Knowledge of malaria control and attitudes towards community involvement among female community volunteers: effect of capacity building in a rural community, Southeast Nigeria

Introduction

community volunteers have limited skills but are an important link between the community and health facilities. We determined the effect of a capacity building intervention on knowledge of malaria control and attitudes towards community involvement among female community volunteers as part of a larger community-based intervention study on pregnant women and children under five.

Methods

we conducted a before and after intervention study (no randomization or controls) among female community volunteers in Amagu community in Abakaliki Local Government Area. The intervention consisted of training sessions on knowledge of malaria and its control. The training took the form of lectures, role plays and practical demonstrations. Supportive supervision by trained community health extension workers was also provided during their field work. We compared pre-training test and post-training test scores after six months interval and analysed the data using paired t test at 5% level of significance with EPI INFO software version 7.2.3.

Results

the mean age of the participants was 28.5(± 6.0) years. All had a minimum level of secondary education. There was significant improvement in the mean scores of their knowledge of malaria signs and symptoms (p < 0.001), preventive measures (p < 0.001) and appropriate drug treatment (p < 0.001) in the post-training test when compared with the pre-training test. The overall mean knowledge scores pre and posttest were 147.8 and 169.8 respectively (p < 0.001) out of a maximum achievable score of 195. Also there was significant improvement in the perception of the participants on community involvement in promoting referral of pregnant women with fever (p = 0.001), the use of intermittent preventive therapy with sulphadoxine-pyrimethamine (p = 0.048) and funding initiatives to sustain activities (p = 0.037).

Conclusion

capacity building of female community volunteers coupled with supportive supervision by trained community health workers improved the female community volunteers´ knowledge of malaria, its control and their perception of community involvement in control activities. It is recommended that the use of community volunteers as a low cost health resource can be explored further for incorporation into existing policies on malaria control in resource constrained environments.

Valuing the Unpaid Contribution of Community Health Volunteers to Mass Drug Administration Programs

Community health volunteers (CHVs) are being used within a growing number of healthcare interventions, and they have become a cornerstone for the delivery of mass drug administration within many neglected tropical disease control programs. However, a greater understanding of the methods used to value the unpaid time CHVs contribute to healthcare programs is needed. We outline the two main approaches used to value CHVs’ unpaid time (the opportunity cost and the replacement cost approaches). We found that for mass drug administration programs the estimates of the economic costs relating to the CHVs’ unpaid time can be significant, with the averages of the different studies varying between US$0.05 and $0.16 per treatment. We estimated that the time donated by CHVs’ to the African Programme for Onchocerciasis Control alone would be valued between US$60 and $90 million. There is a need for greater transparency and consistency in the methods used to value CHVs’ unpaid time.

Enhancing tuberculosis patient detection and care through community volunteers in the urban poor, The Philippines

Setting: The Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association Philippines is a local non-governmental organisation (NGO) established in 2008 to improve access to tuberculosis (TB) services. Community health volunteers (CHVs) from NGO referring facilities were engaged to assist in local TB control activities. Objective: To describe the activities of the CHVs and the barriers experienced by patients with presumptive TB in seeking health care to treatment as documented on a master list, and to identify the CHVs' challenges in community TB care implementation. Design: This was a retrospective evaluation with a non-experimental design reviewing the presumptive TB master list and TB reports and conducting a free discussion session (FDS) in 2012. Results: Of the 78% (281/362) of referred presumptive TB patients who accessed a DOTS facility, 69% (194/281) underwent a diagnostic examination and 42% (81/194) were diagnosed with active TB. Of the 93% (75/81) initiated on treatment, 92% (69/75) were successfully treated. The CHVs contributed approximately 3% (75/2534) to the total TB cases diagnosed at the DOTS facilities. In the FDS, barriers evoked in seeking health care for treatment were transfer of residence and lack of interest in seeking a consultation. In 2012, the CHV attrition rate was 55% (80/145). Conclusion: The CHVs assisted in enhancing access to TB care and case detection. Sustainability of the CHVs' efforts should be explored to retain them in the programme.

CASP - An intervention by community volunteers to reduce suicidal behaviour among refugees

BACKGROUND

Refugees are at risk of psychiatric morbidity because of forced migration, traumatic events and resettlement in unfamiliar environments. Many live in low- and middle-income countries (LAMIC) under stressful conditions contributing to increased suicide risk.

AIMS

This study assessed the feasibility of regular contact and use of safety planning cards (CASP) by community volunteers (CVs) in reducing suicidal behaviour among Sri Lankan refugees residing in camps in Tamil Nadu, South India.

METHODS

A household survey was carried out on consenting adults in two refugee camps - one intervention and one control - randomly selected using lottery method. The primary outcome was reduction in suicidal behaviour. Experience of trauma during war and migration, depression, post-traumatic stress and alcohol use were documented. Individuals scoring >16 on Centre for Epidemiological Studies Depression (CESD) or >30 on Post-traumatic Stress Disorder (PTSD) or with active/passive suicidal ideation or a history of previous suicidal attempts were considered as high risk. CVs were trained to deliver CASP intervention to high-risk individuals. Change from baseline to follow-up was computed for intervention and control groups, and the difference between changes in suicide rates was compared using proportion test.

RESULTS

In total, 639 refugees from intervention and 664 from control camps participated. Of the 288 high-risk refugees in intervention camp, 139 completed the intervention. In the control camp, 187 were categorised as high risk. Prevalence of suicide attempts was 6.1%. Following intervention, differences between sites in changes in combined suicide (attempted suicides and suicides) rates per 100,000 per year were 519 (95% confidence interval (CI): 136-902; p < .01).

CONCLUSION

CASP, an intervention involving contact by CVs and use of safety planning cards, is feasible to implement and can reduce suicidal behaviour among refugees. Its replication in more settings will enhance validity.

[Knowledge and attitudes of community volunteers on Lassa and Ebola viral haemorrhagic fevers in the Donga Department (North Benin)]

Introduction

L’objectif de cette étude était d’évaluer les connaissances et attitudes des relais communautaires vis-à-vis des fièvres hémorragiques à virus Ebola et Lassa et leur implication dans la mise œuvre des activités de prévention de ces maladies.

Méthodes

Une enquête transversale descriptive a été menée auprès des relais communautaires recrutés par tirage au sort dans 40 villages du département de la Donga. Ces relais faisaient la prise en charge à domicile des maladies respiratoires, diarrhéiques et du paludisme chez les enfants de moins de cinq ans. Un questionnaire anonyme a été administré par interview directe. Les données ont été analysées à l’aide du logiciel Epi-info 3.5.1.

Résultats

Au total 58 relais communautaires (RC) ont participé à cette enquête sur les 60 attendus. L’âge moyen était de 38,7±10,6 ans avec un sex-ratio de 3,5. Il y avait majoritairement trente cinq cultivateurs (60,3%) et treize revendeuses (22,4%). Quarante huit enquêtés (82,8%) reconnaissaient les deux maladies comme étant graves, mortelles et transmissibles. Les trois principales voies de transmission citées étaient le contact ou la consommation de gibiers (87,9%), le contact direct avec les personnes infectées (74,1%) ou leurs cadavres (46,6%). Les principaux moyens préventifs énumérés étaient en lien avec les voies de transmission. La fièvre (81,0%), les vomissements (81,0%) et la diarrhée (60,3%) venaient en tête des symptômes cités. Seulement vingt-deux RC (37,9%) disposaient de gants mais les utilisaient rarement pour examiner les enfants malades. Quant à la conduite à tenir devant un cas suspect de fièvre hémorragique virale Lassa ou Ebola, quarante-et-un relais communautaires (70,7%) feraient recours aux agents de santé sans toucher au malade, neuf (15,5%) feraient appel à l’ambulance et huit (13,8%) transporteraient le cas sur leur propre moto ou sur un taxi-moto vers le centre de santé le plus proche.

Conclusion

Le renforcement des capacités des relais communautaires sur les fièvres hémorragiques virales contribuerait à l’amélioration de leurs connaissances sur ces épidémies mortelles et à la qualité de leurs interventions dans la population.

Introduction

This study aimed to evaluate the knowledges and attitudes of community volunteers on Lassa and Ebola viral haemorrhagic fevers and their role in the implementation of activities for the prevention of these diseases.

Methods

We conducted a cross-sectional descriptive survey among community volunteers chosen by lot in 40 villages in the Donga Department. Children under five years of age with respiratory and diarrheal diseases and malaria were treated by these community volunteers in their home. An anonymous questionnaire was administered by direct interview. Data were analyzed using Epi-Info 3.5.1.

Results

Out of 60 community volunteers potentially participating in this survey a total of 58 effectively participated. The average age of community volunteers was 38.7 ± 10.6 years with a sex-ratio of 3.5. The majority of the community volunteers were farmers (thirty-five, 60.3%) and resellers (thirteen, 22.4%). Forty-eight respondents (82.8%) recognized the two diseases as being serious, life-threatening and transmissible. The three main routes of transmission cited were the contact with or the consumption of bushmeat (87.9%), the direct contact with infected people (74.1%) or with their corpses (46.6%). The main preventive measures listed were related to the routes of transmission. Fever (81.0%), vomiting (81.0%) and diarrhea (60.3%) were at the top of the cited symptoms. Only twenty-two community volunteers (37.9%) had gloves but they rarely used them to examine sick children. As regards the procedure to follow in case of suspected Lassa or Ebola viral haemorrhagic fever , forty-one community volunteers (70.7%) would make use of community-based health workers without touching the patient, nine (15.5%) would call for the ambulance and eight (13.8%) would take the patient to the nearest health center using their own motorcycle or a motorcycle-taxi.

Conclusion

Strengthening community volunteers’ capacity to manage viral hemorrhagic fevers would contribute to the improvement of their knowledge of these life-threatening epidemics and to the quality of population health interventions.

The Use of Key Informant Method for Identifying Children with Blindness and Severe Visual Impairment in Developing Countries

PURPOSE

An estimated 19 million children are visually impaired; of these, 1.4 million are irreversibly blind. A key challenge is to identify them early in life to benefit maximally from visual rehabilitation, and/or treatment. This aggregative review and structured literature analysis summarizes evidence of what it is about the key informant (KI) approach that works to identify children with blindness or severe visual impairment (B/SVI) in the community (for whom, to what extent, in what circumstances, in what respect, how and why).

METHODS

Peer-reviewed (PubMed, hand search) and grey literature (Google, World Health Organization website, academic theses, direct requests) were included, and methods and criteria used for identification, productivity (number of children referred per KI), accuracy of referrals (positive predictive value, PPV), age of children with B/SVI, KI definition, sex, information about cost and comparisons aggregated.

RESULTS

We included 31 documents describing 22 unique KI programs. Mostly KIs identified children with B/SVI in 1-3 weeks, i.e. "campaign mode." In 60%, KIs were community volunteers, others formal health sector workers (FHSW). Around 0.02-1.56 children per KI (median = 0.25) were successfully recruited. PPV ranged from 12 to 66%. In two studies comparing FHSWs and community KIs, the latter were 8 and 10 times more productive.

CONCLUSION

KIs working in campaign mode may provide an effective approach to identifying children with B/SVI in communities. Including identification of ocular problems and/or other impairments has been recommended. Research on factors that influence effectiveness and on whether KIs continue to contribute could inform programs.

Effectiveness of a community-based observation of anti-tuberculosis treatment in Bangalore City, India, 2010-2011

SETTING

The Revised National Tuberculosis Control Programme in an urban setting of Bangalore City, India.

OBJECTIVES

To compare treatment outcomes and smear conversion rates among new smear-positive tuberculosis (TB) patients undergoing treatment administered by community directly observed treatment (DOT) providers with those undergoing treatment administered by institutional DOT providers in Bangalore City in 2010-2011.

METHOD

Cohort study of routine data recorded from treatment cards of TB patients undergoing treatment under the public health services from 1 October 2010 to 30 September 2011.

RESULT

Treatment records of 1864 new smear-positive TB patients registered during this period were evaluated. Among those evaluated, 604 (32%) had been administered treatment by community DOT providers and the remainder by institutional DOT providers. The treatment success rate in those undergoing community DOT was 93% (n = 564) and that of those undergoing institutional DOT was 75% (n = 951; RR 1.23, 95%CI 1.19-1.28). The sputum smear conversion rate of patients who underwent community DOT was 92% and that of those who underwent institutional DOT was 71% at the end of 2 months.

CONCLUSION

We conclude that community DOT for treatment supervision of TB patients is more effective than institutional DOT and that it should be reinforced.

The role of 'hidden' community volunteers in community-based health service delivery platforms: examples from sub-Saharan Africa

Community-based research on child survival in sub-Saharan Africa has focussed on the increased provision of curative health services by a formalised cadre of lay community health workers (CHWs), but we have identified a particular configuration, that deserves closer scrutiny. We identified a two-tiered CHW system, with the first tier being the lessor known or ‘hidden’ community/village level volunteers and the second tier being formal, paid CHWs, in Ethiopia, Mali, and Niger. Whilst the disease-focussed tasks of the formal CHW tier may be more amenable to classic epidemiological surveillance, we postulate that understanding the relationship between formalised CHWs and volunteer cadres, in terms of scope, location of practice and ratio to population, would be important for a comprehensive evaluation of child survival in these countries. We report on the findings from our joint qualitative and quantitative investigations, highlighting the need to recognise the ‘hidden’ contribution of volunteers. We need to better characterize the volunteers’ interaction with community-based and primary care services and to better understand ways to improve the volunteer systems with the right type of investments. This is particularly important for considering the models for scale-up of CHWs in sub-Saharan Africa.

Preventive services program: a model engaging volunteers to expand community-based oral health services for children

PURPOSE

This paper describes the Preventive Services Program (PSP), a community based oral health program model which engages volunteers to provide preventive services and education for underserved children in Missouri. In 2006, the Missouri Department of Health and Senior Services created a program for children designed to use a systems approach for population-based prevention of oral disease. Currently, 5 part-time dental hygienists serve as Oral Health Program Consultants to work with the citizens of a community to engage dentists, dental hygienists, parents and other interested stakeholders in the activities of the program. Dental volunteers evaluate oral health and disease in the community's children and facilitate referrals for dental care. Other volunteers apply fluoride varnish and provide educational services to the children.

PROGRAM OUTCOMES

In 2006, 273 volunteer dentists and dental hygienists and 415 community volunteers provided oral screenings, oral health education, 2 fluoride varnish applications and referral for unmet dental care for 8,529 children. In 2011, 775 volunteer dentists and dental hygienists and 1,837 other community volunteers provided by PSP services to nearly 65,000 children.

CONCLUSION

It has been demonstrated that when the local citizens take responsibility for their own needs that a sustainable and evidence-based program like PSP is possible. Guidelines which provide criteria for matching models with the specific community characteristics need to be generated. Furthermore, a national review of successful program models would be helpful to those endeavoring to implement community oral health program.

Community based maternal and child health nutrition project, uttar pradesh: an innovative strategy focusing on "at risk" families

RESEARCH QUESTION

Use of community based volunteers, frequently reaching and counseling a selected group of prioritized families, can make a substantial difference in improving maternal and child care practices and in reducing child undernutrition.

SETTING

Program Rural Uttar Pradesh, India.

STUDY DESIGN

A comparison of baseline and endline surveys following 4 years of community based project intervention.

PARTICIPANTS

"At risk" undernutrition families comprising mothers of under twos, newlyweds, and severely undernourished children below 6 years.

INTERVENTION

Mapping and counseling of "at risk" families. Measuring impact on maternal-child care practices, underweight status.

RESULTS

Trained community mobilizers identified and counseled selected "at risk" families. Following 4 years of implementation in 907 villages of 8 blocks of four districts, significant improvement was noted in practices of early initiation of breastfeeding, feeding colostrum, timely introduction of complementary feeding, and washing the hands after defecation. Percentage of mothers exclusively breastfeeding at 6 months was only 2.1% with 78% receiving prelacteal feeds. A small increase in normal and mild malnutrition and a significant reduction of 43% in severe malnutrition was noted.

CONCLUSION

Frequently counseling by accredited social health activists by focusing on selected defined "at risk" families of under twos and those with severe malnourished children could result in increasing acceptability of correct child health, feeding, and care practices and in contributing to improving nutritional status scenario.