10,502 research outputs found

    Tying Community Engagement With Appropriate Technology At The Last Mile: A Cluster Randomized Trial To Determine The Effectiveness Of A Novel, Digital Pendant And Voice Reminder Platform On Increasing Infant Immunization Adherence Among Mothers In Rural Udaipur, India

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    Background: 500,000 children under the age of five die from vaccine preventable diseases in India every year. More than just improving coverage, increasing timeliness of immunizations is critical to ensuring infant health in the first year of life. Novel, culturally-appropriate, community engagement strategies are worth exploring to close the immunization gap. In this case, a digital pendant and voice call reminder (components of the Khushi Baby platform) are tested for the effectiveness in improving DTP3 adherence within two monthly camps from DTP1 administration. Methodology: A cluster randomized trial was conducted in which 96 village health camps were randomized to three arms: NFC sticker, NFC pendant, and NFC pendant with voice call reminder in local dialect across 5 blocks in the Udaipur District serviced by Seva Mandir from August 2015 to April 2016. Results: The pendant and pendant with voice call reminder arms did not significantly improve adherence compared to the sticker group. Point estimates suggested that there was a higher odds of on-time completion in the pendant with voice call group compared to both the pendant group and the sticker group. Conclusions: Despite the null results for adherence, the fact that the pendant was well retained and well accepted by the community suggests that the pendant can be a valuable social symbol and community engagement tool. Low power and short term follow-up may have masked true effects of the system. A larger randomized trial slated to begin in August 2016 will look to replicate and build off the study findings in the Udaipur district

    Informed Decisions for Actions in Maternal and Newborn Health 2010–17 Report What works, why and how in maternal and newborn health

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    IDEAS is a measurement, learning and evaluation project based at the London School of Hygiene & Tropical Medicine (LSHTM). The project aims to find out “what works, why, and how” for maternal and newborn health in three low-resource settings in Nigeria, India, and Ethiopia. The IDEAS team includes 20 research and professional support staff, living in Abuja, Addis Ababa, London, and New Delhi, who have been working since 2010 with the Bill & Melinda Gates Foundation (the foundation) and with the foundation’s implementation partners

    IMPLEMENTING A WEB-BASED IMMUNIZATION SCHEDULE REMINDER FOR POSTNATAL SERVICE DELIVERY

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    The mortality rate of infants under the age of five is still relatively high in many sub-Sahara African countries like Nigeria. Immunization remains the most crucial and cost-effective public health intervention scheme for protecting children in this region from vaccine-preventable diseases. Immunization, however, is only effective if the nursing mothers keep strict appointment schedules. To this effect, information technology can be leveraged to help in this regard. This paper thus implements a web-based immunization schedule reminder for postnatal service delivery. In order to realize the system, a component-based development approach was used to extend an existing electronic medical record to include the immunization schedule reminder. The resulting system is able to reduce child mortality by reducing the rate of missed appointment schedules. Keywords and phrases: immunization, child mortality, schedule reminder, postnatal service delivery

    WHAT DO COMMUNITY HEALTH WORKERS NEED TO PROVIDE COMPREHENSIVE CARE THAT INCORPORATES NON-COMMUNICABLE DISEASES?

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    Non-Communicable Diseases (NCDs) such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes are the leading cause of premature death and disability worldwide, accounting for 60% of all deaths globally and 80% of NCD related mortality occurring in low and middle-income countries (LMICs). Health systems in LMICs have been oriented toward maternal and child health, and infectious illnesses as these were the main causes of morbidity and mortality until recently. Over the last decade, health systems in LMICs have recognized the need to address NCDs, and have restructured health services to include relevant prevention and control strategies. Health workforce is one of the key building blocks of health systems; however, most LMICs have a shortage of physicians. In addition, the available health care providers are unevenly distributed within countries with the majority concentrated in urban regions compared to rural regions where large proportions of the population reside. This poor distribution and shortage of physicians has led some countries to rely on task shifting, where tasks normally performed by qualified health professionals are transferred to other health providers with a lower level of education and professional training. In 1978, the Declaration of Alma-Ata included trained community health workers (CHWs) and traditional medical practitioners as part of the health team as a fundamental step towards comprehensive primary care. Since then, CHWs have been a cornerstone of health systems in several countries with over 26 different CHW programs identified in the literature across more than 24 LMICs. Traditionally, CHWs do not hold formal professional certification but receive job-related pre-service training. However, there is a lot of variation across countries where some countries require CHW certification before they can start performing their roles. CHWs reside in the community where they work, and are usually volunteers and sometimes receive financial compensation for receiving training and performance-based incentives for health related activities. CHWs can enable essential health care services to be provided in a cost-effective manner. They have been instrumental in reducing maternal and neonatal mortality rates through their presence for home births and making referrals for emergency obstetric care, and by promoting vaccination uptake, breastfeeding, and education about infectious disease. More recently, CHWs have been useful in HIV/AIDS prevention and control, educating communities and performing tasks such as screening, counselling and supplying antiretroviral drugs. With the increasing prevalence of NCDs and to meet changing community health needs, CHWs are sought to provide a similarly appropriate care for NCD risk factors control. While CHWs may not replace qualified health providers, they can play a considerable role in improving health outcomes by educating, screening, referring and following-up individuals at high risk of NCDs. CHWs have been trained in some settings to screen, educate and follow-up patients with NCDs or people at increased risk of NCDs. However, there is a need to better understand how to support CHW programs to be more effective and sustainable. There is knowledge gap in terms of the CHWs current capacity, working conditions, training provided for NCD prevention and control, remuneration, supervision and other upstream challenges facing CHWs and the health systems. The literature suggests that the there is a range of context-specific factors which can have an impact on the performance of CHWs and the quality of the care they provide. Some of these factors include the remuneration schemes employed, the workload, task complexity, lack of clarity in job description, and other essential factors such as interpersonal relationships between CHWs and other members of the primary health care team. CHW programs operate differently across and within countries. Evidence-based policy interventions are required to inform policy decision to ensure effective CHW program implementation. This thesis applies a mixed-methods approach to explore the capacity of the CHWs and the system support necessary to facilitate the CHW’s role in providing comprehensive, community-oriented, continuous primary health care which includes prevention and control strategies for NCDs. Part One provides an insight into the historical background of CHWs and how their role has evolved due to global health needs. With the expanding role of CHWs to incorporate NCDs, part two throws light on training of CHWs for NCDs in LMICs. Chapter two presents results of a systematic review about the effectiveness of training CHWs for cardiovascular disease prevention and management in LMICs. The chapter findings demonstrate the importance of having interactive and culturally adapted training sessions to make the training easier to follow and understand by the CHWs. The findings also highlight the need for evaluating the knowledge and skill-set of the CHWs to capture the training impact; and the necessity of scheduling refresher training at regular intervals to ensure knowledge retention. Chapter three demonstrates the importance of using an evaluation framework such as Kirkpatrick’s evaluation model to evaluate the effectiveness of training among CHWs. Using an evaluation framework, not only assesses the knowledge change but rather employs multiple measures to assess knowledge, skills and behaviour change of the CHWs. This allows for a more comprehensive interpretation of the training outcomes. The qualitative data involved in Chapter three provided insight on the low morale and discontent of the CHWs with their working conditions. In part three, I use a discrete choice experiment (DCE) to provide evidence of effective interventions that can keep the CHWs motivated and retain them in the workforce. Chapter Four explains the process of designing a DCE for Accredited Social Health Activists (ASHAs), who are CHWs in India. It also provides evidence of the feasibility of using Android computer tablets to display the DCE for the CHWs. In chapter five, I examine the relative importance of stated preferences of ASHAs to remain in service using a DCE survey. Career progression was found to be the main influencing factor for ASHAs in addition to fixed salary and other non-financial factors such as priority free family health-check and reduced workload. The findings demonstrated that the ASHAs sociodemographic characteristics such as their education level plays a key role in shaping their preference profile. These findings can inform future policy decisions of evidence-based recruitment and retention strategies that are applicable to the local context. CHWs have proven to be effective in providing a wide range of services including NCDs care. However to optimize the performance of CHW programs, we need to understand the system level support needed and the strategies necessary to be considered in the design and operation of CHWs’ programs. Part four, investigates the policy and implementation elements and system level support needed to enable the CHWs in rural India to provide comprehensive primary health care that incorporates NCDs. Chapter six uses policy review and qualitative research to understand the policy and implementation gaps, current capacity, working conditions and challenges faced by ASHAs in providing NCDs care to their community. It provides an overview of the perspectives of the key stakeholders of the ASHA program including ASHAs, ANMs, primary care doctors, community members, and district medical officers. Findings revealed that ASHAs are unrecognised as formal members of the NCDs delivery team, however they are overburdened with extensive NCDs tasks without receiving training or remuneration for these tasks. ASHAs remain to be volunteers that receive performance based remuneration and are not covered by any of the workers’ rights or laws. However, ASHAs remain enthusiastic about helping their communities and aspire to be recognised as formal employees of the health system with a potential career progression pathway. The concluding chapter summarises the key findings, discusses the main themes emerging from the thesis and outlines the future research directions and policy recommendations

    Assessing the impact of mHealth interventions in low- and middle-income countries – what has been shown to work?

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    PKBackground: Low-cost mobile devices, such as mobile phones, tablets, and personal digital assistants, which can access voice and data services, have revolutionised access to information and communication technology worldwide. These devices have a major impact on many aspects of people’s lives, from business and education to health. This paper reviews the current evidence on the specific impacts of mobile technologies on tangible health outcomes (mHealth) in low- and middle-income countries (LMICs), from the perspectives of various stakeholders. Design: Comprehensive literature searches were undertaken using key medical subject heading search terms on PubMed, Google Scholar, and grey literature sources. Analysis of 676 publications retrieved from the search was undertaken based on key inclusion criteria, resulting in a set of 76 papers for detailed review. The impacts of mHealth interventions reported in these papers were categorised into common mHealth applications. Results: There is a growing evidence base for the efficacy of mHealth interventions in LMICs, particularly in improving treatment adherence, appointment compliance, data gathering, and developing support networks for health workers. However, the quantity and quality of the evidence is still limited in many respects. Conclusions: Over all application areas, there remains a need to take small pilot studies to full scale, enabling more rigorous experimental and quasi-experimental studies to be undertaken in order to strengthen the evidence base

    Syrian Refugees and Digital Health in Lebanon

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    There are currently over 1.1 million Syrian refugees in need of healthcare services from an already overstretched Lebanese healthcare system. Access to antenatal care (ANC) services presents a particular challenge. We conducted focus groups with 59 refugees in rural Lebanon to identify contextual and cultural factors that can inform the design of digital technologies to support refugee ANC. Previously identified high utilization of smartphones by the refugee population offers a particular opportunity for using digital technology to support access to ANC as well as health advocacy. Our findings revealed a number of considerations that should be taken into account in the design of refugee ANC technologies, including: refugee health beliefs and experiences, literacy levels, refugee perceptions of negative attitudes of healthcare providers, and hierarchal and familial structures
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