Community-based Health Care Interventions Research Articles

What influence mothers’ mental health and health care seeking behaviors for their malnourished children in Nepal: building evidence for a broader perspective

IntroductionImplementing research projects on community-based health care interventions in low-ressource settings is feasible with specific methods and applications. In order to critically understand all ins and outs of influencing factors involved in health care pathways for children and their mothers, we must consider to implement more than one research in the same context.ObjectivesThe objective of this presentation is to showcase the continuum of research projects starting from the assessment of the effectiveness of a combined nutrition and psychosocial intervention and its economic evaluation, and how that led to exploring social representations of malnutrition in order to better understand the link with health care seeking behaviours.MethodsThe FUSAM cluster randomized control trial included 427 were severe acutely malnourished (SAM) children and their mothers. They were divided in two groups receiving the standard nutrition treatment while the intervention group benefited from five psychosocial sessions. A battery of tests for child development and maternal mental health was administered pre and post intervention. For the economic evaluation, a data collection was conducted with 98 community members and District Public Health Office personnel in Saptari and 17 Action contre la Faim and government personnel in Kathmandu. Finally, a mixed-method study comparing social representations of malnutrition included 376 adults in Saptari and Nuwakot district. Data analysis was performed according to the study design: a multivariate model analysis for the CRCT, a micro-costing methodology to cost data collection and analysis was favored. For the mixed-method analysis, descriptive and inductive analysis were performed.ResultsRegarding the child development, children in the intervention group showed higher scores than children in the control group at all time points. And the economic evaluation showed that the costs of adding psychosocial counselling to an existing CMAM program was approximately EUR 28,788 for 6 centers per year. However, referrals of children through the community-based screening were not optimal. The findings related to health seeking behaviors showed that different meaning categories were simultaneously resorted to by community members leading to different representations of SAM children and that relevant health advises were neither systematically nor uniquely associated to medical categories but are linked to different meaning categories depending on the cultural context.ConclusionsMultiplying research projects is crucial to mitigate the limitations of the studies often facing numerous contextual challenges and ultimately to leverage further opportunities.Disclosure of InterestNone Declared

Participation in community-based healthcare interventions and non-communicable diseases early detection of general population in Indonesia

BackgroundCommunity-based Healthcare Interventions (CBHIs) are regarded as a critical component of healthcare task-sharing in LMICs and have the potential to address LMICs’ health system weaknesses to improve NCDs prevention care. This study aims to investigate the relationship between participation in CBHIs and NCDs early detection at medical facilities among Indonesians. MethodsData come from the fifth Indonesian Family Life Survey (2014–2015), a total of 27,692 individuals (14,820 female and 12,872 male individuals age 15 and older). Multiple ordered logistics and logistics regression was used to assess the association between individual participation in CBHI and early detection of NCDs at medical facilities. FindingsParticipation in CBHIs are associated with higher odds of having regular blood pressure test (adjusted odds ratio [OR], 3.09; 95% confidence interval [CI], 2.67–3.58), cholesterol test (adjusted OR, 1.88; 95% CI, 1.60–2.22), blood glucose test (adjusted OR, 1.88; 95% CI, 1.58–2.23), electrocardiogram (adjusted OR, 1.37; 95% CI, 1.06–1.76) and basic dental examination (adjusted OR, 1.32; 95% CI, 1.09–1.60) at medical facilities. The odds of having pap smears (adjusted OR, 2.20; 95% CI, 1.62–2.98) and breast self-examination (adjusted OR, 1.73; 95% CI, 1.37–2.19) among females who participated in CBHIs are substantially larger than those who did not participate in CBHIs. No significant association is shown for the basic vision examination (adjusted OR, 1.14; 95% CI, 0.95–1.37), while the association of participation in CBHIs on prostate cancer checkup (adjusted OR, 0.18; 95% CI, 0.04–0.76) was negative and significant. The results were controlled with a wide range of predisposing, enabling and need factors for NCDs early detection. Conclusionand recommendation: CBHIs may benefit NCDs early detection for the general population in Indonesia. Policymakers and health practitioners need to design CBHIs programs that are attractive to the population, especially men and younger people.

Participation in community-based health care interventions (CBHIs) and its association with hypertension awareness, control and treatment in Indonesia.

Little attention has been paid to whether CBHIs improve awareness, treatment and control of hypertension in the contexts of low- and middle- income countries (LMICs). This study therefore aims to examine participation in CBHIs for non-communicable diseases (NCDs) and its association with awareness, treatment, and control of hypertension among Indonesians. This study used data from the 2014 Indonesia Family Life Survey (IFLS), drawn from 30,351 respondents aged 18 years and older. Participation in CBHIs was measured by respondents' participation in CBHIs for NCDs (Posbindu PTM and Posbindu Lansia) during the 12 months prior to the survey. Logistic regressions were used to identify the relationships between participation in CBHIs for NCDs and awareness, treatment, and control of blood pressure among respondents with hypertension. The age-adjusted prevalence of hypertension was 31.2% and 29.2% in urban and rural areas, respectively. The overall age-adjusted prevalence was 30.2%. Approximately 41.8% of respondents with hypertension were aware of their condition, and only 6.6% of respondents were receiving treatment. Participation in CBHIs for NCDs was associated with 50% higher odds of being aware and 118% higher odds of receiving treatment among adults with hypertension. There was no significant association between participation in CBHIs for NCDs and controlled hypertension. Our data emphasise the importance of CBHIs for NCDs to improve the awareness and treatment of hypertension in the Indonesian population.

Nutrition Education as a Community-Based Healthcare Intervention in St. Livingston, CA

Nutrition Education as a Community-Based Healthcare Intervention in St. Livingston, CA

Model Revitalisasi Pondok Kesehatan Desa (Ponkesdes) dan Pos Pembinaan Terpadu (Posbindu) untuk Promosi Kesehatan dan Deteksi Dini Faktor Risiko Penyakit Jantung di Desa Sepanjang Kecamatan Gondanglegi Kabupaten Malang

This study aims to develop a model for revitalizing community based health care intervention for strengthening cardiovascular diseases preventive services. The case of CBHI in Sepanjang village was used to test whether the proposed model is suitable implemented. The findings show that the model was effectively implemented as indicated by the full acceptance of health workers and voluntary health workers as well as the effectiveness of screening and health promotion intervention.

Knowledge, attitude, and practices: assessing community based health care interventions in urban setting

Background: The urban community based Maternal, and Child Health-MCH interventions were implemented in district one of Kabul city from 2013 to 2016. The study intended to assess the changes in mothers’ knowledge, behaviors and practices toward proportions of birth spacing, Ante Natal Care-ANC visits, vaccinations and health care utilization to estimate interventions success.Methods: To measure the success of implemented interventions, the data were collected from the intervention and the control districts. The district two was selected as control as it had similar demographic characteristics to district one. Semi structured interviews were conducted with randomly selected 341 mothers in district one and 341 mothers from district two.Results: The proportions of mothers who ever wished to utilize a contraceptive method, practiced birth spacing, knowledge about the date that the baby was expected to arrive, preference to give birth in a health facility and completion of all ANC visits were significantly higher in intervention district. Additionally, the proportions of under five children who did not complete all scheduled routine vaccinations were lower in intervention district. It is likely, that implemented interventions have contributed to improve MCH knowledge, attitude and practices in intervention district.Conclusions: The result of study imply that interventions contributed to the increase in mothers’ knowledge and attitude about birth spacing. The interventions have also improved the level of knowledge about expected date of delivery and attitude to prefer giving birth in health facility. While, there is still room for improvement as almost half eligible children in intervention district did not complete all scheduled vaccinations.

A Study of Volunteer Community Health Workers Promoting Maternal Health Services in Rural Kenya: A Christian Viewpoint

Introduction: Despite the call for community-based health care interventions in the developing world, there is little research examining the effectiveness of paid versus volunteer community health worker (CHW) programs to increase women’s use of maternal health services. From a Christian perspective, the CHW model is, at its root, discipleship: a credible person leads a neighbor to a source of help and health. This effective model can be expanded to address the health of the whole person, both spiritual and physical. This study of a government health center program in rural Kenya addresses these issues.Methods: The current study analyzed the change in maternal health services after a government program, starting with 30 volunteer CHWs, had been in place for nine months. The intervention was designed and carried out by the authors in collaboration with Sigoti District Health Center in the western Kenyan province of Nyanza.Results: The proportion of facility-based deliveries (FBDs) showed a statistically significant increase (p=0.003), from an average of 38 deliveries before the intervention to 60 afterwards. The proportion of health center deliveries of HIV-positive women also significantly increased (p=0.04) from an average of 6.5 to 14 FBDs. Compared to another program in rural Lesotho with paid CHWs, the Sigoti intervention led to a similar increase in FBDs. Despite their successes, the community-based strategies were time-intensive for both programs, with one CHW adding between 1.12 and 1.7 FBDs per year.Discussion: This study demonstrates that a CHW program can be successful, even when using volunteers. Using solely a metric of time and/or money, the CHW model produces value at a high cost. However, the concerns of cost-effectiveness and CHW attrition, as well as the success of the CHW model, can be meaningfully addressed from a Christian perspective. Using the outcome measure of changed lives, volunteer CHWs could be motivated by a Christian call to discipleship. CHWs may be trained and supported to contribute to the health of the whole person. Future research will test these assumptions with a CHW program operating from a Christian health center to be built soon in the study area.

Increasing health equity and access to skilled birth delivery services for the poor through community-based health-care interventions: evidence from northern Nigeria

Background The Partnership for Transforming Health Systems Phase 2 (PATHS2) project introduced and supports community based interventions such as safe motherhood initiative demand side (SMID) and an emergency transport scheme within northern Nigeria. This study evaluates the effect of PATHS2’s community based interventions in addressing transportation as a barrier to accessing skilled birth delivery services in health facilities.