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 relationships of <i>Echinococcus granulosus</i> sensu lato isolates from Egypt compared to reference sequences of different <i>Echinococcus</i> species in database.

<p>Evolutionary relationship was inferred based on COX1 sequences (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0118509#pone.0118509.t001" target="_blank">Table 1</a>) using the Bayesian inference (BI) implemented in MrBayes software (version 3.2.2). <i>Taenia saginata</i> (NC_009938) was used as the outgroup.</p

GenBank accession numbers of COX1 and NAD1 of <i>Echinococcus</i> species/ genotypes/haplotype used in phylogenetic analysis in the present study.

<p>*Sequences generated in this study.</p><p>GenBank accession numbers of COX1 and NAD1 of <i>Echinococcus</i> species/ genotypes/haplotype used in phylogenetic analysis in the present study.</p

Phylogenetic relationship of <i>Psoroptes</i> spp. based on partial sequences of the ITS2.

<p>Evolutionary relationships of 22 taxa were inferred using the Neighbor-Joining method and Saitou and Nei distances, with the <i>Otodectes cynotis</i> (HQ728005) as the outgroup. Numbers at the internodes correspond to percent bootstrap values from 5,000 replicates.</p

Illustration of a male <i>Psoroptes natalensis</i> mite showing body configuration and distribution of body appendages and setae.

<p><b>A:</b> dorsal surface showing the propodosomal and hysteronotal shields and propodosomal (<i>si</i> and <i>se</i>), metapodosomal (<i>c1</i> and <i>c2</i>) and hysteronotal setae (<i>d1</i>, <i>d2</i>, <i>e1</i>, <i>e2</i> and <i>ps1</i>). Outer opisthosomal setae (<i>h2</i>) and the inner one (<i>h3</i>) were spatulated. B: ventral surface showing the aedeagus located in the metapodosomal region, along with a pair of lateral cuticular pits, followed posteriorly with a pair of adanal suckers, propodosomal setae (<i>1a</i>), and metapodosomal setae (<i>c3</i>, <i>cp</i>, <i>4b</i>, <i>3a</i> and <i>4a</i>).</p

Additional file 1 of Stable expression of mucin glycoproteins GP40 and GP15 of Cryptosporidium parvum in Toxoplasma gondii

Additional file 1: Table S1. Primers used in this study

Phylogenetic relationship of <i>Clostridium difficile</i> subtypes.

<p>The relationship of subtypes identified in this study and other subtypes in a previous study <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002437#pntd.0002437-Kato1" target="_blank">[9]</a> was inferred by a neighbor-joining analysis of <i>slpA</i> sequences, based on the p-distance model. Bootstrap values >50% are shown. Novel and known subtypes identified in this study are indicated by black and white triangles, respectively.</p

Association between animal contact and infection with <i>Cryptosporidium</i> species or <i>C. parvum</i> and <i>C. hominis</i> subtypes in HIV/AIDS patients in Ethiopia^*.

<p>*Contacts with specific animal species other than cattle were not significant risk factors in this study.</p><p>**95% CI: 95% confidence intervals.</p>#<p>Multivariable logistic regressions were performed to adjust the potential confounders including age, gender, HAART, CD4, and type of patients when sample size was sufficient. na: sample size was too small for multivariate logistic regression analysis.</p>##<p>Hosmer and Lemeshow test was applied to test the goodness of fit of multivariate logistics regression models.</p>###<p>For each <i>Cryptosporidium</i> species or subtype family, patients with the species or subtype family were taken as “positive”, patients who were not infected at all were taken as “negative” (referent), while patients infected with other species or subtype families were not included in this specific model.</p

Distribution and Clinical Manifestations of <i>Cryptosporidium</i> Species and Subtypes in HIV/AIDS Patients in Ethiopia

<div><p>Background</p><p>Cryptosporidiosis is an important cause for chronic diarrhea and death in HIV/AIDS patients. Among common <i>Cryptosporidium</i> species in humans, <i>C. parvum</i> is responsible for most zoonotic infections in industrialized nations. Nevertheless, the clinical significance of <i>C. parvum</i> and role of zoonotic transmission in cryptosporidiosis epidemiology in developing countries remain unclear.</p><p>Methodology/Principal Findings</p><p>In this cross-sectional study, 520 HIV/AIDS patients were examined for <i>Cryptosporidium</i> presence in stool samples using genotyping and subtyping techniques. Altogether, 140 (26.9%) patients were positive for <i>Cryptosporidium</i> spp. by PCR-RFLP analysis of the small subunit rRNA gene, belonging to <i>C. parvum</i> (92 patients), <i>C. hominis</i> (25 patients), <i>C. viatorum</i> (10 patients), <i>C. felis</i> (5 patients), <i>C. meleagridis</i> (3 patients), <i>C. canis</i> (2 patients), <i>C. xiaoi</i> (2 patients), and mixture of <i>C. parvum</i> and <i>C. hominis</i> (1 patient). Sequence analyses of the 60 kDa glycoprotein gene revealed a high genetic diversity within the 82 <i>C. parvum</i> and 19 <i>C. hominis</i> specimens subtyped, including <i>C. parvum</i> zoonotic subtype families IIa (71) and IId (5) and anthroponotic subtype families IIc (2), IIb (1), IIe (1) and If-like (2), and <i>C. hominis</i> subtype families Id (13), Ie (5), and Ib (1). Overall, <i>Cryptosporidium</i> infection was associated with the occurrence of diarrhea and vomiting. Diarrhea was attributable mostly to <i>C. parvum</i> subtype family IIa and <i>C. hominis</i>, whereas vomiting was largely attributable to <i>C. hominis</i> and rare <i>Cryptosporidium</i> species. Calf contact was identified as a significant risk factor for infection with <i>Cryptosporidium</i> spp., especially <i>C. parvum</i> subtype family IIa.</p><p>Conclusions/Significance</p><p>Results of the study indicate that <i>C. parvum</i> is a major cause of cryptosporidiosis in HIV-positive patients and zoonotic transmission is important in cryptosporidiosis epidemiology in Ethiopia. In addition, they confirm that different <i>Cryptosporidium</i> species and subtypes are linked to different clinical manifestations.</p></div

Occurrence of <i>Cryptosporidium</i> spp. (n = 140 cases) in 520 HIV/AIDS patients in Ethiopia by age and gender^*.

<p>*M: male; F: female.</p