Engaging communities as partners in health crisis response: a realist-informed scoping review for research and policy

Background: Health is increasingly affected by multiple types of crises. Community engagement is recognised as being a critical element in successful crisis response, and a number of conceptual frameworks and global guideline documents have been produced. However, little is known about the usefulness of such documents and whether they contain sufficient information to guide effective community engagement in crisis response. We undertake a scoping review to examine the usefulness of conceptual literature and official guidelines on community engagement in crisis response using a realist-informed analysis [exploring contexts, mechanisms, and outcomes(CMOs)]. Specifically, we assess the extent to which sufficient detail is provided on specific health crisis contexts, the range of mechanisms (actions) that are developed and employed to engage communities in crisis response and the outcomes achieved. We also consider the extent of analysis of interactions between the mechanisms and contexts which can explain whether successful outcomes are achieved or not. Scope and findings: We retained 30 documents from a total of 10,780 initially identified. Our analysis found that available evidence on context, mechanism and outcomes on community engagement in crisis response, or some of their elements, was promising, but few documents provided details on all three and even fewer were able to show evidence of the interactions between these categories, thus leaving gaps in understanding how to successfully engage communities in crisis response to secure impactful outcomes. There is evidence that involving community members in all the steps of response increases community resilience and helps to build trust. Consistent communication with the communities in time of crisis is the key for effective responses and helps to improve health indicators by avoiding preventable deaths. Conclusions: Our analysis confirms the complexity of successful community engagement and the need for strategies that help to deal with this complexity to achieve good health outcomes. Further primary research is needed to answer questions of how and why specific mechanisms, in particular contexts, can lead to positive outcomes, including what works and what does not work and how to measure these processes

The Prevalence and Intensity of soil-transmitted helminths and Schistosomiasis (Schistosoma mansoni) among primary school children aged 9-14 years in Tonkolili district, Northern Sierra Leone.

Soil-Transmitted Helminths (STH) and Schistosomiasis (SCH) infections are public health problems in areas with less improved sanitary conditions and lack of basic social amenities. The human soil-transmitted helminthiasis infections have been reported in many rural communities of the developing world. Global estimates of STH and SCH is over 2 billion of which ascariasis accounts for 1.6 billion while trichuriasis and hookworms account for about 700 – 800 million. The aim of the study was to investigate the prevalence and intensity of soil-transmitted helminths and Schistosomiasis (Schistosoma mansoni) among primary school children in Tonkolili district. The study employed a cross-sectional study design in two chiefdoms within Tonkolili District. In each Chiefdom, one primary school was sampled and in each school, a random sample of 100 pupils was selected. Kato-Katz technique was used to determine prevalence and intensity of STH and SCH infections and data analysis were done using software version EPi info 3.5.3.The study revealed that the overall prevalence of STH parasites is: Ascaris lumbricoides- 5.0% [95%CI(2.1 – 8.4)] and S. Mansoni has a prevalence of 26.0% [95% CI (20.1 – 32.7)]. The overall intensity of STH parasites: Ascaris lumbricoides-5.4epg; Trichuriasis trichiura-0.6epg; Hookworm-22.0epg, and for schistosomiasis; S. Mansoni has an intensity of 47epg.The study concluded that there has been a decrease in the prevalence and intensity of soil-transmitted helminthiasis in the district over the years. The observed low prevalence could be partly due to the preventive chemotherapy that has been going on through mass drug administration’s since 2009 and the ongoing program of treating children under five with anthelminthic drugs during the Mother and Child Health Week twice annually in the entire country.The study recommends that if the observed decrease in low prevalence and intensity of the infections should be sustained, then mass drugs administration should be done every year

Assessment of Knowledge, Stigmatizing Attitudes and Health-Seeking Behaviors Regarding Hepatitis B Virus Infection in a Pharmacy and Community Setting in Sierra Leone: A Cross-Sectional Study

Hepatitis B virus (HBV) is a major global health challenge. Emerging evidence suggests that poor knowledge and stigma are impacting HBV control efforts in sub-Saharan Africa (SSA), but their role is not well understood. We conducted a cross-sectional study of adults aged ≥18 years in a community and pharmacy setting in Freetown, Sierra Leone. A structured questionnaire was used to assess knowledge, stigmatizing attitudes and health-seeking behaviors regarding HBV. Logistic regression was used to identify predictors of HBV knowledge and related stigma. A total of 306 adult participants were enrolled (50.7% male, 7.5% HBV positive and 11.7% vaccinated). Overall, 52.2% had good HBV knowledge and 49.3% expressed a stigmatizing attitude towards people with HBV. Notwithstanding, 72.2% stated they would receive the HBV vaccine if offered, 80.4% would take anti-HBV medication and 78.8% would be willing to attend clinic regularly. Good HBV knowledge was associated with HBV positive status (aOR 4.41; p = 0.029) and being vaccinated against HBV (aOR 3.30; p = 0.034). HBV-related stigma was associated with secondary or higher level of education (aOR 2.36; p p = 0.006) and pharmacy setting (aOR 1.74, p = 0.037). These findings suggest that education and stigma reduction may benefit HBV elimination efforts in SSA