African American community, Rockingham County: an action-oriented community diagnosis: findings and next steps of action

In October 2007, a team of five graduate students from the University of North Carolina at Chapel Hill School of Public Health began an Action-Oriented Community Diagnosis (AOCD) with the African American community in Rockingham County. An AOCD is a community-based process by which the resources, strengths, needs, and challenges of a community are identified. After identification, the process transitions to generating dialogue and creating action steps to build on community strengths and address challenges. Guided by preceptors Debbie Mason of Rockingham County Healthy Carolinians and Katrina White of the Rockingham County Department of Public Health, the student team spent the next seven months attending community events, examining data about Rockingham County from websites and government documents, and conducting interviews and focus groups with both service providers and community members regarding community strengths and community challenges. After analyzing the responses, the team identified thirteen common themes. With the help of a community advisory committee (CAC), the team planned and held a public forum, “Community Dialogue for Change,” on April 14, 2008. The CAC selected five of the original thirteen themes for focused discussion at the forum based on their importance to the community and how easily they could be addressed. Five themes were chosen so that the five student team members could each lead a discussion group on one theme..At the forum, the team highlighted the community‟s strengths such as churches and spirituality, caring people, and leadership capacity as well as challenges related to the five themes chosen for discussion. The approximately 70 people in attendance broke into smaller discussion groups and generated action steps to address each theme. The following challenges and action steps were presented at the forum: Employment- The lack of job opportunities for African Americans within the county is a concern. This affects both adults who have lost jobs and youth seeking jobs. Develop a mentoring program that would place youth in government, corporate, and small business environments. Survey students to determine their career interests so that job fairs and career programs would be more appealing. Create a resource listing of employers willing to hire ex-offenders. Attitudes Towards Education- There is concern that education is not a priority in the county, as seen by high drop-out rates and not enough students going to college. Approach the school board about offering diversity training to teachers and other employees. Approach local colleges that train teachers about offering diversity training in their curricula. Guidance for Youth- Too many African American youth, especially young men, lack positive guidance for their futures. Set up a forum for youth-adult conversation as a starting point for better understanding. Use the media, church newsletters, and organizations to spread the word about the need to come together for better guidance for youth. Find out what mentoring programs churches currently have in place, and increase the number and quality of these programs. Include volunteering for school mentoring programs in regular church service projects, with an emphasis on peer mentors. Establish programs to re-train parents and include professionals in the community with different skill sets for parenting. Racial Discrimination- Community members noted various ways in which racial discrimination happens in the county, such as differences in pay, ability to get loans, and treatment of students. Create a forum to increase dialogue between parents of school children to address issues such as racial discrimination in schools. Increase parental and community involvement in volunteer opportunities in schools. Create guidelines for fair treatment of students for use by teachers and administrators. Preventive Health Care- Low use of preventive health care services for conditions such as diabetes and high blood pressure leads to an increased need for treatment and poor health. Form a group in charge of developing educational flyers with health messages to be placed in grocery stores, doctors‟ offices, daycares, churches, schools, and recreational facilities. This education campaign would also incorporate the use of nutritionists to develop health messages for church newsletters. Form a “take a friend to the doctor” program to assist those without their own personal transportation in getting to preventive health care appointments. This would build upon existing resources available in the community such as Caregivers of Rockingham County and Pelham Transportation in order to make transportation to medical appointments more convenient for community members. The purpose of this final report is to give the African American community of Rockingham County and other concerned individuals a tangible resource that presents the findings of the community assessment as well as a report of the discussions and action steps which emerged at the community forum. It is divided into six sections: Introduction; Background on Rockingham County; Primary Data Findings; Methods; The Forum; and Recommendations and Conclusions. This document should be a tool which all community members can continuously refer to as they address various challenges and work towards progress.Master of Public Healt

Provider and lay perspectives on intra-uterine contraception: a global review

BACKGROUND: Intra-uterine contraception (IUC) involves the use of an intra-uterine device (IUD), a highly effective, long-acting, reversible contraceptive method. Historically, the popularity of IUC has waxed and waned across different world regions, due to policy choices and shifts in public opinion. However, despite its advantages and cost-effectiveness for programmes, IUC's contribution to contraceptive prevalence is currently negligible in many countries. This paper presents the results of a systematic review of the global literature on provider and lay perspectives on IUC. It aims to shed light on the reasons for low use of IUC and reflect on potential opportunities for the method's promotion. METHODS: A systematic search of the literature was conducted in four peer-reviewed journals and four electronic databases (MEDLINE, EMBASE, POPLINE, and Global Health). Screening resulted in the inclusion of 68 relevant publications. RESULTS: Most included studies were conducted in areas where IUD use is moderate or low. Findings are similar across these areas. Many providers have low or uneven levels of knowledge on IUC and limited training. Many wrongly believe that IUC entails serious side effects such as pelvic inflammatory disease (PID), and are reluctant to provide it to entire eligible categories, such as HIV-positive women. There is particular resistance to providing IUC to teenagers and nulliparae. Provider opinions may be more favourable towards the hormonal IUD. Some health-care providers choose IUC for themselves. Many members of the public have low knowledge and unfounded misconceptions about IUC, such as the fear of infertility. Some are concerned about the insertion and removal processes, and about its effect on menses. However, users of IUC are generally satisfied and report a number of benefits. Peers and providers exert a strong influence on women's attitudes. CONCLUSION: Both providers and lay people have inaccurate knowledge and misconceptions about IUC, which contribute to explaining its low use. However, many reported concerns and fears could be alleviated through correct information. Concerted efforts to train providers, combined with demand creation initiatives, could therefore boost the method's popularity. Further research is needed on provider and lay perspectives on IUDs in low- and middle-income countries

Extent and causes of increased domestic violence during the COVID-19 pandemic: Community health worker perspectives from Kenya, Bangladesh, and Haiti

Background: Emerging data, media reports, and anecdotal evidence suggest that domestic violence (DV) has increased during the COVID-19 pandemic. However, more detailed data are needed on the magnitude, forms, and causes of DV during COVID-19 in different contexts worldwide. We sought to contribute such evidence from the perspective of community health workers (CHWs) in low-middle income countries in three different regions of the world. Methods: We conducted phone surveys with female and male CHWs from September-December 2020 in Kenya (n=1,385), Bangladesh (n=370), and Haiti (n=261). Descriptive and selected bivariate analyses were performed. Results: In total, 56%, 32% and 12% perceived increased DV in their communities during COVID-19 in Kenya, Bangladesh and Haiti, respectively. This included violence against both intimate partners and children. Key reasons reported for DV increases were increased stress/tension due to loss of employment/income ( \u3e 80%) and children being home/misbehaving ( \u3e 50%). In Kenya CHWs also cited partners spending more time together (59%), increased alcohol/substance use (38%), and conflict over childcare/housework responsibilities (33%). In bivariate analyses, in Kenya and Bangladesh, reporting a greater number of reasons for increased DV was associated with reporting co-occurring violence against both intimate partners and children (vs. just partners; P \u3c 0.001). Conclusions: Over half of CHWs in Kenya and one-third in Bangladesh perceived increased DV during COVID-19, largely due to increased stress/tension related to economic hardship and childcare. Fewer perceived increased DV in Haiti, where lockdowns have been less severe. Preventing and responding to DV must be central to COVID-19 response and recovery plans, and should include meeting families’ economic and childcare/schooling needs

Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya

Amidst the COVID-19 pandemic and national responses, trust (one’s belief that a system acts in one’s best interest) is important to consider. In community health systems, trust is embedded in relationships between clients, CHWs, and health system stakeholders. This mixed-methods study explores trust through the evolving COVID-19 crisis in Bangladesh, Haiti, and Kenya, where multi-country community health research was underway. We investigate the extent and ways trust between communities, community health workers (CHWs), and health system actors shift, including its relation to community fear and hostility, through self-reported positive and negative experiences of CHWs and policy/program stakeholders on a phone-based survey with 2,025 CHWs and 72 key informant interviews, including CHWs, in late 2020. On surveys, CHWs reported high levels of community trust (8/10 in Bangladesh and Kenya; 6/10 in Haiti) with over 60% reporting client relief in seeing their CHWs. About one-third of CHWs across countries reported experiencing instances of hostility from community members during the pandemic in the form of refused home-entry, ignored advice, or being shouted at. Multivariate analyses revealed that CHWs reporting more positive and fewer negative experiences is consistently associated with continuing routine work, doing COVID-19-related work, and greater community trust. Qualitative interviews showed that existing pre-pandemic trusting relationships withstood the early phase of COVID-19, mitigating negative community reactions toward CHWs and stigma towards COVID-positive individuals, maintaining routine health services, and sustaining appreciation for CHW-provided prevention information and emotional support. CHW-community and CHW-health system actor trust is strengthened when CHWs are well-resourced; CHW-community trust is strained by public frustration at the pandemic, associated restrictions, and sociopolitical stressors. Our study suggests that with adequate institutional support, bonds of trust can promote resilient community health systems during extended public health crises, through CHWs’ commitment to mitigating misinformation, reducing stigma, maintaining routine service provision, and promoting COVID-19 prevention

Neurology

Of 85 patients with ALS, the authors identified 3 patients with balanced translocations and 2 patients with pericentric inversions, all affecting distinct chromosomal loci. The high rate of constitutional aberrations (5.9%) suggests that ALS is, in part, associated with recombination-based rearrangements of genomic sequences

Negative experiences in the community reported by CHWs 6–8 months into the pandemic.

Negative experiences in the community reported by CHWs 6–8 months into the pandemic.</p

Trusted CHWs and positive community interactions 6–8 months into the pandemic.

Trusted CHWs and positive community interactions 6–8 months into the pandemic.</p

Negative experiences with facility-based providers reported by CHWs 6–8 months into the pandemic.

Negative experiences with facility-based providers reported by CHWs 6–8 months into the pandemic.</p

Results from ordinal logistic regression model with hostility/mistreatment as the outcome.

Results from ordinal logistic regression model with hostility/mistreatment as the outcome.</p

CHW socio-demographic and work characteristics.

CHW socio-demographic and work characteristics.</p