Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study

Background Measles outbreaks re-emerged in 2013–2014 in Guangxi Zhuang Autonomous Region of China, where measles immunisation coverage is high. The discrepancy between the vaccination coverage and outbreaks indicates that timeliness is crucial, yet there is limited knowledge on the health system barriers to timely vaccination. Using integrated evidence at the household, village clinic, and township hospital levels, this study aimed to identify the determinants of failure in receiving timely measles vaccinations among children in rural Guangxi. Methods A multi-stage stratified cluster sampling survey with a nested qualitative study was conducted among children aged 18–54 months in Longan, Zhaoping, Wuxuan, and Longlin counties of Guangxi from June to August 2015. The status of timely vaccinations for the first dose of measles-containing vaccine (MCV1) and the second dose of measles-containing vaccine (MCV2) was verified via vaccination certificates. Data on household-level factors were collected using structured questionnaires, whereas data on village and township-level factors were obtained through in-depth interviews and focus group discussions. Determinants of untimely measles vaccinations were identified using multilevel logistic regression models. Results A total of 1216 target children at the household level, 120 villages, and 20 township hospitals were sampled. Children were more likely to have untimely vaccination when their primary guardian had poor vaccination knowledge [MCV1, odds ratio (OR) = 1.72; MCV2, OR = 1.51], had weak confidence in vaccines (MCV1, OR = 1.28–4.58; MCV2, OR = 1.42–3.12), had few practices towards vaccination (MCV1, OR = 12.5; MCV2, OR = 3.70), or had low satisfaction with vaccination service (MCV1, OR = 2.04; MCV2, OR = 2.08). This trend was also observed in children whose village doctor was not involved in routine vaccination service (MCV1, OR = 1.85; MCV2, OR = 2.11) or whose township hospital did not provide vaccination notices (MCV1, OR = 1.64; MCV2, OR = 2.05), vaccination appointment services (MCV1, OR = 2.96; MCV2, OR = 2.74), sufficient and uniformly distributed sessions for routine vaccination (MCV1, OR = 1.28; MCV2, OR = 1.17; MCV1, OR = 2.08), or vaccination service on local market days (MCV1, OR = 2.48). Conclusions Guardians with poor knowledge, weak beliefs, and little practice towards vaccination; non-involvement of village doctors in routine vaccinations; and inconvenient vaccination services in township hospitals may affect timely measles vaccinations among children in rural China. Graphical abstract

Perceptions and practices on newborn care and managing complications at rural communities in Bangladesh: a qualitative study

Background Community misperception on newborn care and poor treatment of sick newborn attributes to neonatal death and illness severity. Misperceptions and malpractices regarding neonatal care and neonatal complications are the leading causes of neonatal deaths in Bangladesh. The study was conducted to explore neonatal care’s perceptions and practices and manage complications among Bangladesh’s rural communities. Methods A qualitative study was conducted in Netrakona district of Bangladesh from April to June 2015. Three sub-districts (Upazilas) including Purbadhala, Durgapur and Atpara of Netrakona district were selected purposively. Five focus group discussions (FGDs) and twenty in-depth interviews (IDIs) were conducted in the rural community. Themes were identified through reading and re-reading the qualitative data and thematic analysis was performed. Results Community people were far behind, regarding the knowledge of neonatal complications. Most of them felt that the complications occurred due to lack of care by the parents. Some believed that mothers did not follow the religious customs after delivery, which affected the newborns. Many of them followed the practice of bathing the newborns and cutting their hair immediately after birth. The community still preferred to receive traditional treatment from their community, usually from Kabiraj (traditional healer), village doctor, or traditional birth attendant. Families also refrained from seeking treatment from the health facilities during neonatal complications. Instead, they preferred to wait until the traditional healers or village doctors recommended transferring the newborn. Conclusions Poor knowledge, beliefs and practices are the key barriers to ensure the quality of care for the newborns during complications. The communities still depend on traditional practices and the level of demand for facility care is low. Appropriate interventions focusing on these issues might improve the overall neonatal mortality in Bangladesh.

Rationale and Design of a Cluster Randomized Trial of a Village Doctor-Led Intervention on Hypertension Control in China

Background In China, hypertension prevalence is high and increasing while the control rate is low, especially in rural areas. Traditionally, village doctors play an important role in infectious disease control and delivering essential health services to rural residents. We aim to test the effectiveness of a village doctor-led multifaceted intervention compared to usual care on blood pressure (BP) control and cardiovascular disease (CVD) among rural residents with hypertension in China. Methods In the China Rural Hypertension Control Project (CRHCP), a cluster randomized trial, 163 villages were randomly assigned to the village doctor-led intervention and 163 villages to control. A total of 33,995 individuals aged ≥40 years with an untreated BP ≥140/90 mmHg or treated BP ≥130/80 mmHg or with an untreated BP ≥130/80 mmHg and a history of clinical CVD were recruited into the study. The village doctor-led multifaceted intervention is designed to overcome barriers at the healthcare system, provider, patient, and community levels. Village doctors receive training on standard BP measurement, protocol-based hypertension treatment, and health coaching. They also receive technical support and supervision from hypertension specialists/primary care physicians and performance-based financial incentives. Study participants receive health coaching on home BP monitoring, lifestyle changes, and adherence to medications. The primary outcome is BP control (<130/80 mmHg) at 18 months in phase 1 and CVD events over 36 months in phase 2. Conclusions The CRHCP will provide critically important data on the effectiveness, implementation, and sustainability of a hypertension control strategy in rural China for reducing the BP-related CVD burden. Clinical trials registration ClinicalTrials.gov identifier NCT03527719

The Effect of Wechat-Based Training on Improving the Village Doctors’ Knowledge of Tuberculosis Management: A Pre-And-Post Intervention Study from China

Background: In China, village doctors played a crucial role in TB cases referral and management. The current study aimed to evaluate the effect of WeChat-based training program on improving the village doctors’ knowledge on TB management.Methods: A One-year WeChat-based training was conducted by means of releasing original contents (in forms of text, poster, video or cartoon), through WeChat subscription account (WeChat SA) once a week. Pre-and post-training offline tests were hold using the same self-administered questionnaire to evaluate the training effect.Results: A total of 467 village doctor were included in the study. During the training, sixty original articles were posted through WeChat SA. With respect to the two tests, the median score increased from 50 (40.0-60.0) to 60 (53.0-70.0) (p<0.001) after training. The median scores were always higher after training no matter what kind of article contents and forms. In addition, the effectiveness of such training was found to be influenced by gender and education level.Conclusions: Our results indicated that WeChat-based training could partly improve the knowledge of village doctors on TB management. It is worthy to explore more effective new media-based training methods that might promote TB control work in rural China.

Present Status of Aquaculture and Socio-Economic Condition of Fish Farmers in a Rural Setting in Bangladesh

The socio-economic condition of fish farmers was assessed in the HabiganjSadarupazila, Habiganj, Bangladesh to determine the constraints and vulnerability of thecommunity in term of aquaculture. Data from 30 fish farmers were collected duringJanuary to May 2019. Among surveyed farmers, most of the pond size (37.61%)ranged between 0.02 ha to 0.06 ha and 63.33% of ponds under single ownership. Mostof the farmers were interested to stock rohu, catla, mrigal along with other species andaverage stocking density was found to be 16236 fry/ha. All farmers provided feeds forthe cultured species and 73.33% farmers have taken measures against diseaseoutbreak. The highest production was estimated as 6.19 MT/ha/year and lowestproduction was 0.54 MT/ha/year. Highest income of farmer was reported as 5,00,000Tk/ha/year and the lowest as 74534 Tk/ha/year. Highest 34.38% farmers in the studyarea reported high cost of feed is the most important constraint. The study indicatedthat majority of fish farmers (33.33%) were in age structure of 31-40 years. Similar tothe religious profile of the population, Muslims (93.33%) dominated the ownership.Among all the farmers, 40% received primary level education. The study revealed that60% of farmers lived in joint families with tin shed house (43.33%). All farmers hadelectricity in their house and at least one mobile phone. Among the farmers 53.33%have good sanitary facility and 83.33% farmers had own tubewell for drinking waterfacility. 50% farmers received health service from village doctor and 33.33% farmersreceived technical training on fish farming. Res. Agric., Livest. Fish.7(2): 329-339, August 2020

The Influence of Job satisfaction, Resilience and Work engagement on Turnover Intention among Village Doctor in China:a cross-sectional study

Background As the gatekeepers of rural residents ‘health, the team of village doctors plays a vital role in improving the health level of rural residents. However, a large number of village doctor’s turnover, or even dozens of them turnover collectively, threatening the stability of the village medical team. This research evaluated the influence of job satisfaction, resilience, work engagement on turnover intention of village doctor and explored the mediating role of resilience and work engagement between job satisfaction and turnover intention among village doctor in China.Methods A quantitative study using a self-administered questionnaire containing mostly structured items was conducted among the village doctors with a sample size of 2693 from 1345 rural hospitals or clinics of Shandong province, China, during May and June 2019. All variables including demographic characteristics, job satisfaction, resilience, work engagement and turnover intention were based on literature and measured on 5- or 6-point Likert scale. Such statistical methods as one-way ANOVA, bivariate correlation, exploratory factor analysis (EFA) and Structural Equation Modeling (SEM) were used.Results As high as 46.9% of the participants had a high turnover intention and no less than 26.3% of the participants had a medium turnover intention. Job satisfaction not only has a direct negative effect on turnover intention(β=-0.37, p < 0.001), but also has an indirect effect on it through work engagement(β= -0.04, p < 0.001), work engagement has a direct negative impact on turnover intention(β= -0.13, p < 0.002), and resilience had an indirect negative effect on turnover intention through the mediating effect of work engagement(β= -0.09, p < 0.001). The results of this study strongly verified that job satisfaction, resilience, work engagement were early, powerful predicators of turnover intention.Conclusion According to the results, reasonable and fair income, effective promotion mechanism, fair social old-age security, reasonable workload, strong psychological coping mechanism for work stress, should be taken seriously to improve job satisfaction. The turnover intention of village doctors could be reduced through improving job satisfaction, resilience and work engagement.

Pattern of antibiotic prescribing and factors associated with it in eight village clinics in rural Shandong Province, China: a descriptive study

Background This study describes the patterns of antibiotic prescribing in eight village clinics in rural China and evaluates factors associated with antibiotic prescribing using quantitative and qualitative methods. Methods From January 2015 to July 2017, 60 prescriptions were collected monthly from selected village clinics in Shandong, China. Village clinic doctors completed a questionnaire regarding their knowledge of antibiotic prescribing. Semi-structured interviews were conducted with 15 village doctors and 1 deputy director from the township hospital. Results Of the 14 526 prescriptions collected, 5851 (40.3%) contained at least one antibiotic, among which 18.4% had two or more antibiotics and 24.3% had parenteral antibiotics. The antibiotic prescribing rate (β=−0.007 [95% confidence interval −0.009 to −0.004]) showed a declining trend (1.7% per month). Higher antibiotic prescribing rates were observed for patients <45 y of age and those diagnosed with upper respiratory tract infections and among village doctors who had less working experience and a lower level of knowledge on antibiotic prescribing. Qualitative analyses suggested that antibiotic prescribing was influenced by the patients’ symptoms, patients’ requests, policies restraining the overuse of antibiotics, subsidies for referral and routine village doctor training. Conclusions Antibiotic prescribing has declined in the included village clinics, which may be due to the policy of reducing antibiotic overuse in primary health care centres in China.

FARMERS’ KNOWLEDGE, ATTITUDE AND PRACTICES OF MASTITIS IN DAIRY COWS AT SELECTED AREAS OF BANGLADESH

The research work was designed to assess farmers’ knowledge, attitude and practices about bovine mastitis. The data were collected by using structured questionnaire through face to face interview techniques among the 65 dairy farmers of Dhaka, Mymensingh, and Gazipur. Disproportionate stratified random sampling was used to select the farmers based on study areas. Most of the studied farms are small (75.4%) in the studied area, only a few (10.8%) farms were large in Dhaka. In Gazipur and Mymensingh almost (86.2%) firms were small and rest of (13.8%) was medium. According to farmer’s knowledge, major cause of mastitis was microorganisms (46.15%), but 20% farmer reported that it is due to injury and 27.69% farmer don’t know the causes of the mastitis. Most of the farmers (87.7%) think that the source of infection is unhygienic floor, but others have no clear conception about it. Before milking only 23.10% farmers’ wash the whole udder where 58.5% used single towel. About 76.9% farmers have no knowledge of screening mastitis and only 9.2% of total farmers performed regular mastitis checking. Among the farmers, 55.4% are used antiseptic solution during washing the floor and others wash their floor only by water. Highest number of farmer use Tube well water (44.6%) for daily management of their farms. Most of the farmer takes suggestions from village doctor or pharmaceutical representative (64.62%) for maintaining the diseases condition. This study recommends that identification of factors associated with sub-clinical mastitis will help to take necessary steps to reduce the prevalence of sub-clinical mastitis. The most effective way to control sub-clinical mastitis is to take preventive measures such as regular cleaning of the floor, keeping the udder clean, milkman's cleanliness, and dry cow therapy especially in high yielding dairy cows.