The contribution of female community health volunteers (FCHVs) to maternity care in Nepal: a qualitative study.

BACKGROUND: In resource-poor settings, the provision of basic maternity care within health centres is often a challenge. Despite the difficulties, Nepal reduced its maternal mortality ratio by 80% from 850 to an estimated 170 per 100,000 live births between 1991 and 2011 to achieve Millennium Development Goal Five. One group that has been credited for this is community health workers, known as Female Community Health Volunteers (FCHVs), who form an integral part of the government healthcare system. This qualitative study explores the role of FCHVs in maternal healthcare provision in two regions: the Hill and Terai. METHODS: Between May 2014 and September 2014, 20 FCHVs, 11 health workers and 26 service users were purposefully selected and interviewed using semi-structured topic guides. In addition, four focus group discussions were held with 19 FCHVs. Data were analysed using thematic analysis. RESULTS: All study participants acknowledged the contribution of FCHVs in maternity care. All FCHVs reported that they shared key health messages through regularly held mothers' group meetings and referred women for health checks. The main difference between the two study regions was the support available to FCHVs from the local health centres. With regular training and access to medical supplies, FCHVs in the hill villages reported activities such as assisting with childbirth, distributing medicines and administering pregnancy tests. They also reported use of innovative approaches to educate mothers. Such activities were not reported in Terai. In both regions, a lack of monetary incentives was reported as a major challenge for already overburdened volunteers followed by a lack of education for FCHVs. CONCLUSIONS: Our findings suggest that the role of FCHVs varies according to the context in which they work. FCHVs, supported by government health centres with emphasis on the use of local approaches, have the potential to deliver basic maternity care and promote health-seeking behaviour so that serious delays in receiving healthcare can be minimised. However, FCHVs need to be reimbursed and provided with educational training to ensure that they can work effectively. The study underlines the relevance of community health workers in resource-poor settings

Phylogenetic relationship of <i>Cryptosporidium</i> parasites inferred by neighbor-joining analysis of the SSU rRNA based on evolutionary distances calculated using the Kimura two-parameter model.

<p>Bootstrap values were obtained using 1,000 pseudoreplicates.</p

Additional file 1: of Multilocus genotyping of Giardia duodenalis isolates from children in Oromia Special Zone, central Ethiopia

Summary of the target genes, primers and annealing temperature of G. duodenalis used in this study. (DOCX 15 kb

PCR based prevalence of <i>Cryptosporidium</i> in dairy calves by study area, sex, age and breed groups in central Ethiopia (January—June, 2014).

<p>PCR based prevalence of <i>Cryptosporidium</i> in dairy calves by study area, sex, age and breed groups in central Ethiopia (January—June, 2014).</p

Prevalence and distribution of <i>Cryptosporidium</i> spp. in pre-weaned calves in Heilongjiang Province, China by sequence analysis of the SSU rRNA gene.

<p>Prevalence and distribution of <i>Cryptosporidium</i> spp. in pre-weaned calves in Heilongjiang Province, China by sequence analysis of the SSU rRNA gene.</p

Prevalence and percentage of different <i>Cryptosporidium</i> spp. on farms in Heilongjiang Province, China.

<p>Prevalence and percentage of different <i>Cryptosporidium</i> spp. on farms in Heilongjiang Province, China.</p

Genotyping of <i>Enterocytozoon bieneusi</i> in Farmed Blue Foxes (<i>Alopex lagopus</i>) and Raccoon Dogs (<i>Nyctereutes procyonoides</i>) in China

<div><p><i>Enterocytozoon bieneusi</i> is the most common species of microsporidia found both in humans and animals. Farmed animals, particularly closely associated to humans, may play an important role of zoonotic reservoir in transmitting this disease to humans. The fur industry is a major economic component in some parts of China. To understand the prevalence, genotype variety and zoonotic risk of <i>E</i>. <i>bieneusi</i> in farmed foxes and raccoon dogs, two species of fur animals, fecal specimens of 110 blue foxes and 49 raccoon dogs from Heilongjiang and Jilin provinces in China were examined by internal transcribed spacer (ITS)-based PCR. <i>E</i>. <i>bieneusi</i> was detected in 16.4% (18/110) blue foxes and 4.1% (2/49) raccoon dogs. Altogether, four genotypes of <i>E</i>. <i>bieneusi</i> were identified, including two known genotypes D (n = 13) and EbpC (n = 5), and two novel genotypes named as CHN-F1 (n = 1) in a fox and CHN-R1 (n = 1) in a raccoon dog. Phylogenetic analysis revealed that all the four genotypes were the members of zoonotic group 1. Genotypes D and EbpC were found in humans previously. The findings of zoonotic genotypes of <i>E</i>. <i>bieneusi</i> in the foxes and raccoon dogs suggest these animals infected with <i>E</i>. <i>bieneusi</i> may pose a threat to human health.</p></div

Age-specific distribution of <i>Cryptosporidium</i> species in pigs in Heilongjiang Province, China.

<p>Age-specific distribution of <i>Cryptosporidium</i> species in pigs in Heilongjiang Province, China.</p

Prevalence and age distribution of <i>Cryptosporidium</i> in pigs in Heilongjiang Province, China by microscopy and by PCR.

<p>Prevalence and age distribution of <i>Cryptosporidium</i> in pigs in Heilongjiang Province, China by microscopy and by PCR.</p

Phylogenetic relationship of <i>Enterocytozoon bieneusi</i> genotypes identified in the present study and other known genotypes deposited in GenBank was inferred by a neighbor-joining analysis of ITS sequences based on genetic distance by the Kimura two-parameter model.

<p>The numbers on the branches are percent bootstrapping values from 1,000 replicates. Each sequence is identified by its accession number, host origin, and genotype designation. The group terminology for the clusters is based on the work of Zhao et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0142611#pone.0142611.ref026" target="_blank">26</a>]. The squares and circles filled in black indicate novel and known genotypes identified in this study, respectively.</p