Efecto de la intervención de enfermería en el conocimiento sobre alimentación saludable en las madres con niños en etapa preescolar del balneario de Pucusana, Lima 2023

Objetivo: Determinar el efecto de la intervención de enfermería en el conocimiento sobre alimentación saludable en las madres con niños en etapa preescolar del balneario de Pucusana, Lima 2023. Material y métodos: La investigación fue de tipo cuantitativo, de diseño pre experimental y de corte longitudinal puesto que se realizó en distintos momentos. La muestra estuvo fue de 40 madres con niños en etapa pre escolar. Resultados: Se aplicó la prueba Shapiro Wilk, porque la muestra fue menor a 50, dónde se observó que fue una prueba no paramétrica por lo que se utilizó la prueba de deWilcoxon en donde se aceptó la H1 y se rechaza la nula. Conclusiones: La aplicación de un programa educativo mejoró significativamente (p<0.05) los conocimientos en su dimensión conocimientos generales de las madres con niños en etapa preescolar del balneario de Pucusana, Lima 2023

Formación reporteros para radio comunitaria

El proyecto “Reporteros Comunitarios” es una propuesta enfocada desde la Comunicación Social, siguiendo el proceso metodológico de la investigación I A P (Investigación – Acción – Participativa) mediante el trabajo realizado con la comunidad de Acacías, con el ánimo de brindar los conocimientos respectivos sobre el manejo de los medios de comunicación. Alternativos que fueron creados con el propósito de darle cabida a las comunidades las que no se les ofrecía la oportunidad de dar a conocer las necesidades que se registran entre la población, y a la vez se les brinda la oportunidad, para que sean los mismos miembros de las diferentes comunidades quien orienten las emisoras comunitarias. El objetivo del proyecto es el de capacitar lideres comunitarios, capaces de generar procesos de comunicación que conllevan al desarrollo y solución de las necesidades en la comunidad de Acacías a través del enlace entre Comunidad, Reporteros, la Radio Comunitaria de Acacías, el Gobierno Municipal, Institucionales y Organismos Pertinentes. Durante el proceso metodológico se busco darle solución a la problemática planteada por la comunidad, capacitando a un grupo de líderes, con el fin de que sean ellos los que a través de este medio, generen procesos sociales en beneficio de la comunidad y así lograr que la emisora comunitaria cumpla con su misión ya que este medio es un eje importante de enlace que contribuye a darle participación a los diferentes sectores comunitarios que no tienen voz en los medios de comunicación masivos. Por ello se realizo un trabajo intenso de convocatoria, luego de un proceso de investigación en el Municipio de Acacías sobre la finalidad de su Radio comunitaria, se determinó que la comunidad desconocía totalmente la función para la cual fue creada, posteriormente se constituyó un equipo de lideres comunitarios que empezaron a generar procesos sociales de crecimiento, y a dar ejemplo a otros sectores para multiplicar la experiencia y de esta forma crear cultura, sobre el manejo de medios alternativos de comunicación como propuesta para el desarrollo de organización, autogestión y mejoramiento de la calidad de vida de una población.The project “Community Reporters” it is a proposal focused from the Social Communication, following the methodological process of the investigation I TO P (Investigation–Action–Participativa) by means of the work carried out with the community of Acacías, with the spirit of offering the respective knowledge on the handling of the media. Alternative that they were created with the purpose of giving space to the communities those that were not offered the opportunity to give to know the necessities that register among the population, and at the same time they are offered the opportunity, so that they are the same members of the different communities who guide the community radio stations. The objective of the project is the one of qualifying community leaders, able to generate communication processes that bear to the development and solution of the necessities in the community of Acacías through the connection among Community, Reporters, the Community Radio of Acacías, the Municipal, Institutional Government and Pertinent Organisms. During the methodological process you looks for to give solution to the problem outlined by the community, qualifying to a group of leaders with the purpose of that you/they are them those that through this means, generate social processes in benefit of the community and to achieve that the community radio station fulfills its mission since this means is this way an important axis of connection that he/she contributes to give participation to the different community sectors that don't have voice in the massive media. For it one carries out an intense work of convocation, after an investigation process in the Municipality of Acacías about the purpose of their community Radio, it was determined that the community ignored the function totally later on for which was created, a team of community leaders it was constituted that began to generate social processes of growth, and to give example to other sectors to multiply the experience and this way to create culture, on the handling of alternative means of communication like proposal for the organization development, self-management and improvement of the quality of a population's life

Definition of ‘close contacts’ in leprosy studies: protocol for a scoping review [version 1; peer review: 2 approved, 1 approved with reservations]

Despite difficulties to document transmission pathways (assumed to be airborne), increased risk of leprosy infection has been shown for individuals living in close contact with patients. However, variations in the concept of ‘close contacts’ are used in different settings and studies. We conduct this review to identify criteria of space (location, geographical variables, distance, indoor vs outdoor), time (including frequency and duration), physical exposure (skin to skin, sexual), and relationship (familial, occupational, social) involved in the definition of ‘close contacts’ in leprosy studies. We expect this review to provide an overview of the (lack of) conceptualization of this term and its variations across settings. Primary studies and reviews are eligible for inclusion in this review. The main source of records will be the PubMed interface. Secondary searches will be conducted in Google Scholar, as well as through the reference lists of selected publications. The search strategy is based on the combination of the condition of interest (leprosy) and the concept under study (‘contact’). The findings of this review will be presented using thematic narrative synthesis, tables, and figures. The protocol is written in line with the Prisma Extension for Scoping reviews (PRISMA-ScR)

Fostering social innovation and building adaptive capacity for dengue control in Cambodia: a case study

Background: The social-ecological systems theory, with its unique conception of resilience (social-ecological systems & resilience, SESR), provides an operational framework that currently best meets the need for integration and adaptive governance as encouraged by the Sustainable Development Goals. SESR accounts for the complex dynamics of social-ecological systems and operationalizes transdisciplinarity by focusing on community engagement, value co-creation, decentralized leadership and social innovation. Targeting Social Innovation (SI) in the context of implementation research for vector-borne diseases (VBD) control offers a low-cost strategy to contribute to lasting and contextualized community engagement in disease control and health development in low and middle income countries of the global south. In this article we describe the processes of community engagement and transdisciplinary collaboration underpinning community-based dengue management in rural primary schools and households in two districts in Cambodia. Methods: Multiple student-led and community-based interventions have been implemented focusing on empowering education, communication for behavioral change and participatory epidemiology mapping in order to engage Cambodian communities in dengue control. We describe in particular the significance of the participatory processes that have contributed to the design of SI products that emerged following iterative consultations with community stakeholders to address the dengue problem. Results: The SI products that emerged following our interaction with community members are 1) adult mosquito traps made locally from solid waste collections, 2) revised dengue curriculum with hands-on activities for transformative learning, 3) guppy distribution systems led by community members, 4) co-design of dengue prevention communication material by students and community members, 5) community mapping. Conclusions: The initiative described in this article put in motion processes of community engagement towards creating ownership of dengue control interventions tools by community stakeholders, including school children. While the project is ongoing, the project's interventions so far implemented have contributed to the emergence of culturally relevant SI products and provided initial clues regarding 1) the conditions allowing SI to emerge, 2) specific mechanisms by which it happens and 3) how external parties can facilitate SI emergence. Overall there seems to be a strong argument to be made in supporting SI as a desirable outcome of project implementation towards building adaptive capacity and resilience and to use the protocol supporting this project implementation as an operational guiding document for other VBD adaptive management in the region

The role of social cohesion in the implementation and coverage of a mass drug administration trial for malaria control in the Gambia: An in-depth comparison of two intervention villages.

Mass drug administration (MDA), used increasingly in malaria eradication efforts, involves administering medication to an entire target population regardless of individual-level disease status. This strategy requires high levels of coverage and compliance. Previous studies have assessed individual and structural factors affecting MDA coverage, but there is a need to better understand the influence and expressions of community dynamics and social structures, such as social cohesion. We conducted a social science study concurrent to an MDA clinical trial for malaria control in The Gambia; ethnographic research was conducted prior to, throughout, and between MDA implementation July-November 2018, January-March 2019, and July-November 2019. We assessed how social cohesion, as expressed by the trial population, affects trial coverage through an in-depth ethnographic analysis of two trial villages, using observations, interviews, and focus group discussions with community members who took the trial medication and those who did not. We found that the villages had unique expressions of social cohesion. This was reflected through community participation in the trial implementation and may have affected coverage and compliance. The village with low coverage expressed a form of social cohesion where members followed advice to participate through a hierarchal system but did not actively participate in the MDA or its implementation. The village with high coverage expressed social cohesion as more participatory: individuals took the directive to participate but contextualized the trial implementation to their needs and wants. We analyze these different expressions of social cohesion and the important differences they make for the coverage and compliance levels reached in the two different villages

Costs and barriers faced by households seeking malaria treatment in the Upper River Region, The Gambia

Background: Malaria transmission in The Gambia decreased substantially over the last 20 years thanks to the scale-up of control interventions. However, malaria prevalence is still relatively high in eastern Gambia and represents both a health and a financial burden for households. This study aims to quantify the out-of-pocket costs and productivity losses of seeking malaria treatment at household level.Methods: A household survey was carried out through in-person interviews. Respondents were asked about malaria prevention methods, their treatment-seeking behaviour, and any costs incurred for transport, services, food, and/or overnight stays. A bottom-up costing approach was used to calculate the unit cost of treatment and a tobit regression approach to investigate cost drivers.Results: The survey included 864 respondents, mainly subsistence farmers. Most respondents (87%) considered malaria to be a problem affecting their ability to perform their regular duties. Respondents preferred going to a health facility for treatment. The primary reason for not going was related to costs; 70% of respondents incurred costs for seeking health care, with a median of £3.62 (IQR: £1.73 to £6.10). The primary driver of cost was living in one of the villages that are off the main road and/or far from health facilities. 66% reported productivity loss of 5 working days on average during a malaria episode of them or their child.Conclusions: Although malaria prevalence is decreasing and treatment is provided free of charge, households seeking treatment are confronted with out-of-pocket expenditures and lost working days; particularly in remote villages

The Community Lab of Ideas for Health: Community-Based Transdisciplinary Solutions in a Malaria Elimination Trial in The Gambia

Background: Community participation in global health interventions may improve outcomes and solve complex health issues. Although numerous community participatory approaches have been developed and introduced, there has been little focus on "how" and "who" to involve in the implementation of community-based clinical trials where unequal distribution of power between implementers and communities pre-exists. Addressing how to achieve community-based solutions in a malaria elimination trial in The Gambia, we developed the Community Lab of Ideas for Health (CLIH): a participatory approach that enabled communities to shape trial implementation. Methods: As part of transdisciplinary research, we conducted qualitative research with in-depth interviews, discussions, and observations in 17 villages in the North Bank Region of The Gambia between March 2016 and December 2017. We designed an iterative research process involving ethnography, stakeholder-analysis, participatory-discussions, and qualitative monitoring and evaluation, whereby each step guided the next. We drew upon ethnographic results and stakeholder-analysis to identify key-informants who became participants in study design and implementation. The participatory-discussions provided a co-creative space for sharing community-centric ideas to tackle trial implementation challenges. The proposed strategies for trial implementation were continuously refined and improved through our monitoring and evaluation. Results: The CLIH incorporated communities' insights, to co-create tailored trial implementation strategies including: village health workers prescribing and distributing antimalarial treatments; "compounds" as community-accepted treatment units; medicine distribution following compound micro-politics; and appropriate modes of health message delivery. Throughout the iterative research process, the researchers and communities set the common goal, namely to curtail the medical poverty trap by reducing malaria transmission and the burden thereof. This innovative collaborative process built trust among stakeholders and fully engaged researchers and communities in co-creation and co-implementation of the trial. Discussion: The CLIH approach succeeded in touching the local realities by incorporating a spectrum of perspectives from community-members and discerning project-derived knowledge from local-knowledge. This process allowed us to co-develop locally-oriented solutions and ultimately to co-establish an intervention structure that community-members were ready and willing to use, which resulted in high uptake of the intervention (92% adherence to treatment). Successfully, the CLIH contributed in bridging research and implementation

From informed consent to adherence: factors influencing involvement in mass drug administration with ivermectin for malaria elimination in The Gambia.

BACKGROUND: The World Health Organization (WHO) recommends consideration of mass drug administration (MDA) for malaria control in low-endemic settings approaching elimination. However, MDA remains a controversial strategy, as multiple individual, social, and operational factors have shown to affect its acceptability at local levels. This is further complicated by inconsistent definitions of key indicators derived from individual and community involvement-coverage, adherence, and compliance-that cast doubts about the actual and potential epidemiological impact of MDA on disease control and elimination. This study aimed to identify limitations and enabling factors impacting involvement at different stages of a large cluster-randomized trial assessing the effect of combining dihydroartemisinin-piperaquine (DP) and ivermectin (IVM) in malaria transmission in The Gambia. METHODS: This social science study used a mixed-methods approach. Qualitative data were collected in intervention and control villages through ethnographic methods, including in-depth interviews (IDIs), focus group discussions (FGDs), and participant observation conducted with trial participants and decliners, community leaders, and field staff. A cross-sectional survey was conducted in the intervention villages after the first year of MDA. Both strands of the study explored malaria knowledge and opinions, social dynamics influencing decision-making, as well as perceived risks, burdens, and benefits associated with this MDA. RESULTS: 157 IDIs and 11 FGDs were conducted, and 864 respondents were included in the survey. Barriers and enabling factors to involvement were differentially influential at the various stages of the MDA. Issues of social influence, concerns regarding secondary effects of the medication, costs associated with malaria, and acceptability of the implementing organization, among other factors, differently affected the decision-making processes throughout the trial. Rather than a linear trajectory, involvement in this MDA trial was subjected to multiple revaluations from enrolment and consent to medicine intake and adherence to treatment. CONCLUSIONS: This study went beyond the individual factors often associated with coverage and adherence, and found that nuanced social dynamics greatly influence the decision-making process at all phases of the trial. These issues need to be consider for MDA implementation strategies and inform discussions about more accurate ways of reporting on critical effectiveness indicators

Mass Drug Administration With High-Dose Ivermectin and Dihydroartemisinin-Piperaquine for Malaria Elimination in an Area of Low Transmission With High Coverage of Malaria Control Interventions: Protocol for the MASSIV Cluster Randomized Clinical Trial

Background: With a decline in malaria burden, innovative interventions and tools are required to reduce malaria transmission further. Mass drug administration (MDA) of artemisinin-based combination therapy (ACT) has been identified as a potential tool to further reduce malaria transmission, where coverage of vector control interventions is already high. However, the impact is limited in time. Combining an ACT with an endectocide treatment that is able to reduce vector survival, such as ivermectin (IVM), could increase the impact of MDA and offer a new tool to reduce malaria transmission. Objective: The study objective is to evaluate the impact of MDA with IVM plus dihydroartemisinin-piperaquine (DP) on malaria transmission in an area with high coverage of malaria control interventions. Methods: The study is a cluster randomized trial in the Upper River Region of The Gambia and included 32 villages (16 control and 16 intervention). A buffer zone of ~2 km was created around all intervention clusters. MDA with IVM plus DP was implemented in all intervention villages and the buffer zones; control villages received standard malaria interventions according to the Gambian National Malaria Control Program plans. Results: The MDA campaigns were carried out from August to October 2018 for the first year and from July to September 2019 for the second year. Statistical analysis will commence once the database is completed, cleaned, and locked. Conclusions: This is the first cluster randomized clinical trial of MDA with IVM plus DP. The results will provide evidence on the impact of MDA with IVM plus DP on malaria transmission. Trial Registration: ClinicalTrials.gov NCT03576313; https://clinicaltrials.gov/ct2/show/NCT03576313 International Registered Report Identifier (IRRID): DERR1-10.2196/2090

Research agenda for preventing mosquito-transmitted diseases through improving the built environment in sub-Saharan Africa

Mosquito-transmitted diseases are a major threat to health in sub-Saharan Africa, but could be reduced through modifications to the built environment. Here we report findings from a major workshop held to identify the research gaps in this area, namely: (1) evidence of the health benefits to changes to the built environment, (2) understanding how mosquitoes enter buildings, (3) novel methods for reducing mosquito-house entry, (4) sustainable approaches for reducing mosquito habitats, (5) case studies of micro-financing for healthy homes and (6) methods for increasing scale-up. Multidisciplinary research is essential to build out mosquito-transmitted diseases, and not build them in