280 research outputs found
Reducing maternal and neonatal deaths in rural Malawi: evaluating the impact of a community-based womenâs group intervention
Background: Maternal and neonatal mortality are high in Malawi, and cost-effective
and sustainable interventions are needed in order to reduce mortality rates and make
progress to achieve Millennium Development Goals 4 and 5 for mother and child
health. Where health systems are weak and many women deliver at home, community-based
interventions have the potential to make an important contribution to health
improvements.
Methods: A cluster-randomised study with a factorial design was used to evaluate the
impact of two community-based interventions on maternal and child health outcomes. A
prospective pregnancy and birth monitoring system was developed to collect
information on pre-specified pregnancy, birth and infant outcomes. The research
presented here focuses on the womenâs group intervention, which uses participatory
methods to mobilise communities to take actions for maternal and child health problems
they identify.
Results: 18,562 pregnancies were followed up, resulting in 18,340 live births, 362
stillbirths, 434 neonatal deaths and 73 maternal deaths. 11,450 live births were
identified retrospectively, resulting in 484 infant deaths. Statistically significant
reductions in maternal and neonatal mortality as a result of the womenâs group
intervention were not seen (adjusted odds ratio 0.94 (95% CI 0.56-1.61) and 0.95 (95%
CI 0.71-1.28) respectively). There were significant improvements in antenatal care and
immunisation, and reductions in births attended by traditional birth attendants, and there
were non-significant reductions in mortality and increases in health-care seeking.
Discussion:
Although womenâs groups showed promising signs of community-level action for
mother and child health, methodological factors, such as low power and baseline
imbalance after randomisation, may have limited the ability of this study to detect an
impact of the intervention on mother and child health outcomes. Design and
implementation factors may also have caused delays and limited the measurable impact
of the intervention at this time. Follow-up over a longer period may show greater
impact
Womenâs groupsâ perceptions of neonatal and infant health problems in rural Malawi
AimsTo present the perceptions of women in rural Malawi regarding the health problems affecting neonates and infants and to explore the relevance of these perceptions for child health policy and strategy in Malawi.MethodsWomenâs groups in Mchinji district identified newborn and infant health problems (204 groups, 3484 women), prioritised problems they considered most important (204 groups, 3338 women) and recorded these problems on monitoring forms. Qualitative data was obtained through 6 focus-groupdiscussions with the womenâs groups and 22 interviews with individuals living in womenâs group communities but not attending groups.ResultsWomen in Malawi do not define the neonatal period accordingto any epidemiological definition. In order of importance they identified and prioritised the following problems for newborns and infants: diarrhoea, infection, preterm birth, tetanus, malaria, asphyxia, respiratory tract infection, hypothermia, jaundice, convulsions and malnutrition.ConclusionThis study suggests that women in rural Malawi collectively have a developed understanding of neonatal and infant health problems. This makes a strong argument for the involvement of lay people in policy and strategy development and also suggests that this capacity, harnessed and strengthened through community mobilisation approaches, has thepotential to improve neonatal and infant health and reduce mortality
Depression, anxiety, and stress among frontline health workers during the second wave of COVID-19 in southern Vietnam: a cross-sectional survey
Health workers around the world have taken on massive frontline roles in the fight against COVID-19, often under intense pressure and in the face of uncertainty. In this study, we determined the rates of depression, anxiety, stress and related factors among health workers in COVID-19 designated hospitals in southern Vietnam during the second wave of COVID-19. From July-September 2020, we collected self-administered surveys from 499 health workers in 14 hospitals that were designated for the care and treatment of patients with COVID-19. The survey included sections on demographics, co-morbid health conditions, symptoms experienced during patient care, a depression, anxiety and stress assessment (DASS-21), and other related factors. We used logistic regression models to identify factors associated with depression, anxiety and stress, and adjusted for confounding factors. 18%, 11.5%, 7.7% of participants had symptoms of depression, anxiety, and stress, respectively with the majority at mild and moderate levels. The risk factors for increased mental health impact included long working hours, experiencing physical symptoms, fear of transmission to family, COVID-19 related stigma, and worry when watching media about COVID-19. Psychological counseling and training in infection prevention were protective factors that reduced the risk of mental health problems. Further exploration of the association between physical symptoms experienced by health workers and mental health may guide interventions to improve health outcomes. More routine COVID-19 testing among health workers could reduce anxieties about physical symptoms and alleviate the fear of transmitting COVID-19 to family and friends. Medical institutions need to ensure that health workers have access to basic trainings prior to initiation of work, and mental health support during the pandemic and into the future
The Associations Between Cultural Identity and Mental Health Outcomes for Indigenous MÄori Youth in New Zealand
Objectives: To explore the relationships between MÄori cultural identity, ethnic discrimination and mental health outcomes for MÄori youth in New Zealand.Study Design: Nationally representative, anonymous cross-sectional study of New Zealand secondary school students in 2012.Methods: Secondary analysis of MÄori students (n = 1699) from the national Youth'12 secondary school students survey was undertaken. Theoretical development and exploratory factor analysis were undertaken to develop a 14-item MÄori Cultural Identity Scale (MCIS). MÄori students reporting > 8 items were classified as having a strong MCIS. Prevalence of indicators were reported and logistic regression models were used to explore how wellbeing (WHO-5), depressive symptoms (Reynolds Adolescent Depression Scale-SF), and suicide attempts were associated with the MCIS.Results: After adjusting for age, sex, ethnic discrimination and NZ Deprivation Index (NZDep), a strong MÄori cultural identity (MCIS) was associated with improved wellbeing scores (OR 1.53, 95% CI 1.18â2.01) and fewer depressive symptoms (OR 0.53, 95% CI 0.38â0.73). Experiencing discrimination was associated with poorer wellbeing scores (OR 0.50, 95% CI 0.39â0.65), greater depressive symptoms (OR 2.2, 95% CI 1.55â3.18), and a previous suicide attempt (OR 2.47, 95% CI 1.71â3.58). Females less frequently reported good (WHO-5) wellbeing (OR 0.33, 95% CI 0.26â0.42), increased (RADS-SF) depressive symptoms (2.61, 95% CI 1.86â3.64) and increased suicide attempts [OR 3.35 (2.07â5.41)] compared to males. Wellbeing, depressive symptoms and suicide attempts did not differ by age or neighborhood level socio-economic deprivation, except those living in neighborhoods characterized as having medium level incomes, were less likely to have made a suicide attempt (OR 0.49, 95% CI 0.27â0.91).Conclusions: MÄori youth who have a strong cultural identity were more likely to experience good mental health outcomes. Discrimination has a serious negative impact on MÄori youth mental health. Our findings suggest that programmes, policies and practice that promote strong cultural identities and eliminate ethnic discrimination are required to improve mental health equity for MÄori youth
MaiMwana womenâs groups: a community mobilisation intervention to improve mother and child health and reduce mortality in rural Malawi
This article presents a detailed description of a community mobilization intervention involving womenâs groups in Mchinji District, Malawi. The intervention was implemented between 2005 and 2010.The intervention aims to build the capacities of communities to take control of the mother and child health issues that affect them. To achieve this it comprises trained local female facilitators establishing groups and using a manual, participatory rural appraisal tools and picture cards to guide them through a community action cycle to identify and implement solutions to mother and child health problems. Significant resource inputs include salaries for facilitators and supervisors, and training, equipment and materials to support their work with groups.It is hypothesized that the groups will catalyse community collective action to address mother and child health issues and improve the health and reduce the mortality of mothers and children. Their impact, implementation and cost-effectiveness have been rigorously evaluated through a randomizedcontrolled trial design. The results of these evaluations will be reported in 2011
Volunteer infant feeding and care counselors: a health education intervention to improve mother and child health and reduce mortality in rural Malawi
The aim of this report is to describe a health education intervention involving volunteer infant feeding and care counselors being implemented in Mchinji district, Malawi.The intervention was established in January 2004 and involves 72 volunteer infant feeding and care counselors, supervised by 24 government Health Surveillance Assistants, covering 355 villages in Mchinji district. It aims to change the knowledge, attitudes and behaviour of women to promote exclusive breastfeeding and other infant care practices. The main target population are women of child bearing age who are visited at five key points during pregnancy and after birth. Where possible, their partners are also involved. The visits cover exclusive breastfeeding and other important neonatal and infant care practices. Volunteers are provided with an intervention manual and picture book. Resource inputs are low and include training allowances and equipment for counselors and supervisors, and a salary, equipment and materials for a coordinator.It is hypothesized that the counselors will encourage informational and attitudinal change to enhance motivation and risk reduction skills and self-efficacy to promote exclusive breastfeeding and other infant care practices and reduce infant mortality. The impact is being evaluated through a cluster randomised controlled trial and results will be reported in 2012
Maternal mortality in Malawi, 1977-2012.
Millennium Development Goal 5 (MDG 5) targets a 75% reduction in maternal mortality from 1990 to 2015, yet accurate information on trends in maternal mortality and what drives them is sparse. We aimed to fill this gap for Malawi, a country in sub-Saharan Africa with high maternal mortality
Indonesian healthcare professionals' experiences in rural and urban settings during the first wave of COVID-19: a qualitative study
Introduction:Â During the COVID-19 pandemic, healthcare workers (HCWs) faced unprecedented challenges, increased workload, and often struggled to provide healthcare services. We explored the experiences faced by HCWs working at primary healthcare centers (PHCs) and hospitals across urban and rural settings in Indonesia.
Methods:Â As part of a larger multi-country study, we conducted semi-structured in-depth interviews with a purposive sample of Indonesian HCWs. We used thematic analysis to identify the main challenges described by the participants.
Results:Â We interviewed 40 HCWs between December 2020 and March 2021. We identified that challenges varied depending on their role. i) For those in clinical roles, challenges included maintaining trust with communities, and patient referral issues; ii) for those in non-clinical roles, sub-optimal laboratory capacity and logistics, and lack of training were the main challenges; iii) for managerial roles, challenges included access to budget and supplies, and staff shortages due to isolation and overwork. There were also several cross-cutting challenges across all the roles including limited or rapidly changing information (in urban settings), and culture and communication (in rural settings). All of these challenges contributed to mental health issues among all HCW cadres.
Conclusions:Â HCWs across roles and settings were confronted with unprecedented challenges. Understanding the various challenges across different healthcare cadres and within different settings is crucial for supporting HCWs during pandemic times. In rural areas, in particular, HCWs should be more sensitive to cultural and linguistic differences to enhance the effectiveness and awareness of public health messages
Factors associated with strain in co-resident spouses of patients following stroke
Objective: To identify the factors associated with carer strain following stroke.
Design: Co-resident spouses of stroke patients were sent questionnaire measures of their perceptions of strain, stress, mood, handicap, adjustment, social support, life satisfaction and personality, and patientâs mood and independence in activities of daily living.
Setting: Stroke spouses were identified from the stroke register at City Hospital, Nottingham.
Results: In a sample of 222 carers, 37% had significant strain. Strain was highly correlated with negative affectivity on the Positive and Negative Affectivity Scale, carer mood on the General Health Questionnaire-12 (GHQ-12) and carerâs perceptions of patientâs independence in activities of daily living on the Extended Activities of Daily Living Scale (EADL). Logistic regression analysis of 96 of these carers supported the correlations and showed three factors, carer GHQ-12, patient EADL and negative affectivity, were independently associated with carer strain.
Conclusion: The relationship between these factors and strain needs to be tested prospectively. Early identification of carers who may be at risk of strain later on will enable services to be targeted at prevention rather than cure
Intracluster correlation coefficients and coefficients of variation for perinatal outcomes from five cluster-randomised controlled trials in low and middle-income countries: results and methodological implications
Background: Public health interventions are increasingly evaluated using cluster-randomised trials in which groups rather than individuals are allocated randomly to treatment and control arms. Outcomes for individuals within the same cluster are often more correlated than outcomes for individuals in different clusters. This needs to be taken into account in sample size estimations for planned trials, but most estimates of intracluster correlation for perinatal health outcomes come from hospital-based studies and may therefore not reflect outcomes in the community. In this study we report estimates for perinatal health outcomes from community-based trials to help researchers plan future evaluations.Methods: We estimated the intracluster correlation and the coefficient of variation for a range of outcomes using data from five community-based cluster randomised controlled trials in three low-income countries: India, Bangladesh and Malawi. We also performed a simulation exercise to investigate the impact of cluster size and number of clusters on the reliability of estimates of the coefficient of variation for rare outcomes.Results: Estimates of intracluster correlation for mortality outcomes were lower than those for process outcomes, with narrower confidence intervals throughout for trials with larger numbers of clusters. Estimates of intracluster correlation for maternal mortality were particularly variable with large confidence intervals. Stratified randomisation had the effect of reducing estimates of intracluster correlation. The simulation exercise showed that estimates of intracluster correlation are much less reliable for rare outcomes such as maternal mortality. The size of the cluster had a greater impact than the number of clusters on the reliability of estimates for rare outcomes.Conclusions: The breadth of intracluster correlation estimates reported here in terms of outcomes and contexts will help researchers plan future community-based public health interventions around maternal and newborn health. Our study confirms previous work finding that estimates of intracluster correlation are associated with the prevalence of the outcome of interest, the nature of the outcome of interest ( mortality or behavioural) and the size and number of clusters. Estimates of intracluster correlation for maternal mortality need to be treated with caution and a range of estimates should be used in planning future trials
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