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

Integrating Nutrition Into Health Systems at Community Level:Impact Evaluation of the Community‐Based Maternal Andneonatal Health and Nutrition Projects in Ethiopia, Kenya, and Senegal

Maternal undernutrition and mortality remain high in several African countries. Key nutrition andhealth interventions improve maternal and birth outcomes. Evidence is scarce on how tostrengthen health systems to ensure pregnant women and newborns are reached with theseinterventions. We conducted three quasi‐experimental nonrandomized Community BasedMaternal and Neonatal Health and Nutrition projects in regions of Ethiopia, Senegal, and Kenyato demonstrate how proven nutrition interventions could be integrated into health programs toimprove knowledge and practices during pregnancy, birth, and postpartum. We evaluated impacton knowledge and practices related to maternal and neonatal care using logistic regression andrepeated‐measures models with districts as a fixed variable and adjusted for covariates. Com-bined country analyses show significant positive effects of the intervention on women receivingfirst antenatal care visit (ANC) during first trimester (OR = 1.44;p\u3c .001), those consuming anyiron and folic acid supplement during their latest pregnancy (OR = 1.60;p= .005), those whose\u3c6 months infants were exclusively breastfed (OR = 2.01;p=.003), those whose delivery wasfacility based (OR = 1.48;p=.031), and those whose postnatal care was facility based (OR =2.15;p\u3c.001). There was no significant differences between intervention and control groupsregarding one or more and four or more ANC visits, women consuming iron and folic acid for≥90 days, and early initiation of breastfeeding. We conclude that integrating proven nutritioninterventions into health programs at community level improved components of access to anduse of ANC, delivery services, and postnatal care by women in three African countries

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

Priority setting for health in the context of devolution in Kenya: implications for health equity and community-based primary care

Devolution changes the locus of power within a country from central to sub-national levels. In 2013, Kenya devolved health and other services from central government to 47 new sub-national governments (known as counties). This transition seeks to strengthen democracy and accountability, increase community participation, improve efficiency and reduce inequities. With changing responsibilities and power following devolution reforms, comes the need for priority-setting at the new county level. Priority-setting arises as a consequence of the needs and demand for healthcare resources exceeding the resources available, resulting in the need for some means of choosing between competing demands. We sought to explore the impact of devolution on priority-setting for health equity and community health services. We conducted key informant and in-depth interviews with health policymakers, health providers and politicians from 10 counties (n = 269 individuals) and 14 focus group discussions with community members based in 2 counties (n = 146 individuals). Qualitative data were analysed using the framework approach. We found Kenya’s devolution reforms were driven by the need to demonstrate responsiveness to county contexts, with positive ramifications for health equity in previously neglected counties. The rapidity of the process, however, combined with limited technical capacity and guidance has meant that decision-making and prioritization have been captured and distorted for political and power interests. Less visible community health services that focus on health promotion, disease prevention and referral have been neglected within the prioritization process in favour of more tangible curative health services. The rapid transition in power carries a degree of risk of not meeting stated objectives. As Kenya moves forward, decision-makers need to address the community health gap and lay down institutional structures, processes and norms which promote health equity for all Kenyans