Community health workers can provide psychosocial support to the people during COVID-19 and beyond in low- and middle- income countries

The COVID-19 pandemic has been the most challenging public health issue which not only affected the physical health of the global population but also aggravated the mental health conditions such as stress, anxiety, fear, depression and anger. While mental health services are seriously hampered amid this COVID-19 pandemic, health services, particularly those of Low- and Middle- Income Countries (LMICs) are looking for alternatives to provide psychosocial support to the people amid this COVID-19 and beyond. Community Health Workers (CHWs) are an integral part of the health systems in many LMICs and played significant roles such as health education, contact tracing, isolation and mobilization during past emergencies and amid COVID-19 in many LMICs. However, despite their potentials in providing psychosocial support to the people amid this COVID-19 pandemic, they have been underutilized in most health systems in LMICs. The CHWs can be effectively engaged to provide psychosocial support at the community level. Engaging them can also be cost-saving as they are already in place and may cost less compared to other health professionals. However, they need training and supervision and their safety and security needs to be protected during this COVID-19. While many LMICs have mental health policies but their enactment is limited due to the fragility of health systems and limited health care resources. CHWs can contribute in this regard and help to address the psychosocial vulnerabilities of affected population in LMICs during COVID-19 and beyond

The time has come to eliminate the gaps in the under-recognized burden of elder mistreatment: A community-based, cross-sectional study from rural eastern Nepal

<div><p>Background</p><p>Elder mistreatment is a well-recognized public health issue with complex underlying factors. The current study hypothesized that there is no effect of any of the following factors on any type of elder mistreatment: ethnicity, age group, education status, gender, living arrangement, concentration problems, medication for any disease, income level of caregiver, use of alcohol and tobacco products, and dependence on family or caregivers for daily activities.</p><p>Materials and methods</p><p>We conducted a cross-sectional study of 339 elders adults aged 60 or above residing in a rural part of eastern Nepal between August and November 2016. Multi-stage cluster sampling was adopted to select the study subjects. Information was collected using semi-structured questionnaires administered to elderly people by a designated interviewer. Factors associated with elder mistreatment were analyzed using logistic regression.</p><p>Results</p><p>Our findings revealed that 61.7% of 60+-year-olds experienced some form of mistreatment (physical 2.4%, psychological 22.4%, caregiver neglect 57.5%, financial 12.1% and stranger-inflicted 8.3%). Elder mistreatment was associated with the following characteristics of elders: dependent on family for daily living activities, illiterate, experiencing concentration problems, residing in a living arrangement with their son(s)/daughter(s)-in-law, taking regular medications, belonging to the Dalit community according to the Hindu traditional caste system, and residing with a caregiver having a monthly family income of less than NRs. 20,000 (193USD).</p><p>Conclusions</p><p>Our data show that elder mistreatment is prevalent in a rural community of Nepal. Addressing the lower socio-economic or socio-cultural classes of caregivers and elders via community-focused development programs might have significant implications for improving the well-being of elders.</p></div

Stepwise multivariable logistic regression analysis for some form of elder mistreatment and its subtypes among the elder population.

<p>Stepwise multivariable logistic regression analysis for some form of elder mistreatment and its subtypes among the elder population.</p

Gender-stratified prevalence of various types of elder mistreatment.

<p>Gender-stratified prevalence of various types of elder mistreatment.</p

Fig illustrates the flow diagram of the study subjects based on the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines [16].

<p>Fig illustrates the flow diagram of the study subjects based on the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0198410#pone.0198410.ref016" target="_blank">16</a>].</p

Stepwise multivariable logistic regression analysis for mistreatment subtypes among the elder population.

<p>Stepwise multivariable logistic regression analysis for mistreatment subtypes among the elder population.</p

Socio-demographic profiles of study participants (n = 339).

<p>Socio-demographic profiles of study participants (n = 339).</p

Factors associated with osteoarthritis prevalence in the pooled data (n = 2077).

Factors associated with osteoarthritis prevalence in the pooled data (n = 2077).</p

Changes in prevalence of osteoarthritis after adjusting for potential covariates (n = 2077).

Changes in prevalence of osteoarthritis after adjusting for potential covariates (n = 2077).</p

Data file of the study.

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