Background: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expan...ding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).
Methods: We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.
Findings: The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (−0.8 percentage points (pp) (95% credible interval: −2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: −0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (−0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (−0.6 per 1000 (95% CI −2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges.
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Non-Communicable Diseases (NCDs), including mental disorders, currently pose one of the biggest threats to health and development globally, particularly in low and middle income countries2. It is predicted that unless proven interventions are rapidly implemented in countries, in the short to medium ...term, health care costs will increase exponentially and severe negative consequences will ensue not only to individuals and families but to whole societies and economies. NCDs are already a major burden in South Africa, but without added rigorous and timely action the health and development consequences may well become catastrophic. Immediate and additional, high quality, evidence based and focussed interventions are needed to promote health, prevent disease and provide more effective and equitable care and treatment for people living with NCDs at all levels of the health system. The problem is further compounded by the rising global prevalence of multi-morbidity (defined as the coexistence of two or more chronic diseases in one individual).
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This study identifies barriers and provides recommendations to improve asthma care in children across sub-Saharan Africa, where qualitative data is lacking despite high rates.
Background
Asthma remains highly prevalent, with more severe symptoms in low-income to middle-income countries (LMICs) compared with high-income countries. Identifying risk factors for severe asthma symptoms can assist with improving outcomes. We aimed to determine the prevalence, severity and ris...k factors for asthma in adolescents in an LMIC.
Methods
A cross-sectional survey using the Global Asthma Network written and video questionnaires was conducted in adolescents aged 13 and 14 from randomly selected schools in Durban, South Africa, between May 2019 and June 2021.
Results
A total of 3957 adolescents (51.9% female) were included. The prevalence of lifetime, current and severe asthma was 24.6%, 13.7% and 9.1%, respectively. Of those with current and severe asthma symptoms; 38.9% (n=211/543) and 40.7% (n=147/361) had doctor-diagnosed asthma; of these, 72.0% (n=152/211) and 70.7% (n=104/147), respectively, reported using inhaled medication in the last 12 months. Short-acting beta agonists (80.4%) were more commonly used than inhaled corticosteroids (13.7%). Severe asthma was associated with: fee-paying school quintile (adjusted OR (CI)): 1.78 (1.27 to 2.48), overweight (1.60 (1.15 to 2.22)), exposure to traffic pollution (1.42 (1.11 to 1.82)), tobacco smoking (2.06 (1.15 to 3.68)), rhinoconjunctivitis (3.62 (2.80 to 4.67)) and eczema (2.24 (1.59 to 3.14)), all p<0.01.
Conclusion
Asthma prevalence in this population (13.7%) is higher than the global average (10.4%). Although common, severe asthma symptoms are underdiagnosed and associated with atopy, environmental and lifestyle factors. Equitable access to affordable essential controller inhaled medicines addressing the disproportionate burden of asthma is needed in this setting.
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To give you a better idea of when and how psychotherapy can help you, we have written this brochure titled Paths to Psychotherapy. While it is therefore primarily intended for people who have never been treated by a psychotherapist, the brochure can also enable those who have previously had psychoth...erapy to find out about the range of psychotherapeutic care and assistance that is currently available. Regardless of your previous experience with psychotherapy, this brochure offers you clear information about what a mental illness is, whether scheduling an initial appointment is advisable, and the circumstances in which psychotherapeutic treatment is necessary.
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El asesoramiento sobre lactancia materna es una interacción bidireccional entre un/a asesor/a con formación en lactancia
materna y una o varias mujeres embarazadas, madres u otras personas cuidadoras de niños/as menores de dos años
(normalmente). El proceso consiste en escuchar inquietudes, ab...ordar distintas cuestiones, instruir en torno a la lactancia
materna y observar y acompañar el proceso normal de lactancia materna y las dificultades que puede plantear. El propósito
del asesoramiento sobre lactancia materna es empoderar a las mujeres para que la practiquen y fortalecer las prácticas de
cuidados receptivos, respetando en todo momento su situación personal y su voluntadx
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The purpose of this ‘Facilitator Guidebook’ is to help the Course Coordinator deliver and document consistently high-quality CBDRR training courses.
- Module 1: Understanding the Basics: introduces the participants to the basics of CBDRR implementation of MRCS, general aspects of CBDRR in ...the context of Myanmar.
- Module 2: Implementing the Program: introduces the participants to the 9 CBDRR steps that are followed by MRCS when implementing community- and school-based programs and key points.
- Module 3: Ensuring Sustainability: introduces the participants to two aspects that are often forgotten when it comes to program implementation.
- Module 4: Being a Facilitator:introduces the participants to facilitation skills and some exercises are carried out that willhelp the participants to be a facilitator of the course themselves in the end.
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Baseado no livro Preparación y respuesta ante la eventual introducción del virus chikungunya en las américas
Este documento propone: Contenidos técnicos sobre el ZIKV, sus manifestaciones, complicaciones, formas de transmisión y medidas de prevención a utilizar para el abordaje de “preguntas más frecuentes” y de mensajes en piezas y materiales de información y comunicación, charlas comunitarias, ...vocerías entre otros. Recomendaciones para la elaboración de planes de comunicación y acciones de comunicación de riesgos ante el ZIKV
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A finalidade deste documento é apresentar orientações
provisórias para intervenções destinadas a reduzir o risco
de infecção pelo vírus Zika e para tratar potenciais complicações durante a gravidez. Estas orienta ções baseiam-se nas melhores evidências disponíveis da investigação... e abrange áreas priorizadas por um grupo
internacional e multidisciplinar de profissionais de saúde e outras partes interessadas. Especificamente, apresenta: orientações para evitar a infecção pelo vírus Zika; cuidados pré-natais e tratamento dasmulherescom infecção;e cuidados durante a gravidez atodas as mulheres grávidas que vivam nas zonas afectadas, com o objectivo de
optimizar os resultados da saúde nas mães e nos recém-nascidos.
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Se espera que sean una referencia para la elaboración de protocolos clínicos y políticas sanitarias a nivel nacional y local relacionados con el embarazo, en el contexto de la transmisión del virus de Zika, pero no se pretende ofrecer una guía práctica completa para la prevención y el tratami...ento de esta infección.
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Una Guída Esencial de Buenas Pràcticas
Séptima Edición 2019
Guías para programas nacionales y otros interesados directos
Ciudad de México, México - 26 al 28 de mayo del 2014