategies of sarcopenia.

Community Health Workers (CHWs) to Improve Primary Health Care Services Delivery: A Case of Female Community Health Volunteers (FCHV) Program in Nepal

Community health workers (CHWs) have played a vital role in improving primary healthcare services in different parts of the world, in particular, for those services related to the prevention and control of communicable diseases, immunization services, reproductive health, maternal and child health, HIV/AIDS prevention and care and nutrition promotion. The Female Community Health Volunteers (FCHVs) program, which was introduced in 1988 in Nepal, has now reached over 51,000 FCHVs. They are key community level CHWs in Nepal and have contributed significantly in achieving several health and related outcomes and meeting several Millennium Development Goals. In such, there is also a potential and needs for engaging them to prevent and control emerging health challenges such as non-communicable diseases prevention and control and re-emerging health issues. Their effective involvement to ongoing health programs would be critical to achieving Sustainable Development Goals, agenda in particular “SDG 3 – Health and Wellbeing” by 2030.

Trend and Determinants of Abortions among Adolescent Women in Rural Matlab, Bangladesh: Evidence a Prospective Cohort Study

Background:Every year about 2.5 million adolescents have unsafe abortions. In Bangladesh, data on incidence of abortion suffer from under-reporting and incomplete record keeping in cases of adolescent women. So, we proposed a study to estimate level and determinants of adolescent abortions in Matlab in Bangladesh. Methods:This study analyzed vital events recorded by Matlab Health and Demographic Surveillance System (HDSS) from a well-defined population during 2007-2015. HDSS is operating since 1966, HDSS area was divided into two halves; icddr,b provides quality maternal and family planning (MNCH/FP) services in one half and another half receives government standard MNCH/FP services. Female community health research workers visit bi-monthly women at their home to identify pregnancy and record vital events and migration. Woman’s age in most cases is known by date of birth. Study Population: Women, who had pregnancy outcomes before age of 20 years were the study population. This resulted in a final sample of 5,715 adolescent women who become pregnant between this age.Result:There were 5,715 adolescents in the HDSS database have complete birth form for every pregnancy outcome who become pregnant outcomes between 2007 and 2015. The adolescent abortion rates were Lower (by 18%) in ISA than GSA; higher among mothers who have primary and higher education and who are pregnant for the first time Conclusion: This study has estimated the first time the adolescent abortion rate in Bangladesh and reveals that MCH-FP services lower abortion rate. Reducing abortion among adolescent, post-abortion education and family planning services are needed.

‘All across Europe it had come’: The Black Death and Fascism in Sylvia Townsend Warner’s The Corner That Held Them

Sylvia Townsend Warner’s wartime novel The Corner that Held Them (1948), about a nunnery during the Black Death, reflects on female community and bonding in a period of male fascist violence. The novel explores the shift from pacifism to acceptance of the need for anti-fascist war which characterised Warner’s intellectual beliefs from the 1930s into wartime, probing the arts of peace in compositional practice. Such a dialectic of war and peace is considered in relation to what Maud Ellmann has described as the outward turn to collective choral consciousness in mid-century modernism. This article explores both the staging of fascism as plague and the feminist daring and limits that Warner saw as operative in female witnessing and withstanding of Nazi ideology and menace. It closely reads key scenes from the panorama of a novel (notably Alianor’s stillness as her husband is killed, Alicia’s plans to withstand the economic impact of the Black Death and the cure of Ralph’s plague symptoms) to register the satirical and allegorical substance of Warner’s rescripting of Woolfian notions of resistance to warmongering misogyny by a society of outsiders. The readings seek to consolidate a varied and multiple sense of the book as a Marxist historical novel that gives voice to the ruled. In doing so Warner analyses the Black Death as a moment in history that saw the emergence of early modern capitalism and labour relations out of the feudal system, even as the religious framework that had structured medieval Europe gave way to more secular beliefs in autonomy, self-determination, citizen and collective dreams, projects and affects. At the same time the plague as a political trope, rooted in anti-fascist rhetoric that turns Nazi anti-Semitic uses of the Black Death motif on their head, triggers readings that bring those historical scenes into allegorical relation with the ways in which the Second World War was experienced by marginalised female communities.

Mental health care delivery in poor settings through trained female community health workers: A five-year intervention program in Somaliland

Background: The situation of mental health globally is alarming particularly in developing countries. In Somaliland/Somalia, every third person may be suffering from some sort of mental illness according to the World Health Organization. Major barriers to improve mental health include stigma and lack of skilled human resources. Objectives: The aim was to explore the feasibility of organizing integrated community-based mental, epilepsy and mother and child health services delivered by trained female community health workers (FCHWs) in three urban sites (Borama, Baki and Dila) in the Awdal Region, Somaliland. Methods: After selection of the 3 project sites and recruitment and training of project staff, a baseline survey was carried out. First, the sites were properly mapped based on existing geographical administrative sectors and sub-sectors of the sites. Then a representative sample of 2,722 households was randomly selected from all the 3 sites. The female head of each of those households were then interviewed using a questionnaire containing 22 questions on the target groups. The questionnaire responses were coded, and data analysed using Statistical software program, SPSS. After the baseline survey, the FCHWs were deployed in the sites assigning a specified area to each female worker. The FCHWs worked 6 hours per day 6 days per week and were required to visit 6 families each day including follow-ups. Their activities included identification of patients with severe mental illness (SMI) or with epilepsy, counselling, distribution of medications, follow-up of patients already on medication, referral, stigma reduction and documentation of their daily activities in logbooks. Results: The baseline study showed that 12% of the households were taking care of at least one person with SMI each, while 7% had one person with epilepsy each. Of the patients with SMI, 18% were on chains. During the project period (2015-2019), the number of people with SMI or with epilepsy who benefited from the project was 2.225 and 738 respectively and their families empowered through increased mental health awareness. Among the patients with SMI, 237 were on chains before intervention and 85% of them were successfully released from their shackles. Conclusions: This project has shown that deployment of trained and supported FCHWs can be used to reduce the mental health care gap in Somaliland. It is suggested as a model project which could, hopefully, be replicated and tested in other similar settings.

Multilevel factors influencing contraceptive use and childbearing among adolescent girls in Bara district of Nepal: a qualitative study using the socioecological model

ObjectivesThis study aimed to identify the multilevel factors that influence contraceptive use and childbearing decisions in Nepal and examine relationships among these factors.DesignThe study drew on qualitative data collected through in-depth interviews (IDIs) and key informant interviews (KIIs) and triangulated results.SettingAn urban municipality and a rural municipality in Bara district, Nepal.ParticipantsWe recruited a total of 60 participants (e.g., 20 married adolescent girls aged 15–19, 20 husbands, 20 mothers-in-law) for IDIs and 10 (e.g., four healthcare providers, three health coordinators, three female community health volunteers) for KIIs.ResultsMarried adolescent girls faced a range of barriers that are inter-related across different levels. Patriarchal norms and power imbalances between spouses limited their decision-making power regarding contraception. Social pressures to give birth soon after marriage drove the fear of infertility, abandonment and the stigmatisation of childless married couples, which leads to lack of women’s autonomy in making decisions about family planning. Mothers-in-law and religion exerted considerable influence over couples’ decisions regarding contraception. Limited access to information about the benefits and methods of family planning contributed to fear of the side effects of contraceptives and low awareness about the risks involved in adolescent pregnancy.ConclusionsThe convergent results from triangulation confirm that the decision to postpone childbearing is not merely the personal choice of an individual or a couple, highlighting the importance of targeting families and communities. The study underscores the need to challenge restrictive sociocultural norms so that adolescent girls become empowered to exercise greater control over contraceptive use.