Research excellence in community health research in Togo : a reflection paper for the 2013 IDRC / Coady Canadian Learning Forum

Excellent research is guided by internationally-accepted research protocols and experience shared by fellow researchers in peer-reviewed literature. The concept of research excellence can be summarized by the principles of scientific rigour, contribution to the evidence base for improved policy and practice, and community engagement and capacity building. The paper explores how these three principles played a critical role in the design and implementation of a malaria research and bed net project in Togo. Challenges are also discussed

“Health divide” between indigenous and non-indigenous populations in Kerala, India: Population based study

BACKGROUND: The objective of this study is to investigate the magnitude and nature of health inequalities between indigenous (Scheduled Tribes) and non-indigenous populations, as well as between different indigenous groups, in a rural district of Kerala State, India. METHODS: A health survey was carried out in a rural community (N = 1660 men and women, 18–96 years). Age- and sex-standardised prevalence of underweight (BMI < 18.5 kg/m(2)), anaemia, goitre, suspected tuberculosis and hypertension was compared across forward castes, other backward classes and tribal populations. Multi-level weighted logistic regression models were used to estimate the predicted prevalence of morbidity for each age and social group. A Blinder-Oaxaca decomposition was used to further explore the health gap between tribes and non-tribes, and between subgroups of tribes. RESULTS: Social stratification remains a strong determinant of health in the progressive social policy environment of Kerala. The tribal groups are bearing a higher burden of underweight (46.1 vs. 24.3%), anaemia (9.9 vs. 3.5%) and goitre (8.5 vs. 3.6%) compared to non-tribes, but have similar levels of tuberculosis (21.4 vs. 20.4%) and hypertension (23.5 vs. 20.1%). Significant health inequalities also exist within tribal populations; the Paniya have higher levels of underweight (54.8 vs. 40.7%) and anaemia (17.2 vs. 5.7%) than other Scheduled Tribes. The social gradient in health is evident in each age group, with the exception of hypertension. The predicted prevalence of underweight is 31 and 13 percentage points higher for Paniya and other Scheduled Tribe members, respectively, compared to Forward Caste members 18–30 y (27.1%). Higher hypertension is only evident among Paniya adults 18–30 y (10 percentage points higher than Forward Caste adults of the same age group (5.4%)). The decomposition analysis shows that poverty and other determinants of health only explain 51% and 42% of the health gap between tribes and non-tribes for underweight and goitre, respectively. CONCLUSIONS: Policies and programmes designed to benefit the Scheduled Tribes need to promote their well-being in general but also target the specific needs of the most vulnerable indigenous groups. There is a need to enhance the capacity of the disadvantaged to equally take advantage of health opportunities

Community-based health care is an essential component of a resilient health system: evidence from Ebola outbreak in Liberia

gCHV Community Register Data. This file provides the raw data and summary data of CHW community registers in the LNRCS MNCH project communities. (XLS 299 kb

Can an Integrated Approach Reduce Child Vulnerability to Anaemia? Evidence from Three African Countries.

Addressing the complex, multi-factorial causes of childhood anaemia is best done through integrated packages of interventions. We hypothesized that due to reduced child vulnerability, a "buffering" of risk associated with known causes of anaemia would be observed among children living in areas benefiting from a community-based health and nutrition program intervention. Cross-sectional data on the nutrition and health status of children 24-59 mo (N = 2405) were obtained in 2000 and 2004 from program evaluation surveys in Ghana, Malawi and Tanzania. Linear regression models estimated the association between haemoglobin and immediate, underlying and basic causes of child anaemia and variation in this association between years. Lower haemoglobin levels were observed in children assessed in 2000 compared to 2004 (difference -3.30 g/L), children from Tanzania (-9.15 g/L) and Malawi (-2.96 g/L) compared to Ghana, and the youngest (24-35 mo) compared to oldest age group (48-59 mo; -5.43 g/L). Children who were stunted, malaria positive and recently ill also had lower haemoglobin, independent of age, sex and other underlying and basic causes of anaemia. Despite ongoing morbidity, risk of lower haemoglobin decreased for children with malaria and recent illness, suggesting decreased vulnerability to their anaemia-producing effects. Stunting remained an independent and unbuffered risk factor. Reducing chronic undernutrition is required in order to further reduce child vulnerability and ensure maximum impact of anaemia control programs. Buffering the impact of child morbidity on haemoglobin levels, including malaria, may be achieved in certain settings

Conceptual framework for the analysis of anaemia risk [Adapted from 3,4].

<p>Conceptual framework for the analysis of anaemia risk [Adapted from 3,4].</p

Difference in mean Hb (g/L) with 95% CI based on multiple regression model (N = 2405; model adjusted for potable water source, toilet type, wealth rank, maternal education and distance to health facility).

<p>Difference in mean Hb (g/L) with 95% CI based on multiple regression model (N = 2405; model adjusted for potable water source, toilet type, wealth rank, maternal education and distance to health facility).</p

Comparison of mean haemoglobin with 95% CI among children with and without illness in the previous two days by year and country.

<p>Comparison of mean haemoglobin with 95% CI among children with and without illness in the previous two days by year and country.</p

Comparison of mean haemoglobin with 95% CI among children with and without malaria parasitaemia by year and country.

<p>Comparison of mean haemoglobin with 95% CI among children with and without malaria parasitaemia by year and country.</p