Community-based Health Education Research Articles

Knowledge and Attitude About Diabetes Mellitus and Its Associated Factors Among People in DebreTabor Town, Northwest Ethiopia: Cross Sectional Study

Background: Diabetes mellitus is recognized as one of the emerging public health problems in developing countries. However, people’s knowledge and attitude about diabetes mellitus have not been efficiently investigated in Ethiopia. Objective: This study was conducted to assess the knowledge and attitude about diabetes mellitus and its associated factors among people in Debre Tabor town, Northwest Ethiopia. Methods: A community based cross-sectional study design was conducted among people age 18 years and above in Debre Tabor town during June 10 to August 20, 2014. A total of 832 participants were selected by systematic random sampling technique .Data were collected using a pretested structured Interviewer administered questionnaire and Epi info version 3.5.1 for data entry and SPSS version 20 for analysis used. Bivariate and multivariate analyses were used. Results: -Among 832 respondents, 408 (49%) participants had good knowledge and 329 (39.5%) participants had good attitude about diabetes mellitus. Educational status (Grade 1-8 AOR=2.6, 95% CI: 1.22-5.22, Grade 9-12 AOR=3.49, 95%CI: 1.68-7.22, and Certificate and above AOR=5.58;95%CI:2.73-11.44), family income per month (501-800Birr AOR=1.59,95%CI:1.07-2.40), 801-1450Birr AOR=1.61;95%CI:1.05-2.48, and ≥1451 Birr AOR=2.14; 95%CI:1.36-3.36) and family history of diabetes mellitus (AOR=3.89,95%CI :1.27-11.88) were significantly associated with good knowledge about diabetes mellitus. Educational status (Grade 1-8 AOR =2.53, 95 %CI: 1.24- 5.16, Grade 9-12 AOR=2.17, 95 % CI: 1.08-4.31 and Certificate and above AOR=3. 39, 95 % CI: 1.78-6.47) was significantly associated with good attitude towards diabetes mellitus. Conclusion and recommendation:-This study revealed a limited status in good knowledge and low in good attitude about Diabetes Mellitus. Comprehensive community based health education program about diabetes mellitus is necessary to improve this situation.

Major Risk Factors Predicting Anemia Development during Pregnancy: Unmatched-Case Control Study

Background: Anemia in pregnancy is associated with increased rates of maternal and perinatal mortality, premature delivery and other adverse outcomes. Hence, identifying anemia predicting risk factors in high-risk groups such as pregnant women is essential for problem based intervention modalities, particularly for developing countries. The aim of this study was to identify the major risk factors predictive of anemia development during pregnancy in Hawassa and Yirgalem cities located in Sidama Zone, Ethiopia. Methods: Unmatched case-control study, involving 561 pregnant women who initiated antenatal care follow up during their first trimester, was conducted from February to March 2011. Socio-demographic, hemoglobin level, obstetric and medical data of the study participants were collected using pre-tested well-structured questionnaire and reviewing antenatal care follow up record cards of each pregnant woman. Hemoglobin level <11 g/dl was used to define anemia during pregnancy. Bivariate and multivariate analyses were conducted to find predictors of anemia, P-value <0.05 was considered as statistically significant. Results: The major predicting risk factors for occurrence of anemia among pregnant women were, lower educational level (AOR=3.3, 95% CI: 1.3-8.0, P=0.007), prolonged menstruation period 6-8 days before the index pregnancy (AOR=3.1, 95% CI: 1.6-5.9., P=0.001), intestinal parasitic infection (AOR=2.9, 95% CI: 1.4-8.1, P=0.000), gastritis with duodenal ulcer bleeding (AOR=3.87, 95% CI: 1.8-8.0, P=0.000) and not taking meat/organ meats (AOR=2.8, 95% CI: 1.3-6.1, P=0.008). Conclusions: Family illiteracy, intestinal parasitic infection, duration of menstrual bleeding, gastritis with duodenal ulcer bleeding, and inadequate intake of organ meats were identified as strong predicting risk factors of anemia among pregnant women. Therefore, to reduce maternal mortality, the overall anemia prevention strategy in pregnant women should promote community-based health education to low educated families, mass de-worming of intestinal parasites and focused counseling for those women who have prolonged menstruation and peptic ulcer diseases.

Assessment of physical health status and quality of life among Saudi older adults.

[Purpose] This study investigated physical health status and quality of life among older Saudi adults. [Subjects and Methods] Participants included older adults (N = 55) aged 60–90 years (mean = 67.9± 7.71) from a major hospital in Jeddah. Subjects completed surveys and evaluations including assessments of personal and socio-demographic characteristics, caregiver presence, personal habits, perceived health, primary physical and psychological complaints, physician-diagnosed chronic diseases, and functional capacity (i.e., activities of daily living). [Results] Results showed a significant positive correlation between age and ADL; age and memory problems, anxiety, and loneliness; and sleep disturbance and falls. Main factors contributing to quality of life decline were chronic disease, falls, sedentary lifestyle, sleep disturbances, and financial concerns. Participants with diabetes mellitus (58.18%) and hypertension (29.0%) had a very high fall rate. Participants engaged in minimal physical activity (63%), often due to bone and joint pain (90.0%), and led sedentary lives (69%). Single sensory impairments were significantly and independently linked to high depression risk and decreased self-sufficiency. [Conclusion] Healthy lifestyle and behavioral changes should be promoted through community-based health education programs for older Saudi adults. Chronic disease screening programs for the elderly population (especially diabetes and hypertension) are recommended.

“Today we are not good at talking about these things”: A mixed methods study of Inuit parent/guardian-youth sexual health communication in Greenland

Some of the highest rates of sexually transmitted infections (STIs) are reported in the Arctic. For example, the Inuit youth of Greenland have the highest STI rates in the circumpolar region. In this study, we used a mixed method approach to examine parent/guardian–youth communication about STIs and other sexual health topics. The quantitative component of the study involved the parents/guardians completing a brief questionnaire while the qualitative component involved their participation in focus groups. Parents/guardians reported that, although they found little difficulty communicating with youth in general, this was not the case for sexual topics. Similarly, parents/guardians reported a lack of communication about topics such as masturbation, why people engage in sex, and what it feels like to have sex. In general parents/guardians stated that it is uncomfortable for them to talk with their youth about sexual matters. At the same time, they are concerned about the high rates of unwanted pregnancy in their communities, and they would like to see more collaborative partnerships aimed at increasing sexual health education for youth. Future STI prevention efforts in Greenland would benefit from involving Greenlandic youth and their families in the design of community-based sexual health education programs that increase communication skills in families about topics related to sex. Community based efforts that involve families and empower them to educate their youth around STI risk-prevention behaviours is a necessary area of future development in Greenland.

Community health screenings can complement public health outreach to minority immigrant communities.

We sought to provide culturally competent, community-based respiratory health screening and education in minority communities with high concentrations of Latino immigrants on Long Island and to assess the impact of this intervention on their decision to seek medical care. Seven health care screenings were performed in communities with high concentrations of immigrants from Latin America. A subgroup of participants who identified themselves as Hispanic/Latino were analyzed. After completion of a respiratory health questionnaire and spirometry, screening scores were calculated, education provided, and recommendations were made for medical evaluation in those who screened positive. A positive screen was defined as abnormal respiratory symptoms, abnormal spirometry, or both. Follow-up contacts were made at 1, 6, and 12 months to assess compliance with the recommendation to seek care in those who screened positive. High positive screening rates for both men (64%) and women (61%) were found. Of the participants who screened positive and were advised to seek medical care, 52% did so. Compliance with the recommendation to seek care was associated with the presence of an identified medical provider at baseline. Of those who screened positive and who did not comply with team's recommendation, 75% were unable to identify a health care provider. A significant number of participants who screened positive could not identify a health care provider and did not follow-up with the recommendation to seek medical evaluation. Community-based screenings provide an opportunity to access at-risk immigrant populations for health screening and education, and to facilitate referral and access to medical services.

Health and psychosocial service use among suicides without psychiatric illness.

Although mental illness is a major suicide risk factor, some cases of suicide list no symptoms of mental disorder at the time of death. Studying suicides without psychiatric illness has important implications for social work because this group's service needs seem to have been overlooked. The authors of this article conducted a psychological autopsy study of 150 people who committed suicide and 150 age- and gender-matched living controls. Suicides without psychiatric illness showed similar detectable psychopathology as the suicide and living control groups with nonpsychotic psychiatric disorders. Though suicides without psychiatric disorders showed fewer warning signs that could be noticed by their informants, they experienced more negative life events than living controls. The suicide cases without psychiatric illness also seemed to be less protected by enabling factors (such as social support and employment) than living controls with and without psychiatric disorders. Furthermore, they had lower use of services than the control and deceased-with-diagnosis groups. With fewer at-risk signs and poorer enabling resources, they were undetected or unengaged by the existing physical, psychiatric, and psychosocial services. This group should be of concern to social workers, who may develop community-based health education programs and preventive services to meet this vulnerable population's psychosocial needs.

Mapping the pathways to eye care in a rural south-east Nigerian population: any implications for practice, eye care programs and policy?

The appropriateness of the initial pathway to care, especially eye care, is critical for timeliness and outcomes of care. Individual-dependent and health system-determined factors influence the preferred initial pathway to care. This study aimed to map the initial pathways to eye care in a rural population in south-east Nigeria and identify the associated factors. This study was a population-based, cross-sectional descriptive survey conducted in Abagana, a rural south-east Nigeria community, in September 2011. Using a researcher-administered questionnaire, data on participants' sociodemographics, preferred initial eyecare pathway when confronted with an eye disorder and their reason(s) for the choice of pathway were collected. Descriptive and analytical statistics were performed. Regression analysis was used to identify independent predictors of visiting an ophthalmologist when confronted with an eye disorder. In all comparisons, p < 0.05 was considered statistically significant. The participants (n = 501: 263 men; 238 women) were aged 48.9±16.3 years (range 18-93 years). The majority of the participants were married (339; 67.7%) and possessed formal education (415; 82.8%). The participants' frequently preferred initial pathways to eye care were to consult a patent medicine dealer (178; 35.0%), to consult an ophthalmologist (165; 33.0%), and to self-medicate (125; 25.0%). Possession of formal education (odds ratio 0.3; 95% confidence interval 0.1-0.5; p < 0.001) was the only significant sociodemographic predictor of consulting an ophthalmologist when confronted with an eye disorder The participants' main reasons for not consulting an ophthalmologist were ignorance (190; 56.5%), cost (199; 59.2%), and restricted spatial access (228; 67.9%). The majority of the respondents chose an inappropriate eyecare pathway in the event of an eye disorder. The reported barriers to appropriate pathway selection are amenable to community-based eye health education, enhanced affordability, and even distribution of eyecare services. Integrating other alternative care pathways into orthodox eye care should be considered.

Abstract A26: Tackling cervical cancer disparities through African American beauty salons: A community-based health education intervention

Abstract While traditional settings such as physician offices and community health agencies have had measurable success in delivering behavioral health interventions, they are less successful in recruiting underserved African American participants. Inner-city African American women, faced with multiple risk factors contributing to persistent health disparities, require a source of reliable health information in a setting that is easily accessible and credible to them. Salon-based health education programs are becoming increasingly popular for reaching African American females because they engage trusted members of the community (salon owners and hair stylists) in a location that represents care and reflects the tradition of sharing information through oral communication. We partnered with neighborhood hair salons to promote messages about persistent cervical cancer disparities and low rates of human papillomavirus (HPV) vaccination in the African American community. Study goals were to: (1) recruit eight beauty salons in low-income Philadelphia neighborhoods to serve as health education sites; (2) train hair stylist to be able to discuss cervical cancer disparities and HPV infection with their customers, and (3) increase knowledge and awareness about HPV, as well as intentions to vaccinate, among customers at each salon. Study inclusion criteria for customers consisted of being a young woman ages 18 to 26 or the caregiver of a young female ages 9 to 17. Stylists were trained by members of the research team to be able to briefly discuss cervical cancer and HPV with their customers during regular salon hours. Additionally, professional health educators were trained more substantially on the health topics and were placed in the salons to supplement the work of the stylists and provide a more in-depth educational experience for the customers. Survey data related to knowledge and attitudes about HPV and HPV vaccination were collected from customers immediately before and after the health education, and approximately one month later. Salon stylists and owners were interviewed post-intervention to assess their experiences with participating in the intervention. Two hundred and forty women from 10 salons were enrolled in the study. Roughly 60% of participants were caregivers while 40% were young women. Knowledge about cervical cancer and HPV infection increased significantly in both groups from baseline to endpoint and remained high at the one-month follow-up assessment. At follow-up, 68% of participants said that they had had a discussion with a friend or family member about what they learned, and 57% planned to talk to their doctor or their daughter's doctor about HPV vaccination. Sixty-two percent of caregivers reported that it was important that their daughter be vaccinated against HPV in the future. There were no significant differences between the caregivers and the young women on outcome measures of knowledge, attitudes, or intentions to vaccinate. During the post-intervention interviews with the stylists, many indicated that they enjoyed having discussions about health in the salon and that salons should continue to serve as venues of education for women in the African American community. The majority of stylists indicated that neither they, nor their customers, were aware of the magnitude of cervical cancer disparities among African American women nor the availability of the HPV vaccine as a method of protection for young women. Results of the study indicate that such community-based interventions are both feasible and effective in reaching populations not traditionally included in health education interventions. Citation Format: Amy Leader, Pamela Weddington, Ralph DiClemente, Gina Wingood, Alicia Jackson, Ivan Juzang. Tackling cervical cancer disparities through African American beauty salons: A community-based health education intervention. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A26. doi:10.1158/1538-7755.DISP13-A26

Determinants and pattern of care seeking for preterm newborns in a rural Bangladeshi cohort.

BackgroundDespite the increased burden of preterm birth and its complications, the dearth of care seeking data for preterm newborns remains a significant knowledge gap. Among preterm babies in rural Bangladesh, we examined: 1) determinants and patterns of care seeking, and 2) risk analysis for care-seeking from qualified and unqualified providers.MethodTrained community health workers collected data prospectively from 27,460 mother-liveborn baby pairs, including 6,090 preterm babies, between June 2007 and September 2009. Statistical analyses included binomial and multinomial logistic regressions.ResultsOnly one-fifth (19.7%) of preterm newborns were taken to seek either preventive or curative health care. Among care-seeker preterm newborns, preferred providers included homeopathic practitioners (50.0%), and less than a third (30.9%) sought care from qualified providers. Care-seeking from either unqualified or qualified providers was significantly lower for female preterm babies, compared to male babies [Relative Risk Ratio (RRR) for unqualified care: 0.68; 95% Confidence Interval (CI): 0.58, 0.80; RRR for qualified care: 0.52; 95% CI: 0.41, 0.66]. Among preterm babies, care-seeking was significantly higher among caregivers who recognized symptoms of illness [RR: 2.14; 95% CI: 1.93, 2.38] or signs of local infection (RR: 2.53; 95% CI: 2.23, 2.87), had a history of child death [RR: 1.21; 95% CI: 1.07, 1.37], any antenatal care (ANC) visit [RR: 1.41; 95% CI: 1.25, 1.59]. Birth preparedness (RRR: 1.24; 95% CI: 1.09, 1.68) and any ANC visit (RRR: 1.73; 95% CI: 1.50, 2.49) were also associated with increased likelihood of care seeking for preterm babies from qualified providers.ConclusionTo improve care seeking practices for preterm babies and referral of sick newborns to qualified providers/facilities, we recommend: 1) involving community-preferred health care providers in community-based health education and awareness raising programs; 2) integrating postnatal care seeking messages into antenatal counselling; and 3) further research on care seeking practices for preterm babies.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-417) contains supplementary material, which is available to authorized users.

What Women Want: Patient Recommendations for Improving Access to Breast and Cervical Cancer Screening and Follow-up

BackgroundThe patient voice remains underrepresented in clinical and public health interventions. To inform interventions that strive to improve access to breast and cervical cancer screening and follow-up among low-income populations, we explored recommendations from low-income women pursuing health care in the safety net. MethodsSemi-structured interviews were conducted among women receiving follow-up care for an abnormal breast or cervical cancer screening result or a positive cancer diagnosis in federally qualified health centers, free clinics, or an academic cancer center in the Chicago metropolitan area. FindingsOf the 138 women interviewed in the parent study, 52 women provided recommendations for improving access to screening and follow-up care. Most were between 41 and 65 years old (62%) and African American (60%) or White (25%). Recommendations included strengthening community-based health education with more urgent messaging, strategic partnerships, and active learning experiences to increase patient engagement, which women regarded as a key driver of access. Women also suggested increasing access by way of changes to health care delivery systems and policy, including more direct patient–provider and patient–clinic communications, addressing delays caused by high patient volume, combining preventive services, expanding insurance coverage, and adjusting screening guidelines. ConclusionsThis exploratory study demonstrates important insights from the patient lens that may help to increase the acceptability and efficacy of community and clinical interventions aimed at improving access to breast and cervical cancer screening and follow-up. Further research is needed to identify appropriate integration of patient input into interventions, practice, and policy change.

Magnitude and trends of inequalities in antenatal care and delivery under skilled care among different socio-demographic groups in Ghana from 1988 - 2008.

BackgroundImproving maternal and reproductive health still remains a major challenge in most low-income countries especially in sub-Saharan Africa. The growing inequality in access to maternal health interventions is an issue of great concern. In Ghana, inadequate attention has been given to the inequality gap that exists amongst women when accessing antenatal care during pregnancy and skilled attendance at birth. This study therefore aimed at investigating the magnitude and trends in income-, education-, residence-, and parity-related inequalities in access to antenatal care and skilled attendance at birth.MethodsA database was constructed using data from the Ghana Demographic and Health Surveys (DHS) 1988, 1993, 1998, 2003, and 2008. The surveys employed standard DHS questionnaires and techniques for data collection. We applied regression-based Total Attributable Fraction (TAF) as an index for measuring socioeconomic inequalities in antenatal care and skilled birth attendance utilization.ResultsThe rural–urban gap and education-related inequalities in the utilization of antenatal care and skilled birth attendants seem to be closing over time, while income- and parity-related inequalities in the use of antenatal care are on a sharp rise. Income inequality regarding the utilization of skilled birth attendance was rather low and stable from 1988 to 1998, increased sharply to a peak between 1998 and 2003, and then leveled-off after 2003.ConclusionsThe increased income-related inequalities seen in the use of antenatal care and skilled birth attendance should be addressed through appropriate strategies. Intensifying community-based health education through media and door-to-door campaigns could further reduce the mentioned education- and parity-related inequalities. Women should be highly motivated and incentivized to attend school up to secondary level or higher. Education on the use of maternal health services should be integrated into basic schools so that women at the lowest level would be inoculated with the appropriate health messages.

Assessment of Some Indices of Primary Health Care in Masaki Village, Tanzania

Background: Primary Health Care (PHC) is a critical element in health and socioeconomic development of communities especially in rural Africa. There is paucity of information on the assessment of many indices of PHC in Tanzanian villages. This study was therefore designed with the purpose of evaluating some critical primary PHC indices of Masaki Village in Tanzania. Methodology: One hundred owners of homesteads living within Masaki village were recruited for the study based on informed consent. Information on socio-demographic characteristics, quality of housing, water supply, personal hygiene, diseases’ vectors, general health status and environmental sanitation were gotten through self-administered semi-structured questionnaires. Data collected was analyzed using standard statistical methods. Results: The results showed that standard of living (quality of housing is low 23%) and education level of adults in Masaki is low (no education 47%). Water supply is a major problem (only 13% accessed safe water), diseases’ vectors are very common (95%). There is high prevalence of malaria (73%), acute respiratory tract infections (19%), typhoid (10%) and diarrhea (6%). Environmental sanitation is poor (56% inadequate refuse disposal and 35% deep latrine). Conclusion: PHC indicators; standard of living, water supply, education, sanitation and diseases’ vectors need to be addressed appropriately. Community based health education activities and other programmes geared towards enhancing PHC should be developed and implemented.

Efektivitas Metode Kolaboratif Learning dan Kooperatif dalam Pendidikan Kesehatan Berbasis Komunitas

Background: The role of the learning methods is changing from teacher centered learning to student centered learning (SCL). One of the SCL methods is collaborative and cooperative learning. The past twenty years have seen an increase in collaborative and cooperative learning based pedagogies in colleges, but not in community based health education. The aim of this study is to identify the efectivity of collaborative and cooperative learning in community based health educationMethod: This research used quasi experimental non-randomized control group post test design. Respondent of the research are 111 geriatric cadres of Kecamatan Kepanjen and 72 geriatric cadres of Kecamatan Singosari.Results: Data shows that cadre’s knowledge in first training, 30 and 90 days after first training increased in both groups (p&lt;0,001). There is no relationship between individual characteristic (age, education, occupation, time to work as a cadre, training) and increase of knowledge (p&gt;0,05).Conclusion: Collaborative and cooperative method can increase cadre’s knowledge of stroke effectively and maintain memory retention longer than conventional method.

Health belief model based evaluation of school health education programme for injury prevention among high school students in the community context

BackgroundAlthough multifaceted community-based programmes have been widely developed, there remains a paucity of evaluation of the effectiveness of multifaceted injury prevention programmes implemented in different settings in the community context. This study was to provide information for the evaluation of community-based health education programmes of injury prevention among high school students.MethodsThe pre-intervention survey was conducted in November 2009. Health belief model (HBM) based health education for injury prevention started in January 2010 and stopped in the end of 2011 among high school students in the community context in Shanghai, China. A post-intervention survey was conducted six weeks after the completion of intervention. Injury-related health belief indicators were captured by a short questionnaire before and after the intervention. Health belief scores were calculated and compared using the simple sum score (SSS) method and the confirmatory factor analysis weighted score (CFAWS) method, respectively.ResultsThe average reliability coefficient for the questionnaire was 0.89. The factor structure of HBM was given and the data fit HBM in the confirmatory factor analysis (CFA) very well. The result of CFA showed that Perceived Benefits of Taking Action (BEN) and Perceived Seriousness (SER) had the greatest impact on the health belief, Perceived Susceptibility (SUS) and Cues to Action (CTA) were the second and third most important components of HBM respectively. Barriers to Taking Action (BAR) had no notable impact on HBM. The standardized path coefficient was only 0.35, with only a small impact on CTA. The health belief score was significantly higher after intervention (p < 0.001), which was similar in the CFAWS method and in the SSS method. However, the 95% confidential interval in the CFAWS method was narrower than that in the SSS method.ConclusionsThe results of CFA provide further empirical support for the HBM in injury intervention. The CFAWS method can be used to calculate the health belief scores and evaluate the injury related intervention. The community-based school health education might improve injury-related health belief among high school students; however, this preliminary observation needs to be confirmed in further research.

Extending community based health care services to counter the multi-dimensional threat of hypertension

Hypertension has been identified as an important public health concern of global distribution and as the key risk factor for most of the common cardiovascular diseases. Rationale and adequate control of hypertension is a key element in the prevention of hypertension induced-organ damage and the associated life threatening complications. An extensive search of all materials related to the topic was done in Pubmed, Medline, World Health Organization website and Google Scholar search engines. Keywords used in the search included hypertension, cardiovascular disease, public health, lifestyle modifications, and awareness. A diverse range of socio-demographic and health system related factors have been acknowledged in the causation and determining the long-term outcomes of the disease. As the natural history of hypertension is complex the strategy to combat also should be multi-pronged based on the pre-existing factors in different settings. Altogether, although some progress has been observed in the field of community awareness, blood pressure level control, and therapeutic modalities, the need is to implement sustainable and cost-effective interventions that will not only halt but also reverse the rising trend of hypertension. Community-based health education strategies, adoption of healthy dietary and lifestyle practices, and availability of effective drugs are effective measures to mitigate the overall burden of the disease.

Once a year school-based deworming with praziquantel and albendazole combination may not be adequate for control of urogenital schistosomiasis and hookworm infection in Matuga District, Kwale County, Kenya

BackgroundNeglected tropical diseases (NTDs) predominantly occur in resource poor settings where they often present a serious public health burden. Sustained global advocacy has been important in raising awareness of NTDs and the relatively low cost for control of helminthic NTDs using preventive chemotherapy. This enthusiasm was boosted at the London declaration on NTDs in 2012 through commitments by different partners to avail resources required for control of NTDs particularly those that employ preventive chemotherapy as the major intervention strategy. Subsequently, national NTD programmes are responding to these new opportunities by implementing preventive chemotherapy including school-based deworming (SBD). Further, with the availability of increased resources, both financial and pharma, the optimal strategies for implementing preventive chemotherapy in highly endemic settings are under debate and this paper goes some way to addressing this issue in a specific setting in coastal Kenya.MethodsWe conducted a repeated cross-sectional study in Matuga District, Kwale County, Kenya to evaluate the effect of school-based co-administration of praziquantel and albendazole against urogenital schistosomiasis and soil-transmitted helminth (STH) infections. A total of 1022 school children in 5 study schools were tested for the infections in urine and stool samples during a baseline survey in September 2009. The presence of Schistosoma haematobium infection was determined by the urine filtration method while STH infections were determined by Kato-Katz technique.ResultsUrogenital schistosomiasis and hookworm infection were the major parasitic infections among the children in the study area. There was significant decrease in both prevalence and intensity of S. haematobium infection after treatment but varying levels of rebound were observed during the period between the treatments. The school-based treatment, however, did not have any significant effect on both the prevalence and intensity of hookworm infection.ConclusionsOnce per year SBD programmes may not be adequate for controlling hookworm infection and urogenital schistosomiasis in rural areas of Kwale County. There is a need to consider expanded preventive chemotherapy strategies that will allow inclusion of the adult populations. Community-based health education campaigns focusing on increasing household latrine ownership and use, as a complementary measure to control STH and urogenital schistosomiasis in similar settings, may also be useful.

Knowledge, attitudes and practices of Ugandan men regarding prostate cancer

BackgroundThe incidence of prostate cancer in Uganda is one of the highest recorded in Africa. Prostate cancer is the most common cancer among men in Uganda. ObjectiveThis study assessed the current knowledge, attitudes and practices of adult Ugandan men regarding prostate cancer. Subjects and MethodsWe conducted a descriptive cross-sectional study using interviewer administered questionnaires and focus group discussions among 545 adult men aged 18–71 years, residing in Kampala, the capital of Uganda. Quantitative data were analyzed with SPSS version 20. Qualitative data were collected using audio recorded focus group discussions, transcribed and analyzed by clustering into themes. ResultsThe majority of the respondents (324, 59.4%) were aged 18–28 years, 295 (54.1%) had heard about prostate cancer and 250 (45.9%) had never heard about it. The commonest source of information about prostate cancer was the mass media. Only 12.5% of the respondents obtained information about prostate cancer from a health worker, 37.4% did not know the age group that prostate cancer affects and 50.2% could not identify any risk factor for prostate cancer. Participants in the focus group discussions confused prostate cancer with gonorrhea and had various misconceptions about the causes of prostate cancer. Only 10.3% of the respondents had good knowledge of the symptoms of prostate cancer and only 9% knew about serum prostate specific antigen (PSA) testing. Although 63.5% thought they were susceptible to prostate cancer, only 22.9% considered getting and only 3.5% had ever undergone a serum PSA test. ConclusionThere was generally poor knowledge and several misconceptions regarding prostate cancer and screening in the study population. Community based health education programs about prostate cancer are greatly needed for this population.

Coronary heart disease: pandemic in a true sense.

Cardiovascular diseases are caused because of abnormalities in the heart and blood vessels. Recent trends reveal that the incidence of coronary heart disease (CHD) has gradually decreased in many developed countries, but the situation remains quite challenging in developing nations that account for more than 60% of the global burden. Multiple socio-demographic, personal, physician related and healthcare delivery system related factors have been identified which act in variable combinations to either influence the incidence of CHD or affect the short/long-term outcome of the disease. Of all CHD cases who succumb within 28 days of onset of symptoms, almost 67% fail to reach even a hospital. This clearly signifies the importance of primary prevention and early recognition of the warning signs in averting cause-specific mortality. The main priority is to develop cost-effective equitable health care innovations in CHD prevention and to monitor the trend of CHD so that evidence-based interventions can be formulated. To conclude, inculcating health-promoting behaviors in school children and the general population by means of community-based health screening and education interventions could avert many more deaths attributed to CHDs.

Family, community and clinic collaboration to treat overweight and obese children: Stanford GOALS—A randomized controlled trial of a three-year, multi-component, multi-level, multi-setting intervention

ObjectiveTo test the effects of a three-year, community-based, multi-component, multi-level, multi-setting (MMM) approach for treating overweight and obese children. DesignTwo-arm, parallel group, randomized controlled trial with measures at baseline, 12, 24, and 36months after randomization. ParticipantsSeven through eleven year old, overweight and obese children (BMI≥85th percentile) and their parents/caregivers recruited from community locations in low-income, primarily Latino neighborhoods in Northern California. InterventionsFamilies are randomized to the MMM intervention versus a community health education active-placebo comparison intervention. Interventions last for three years for each participant. The MMM intervention includes a community-based after school team sports program designed specifically for overweight and obese children, a home-based family intervention to reduce screen time, alter the home food/eating environment, and promote self-regulatory skills for eating and activity behavior change, and a primary care behavioral counseling intervention linked to the community and home interventions. The active-placebo comparison intervention includes semi-annual health education home visits, monthly health education newsletters for children and for parents/guardians, and a series of community-based health education events for families. Main outcome measureBody mass index trajectory over the three-year study. Secondary outcome measures include waist circumference, triceps skinfold thickness, accelerometer-measured physical activity, 24-hour dietary recalls, screen time and other sedentary behaviors, blood pressure, fasting lipids, glucose, insulin, hemoglobin A1c, C-reactive protein, alanine aminotransferase, and psychosocial measures. ConclusionsThe Stanford GOALS trial is testing the efficacy of a novel community-based multi-component, multi-level, multi-setting treatment for childhood overweight and obesity in low-income, Latino families.

Sustainability of promotora initiatives: program planners' perspectives.

The use of promotoras de salud is an increasingly widespread delivery approach for community-based health education and promotion programs targeting obesity-related lifestyle behaviors for Hispanic populations. Addressing a gap in the literature, this research examined the sustainability of promotora-led initiatives from the perspectives of those who plan, implement, and evaluate these programs. We conducted 24 in-depth interviews with program planners representing 22 promotora programs focused on Hispanic women's health in 10 states. Findings illustrated program planners' opinions regarding the components, logistics, and barriers to promotora program sustainability. Several participants challenged the notion of promotora program sustainability by reframing the issue as promoting individual promotoras' well-being and social mobility rather than maintaining their role in the program over time. Implications for community health planning, management, and policy include developing sustainability strategies during program planning stages and implementation of policies to more effectively integrate promotoras into existing health care systems at local, state, and national levels.