Community-based Health Programs Research Articles

The Problems Affecting the Implementation of Posyandu Program: A Literature Review

Integrated Health Post for Child Center/Pos Pelayanan Terpadu (Posyandu) is a form of community-based health program carried out by, from, and along with the community to empower and provide facilities for the community to obtain health services for mothers, babies, and toddlers. Posyandu activities include: KIA, family planning, immunization, nutrition, diarrhea prevention. Posyandu in Indonesia still faced several problems. This study aimed at investigating the problems that affect the implementation of Posyandu program and actions to improve Posyandu program services. The method used in this study was literature review. The literatures used in this study were the search results through national and international journals. National includes google scholar [https://scholar.google.co.id/] and international includes Pubmed [https://www.ncbi.nlm.nih.gov/pubmed] with the keyword “Problems and Posyandu Program” published in 2016-2020. Based on the search results, 8 national and 2 international articles related to the topic and in accordance with the inclusion and exclusion criteria were found. The results of 10 literature reviews show there are several fundamental problems of Posyandu program in Indonesia, namely: 1) the low role of Posyandu cadres; 2) the lack of understanding on the benefit of Posyandu program; 3) The lack of participation in Posyandu activities; 4) The lack of facilities and infrastructure for Posyandu activities; and 5) the lack of cross-program and cross-sector cooperation. In addition, there are 5 actions needed to solve the problems. The first action is to conduct a training program for Posyandu cadres. The second one is to conduct regular outreach at Posyandu for mothers and families by trained cadres. The third one is to improve the facilities and infrastructure in Posyandu. The fourth one is to provide both material and immaterial incentives for an active Posyandu’s cadre. Lastly, the fifth action is to increase advocacy efforts to related parties. Posyandu program are still facing problems affecting its implementation. Therefore, the posyandu revitalization actions are needed. The main key lies in increasing cadres' capacity through training.

About the Contributors

About the Contributors

Covid-19 Impact on Agricultural Farmer’s Social, Physical, and Mental Health: A Literature Review

Background: COVID-19 pandemic disrupted in many business sectors and affected negatively the agricultural sector. The objectives of this review are to determine the impact of COVID-19 in the social life, physical and mental of agricultural farmer.Method: This study was a literature review. The population in the study was farmers. The process of review was; identification of literature; screening questions; eligibility using inclusion criteria; and assessment of the quality of the studies. This review was conducted by identify relevant literature, in Science Direct, PubMed, Scopus and Google Scholar using the following keywords: “Covid-19” OR “Pandemic” combined with “farmer” “farmworker” “agricultural worker”. Articles found then be charted and analysis.Result: This review found 10 articles. The finding of this review showed that COVID 19 has impacted directly on the farmer’s life both on social life, physical and mental health.Conclusion: This finding showed that farmers problems should be addressed to prevent long-term negative consequences that impair the food system and enlarge current inequalities. Also, it should be developed and implemented the appropriate community-based mental health programs targeting farmers who impacted by pandemic and who are at risk to develop adverse mental health outcomes.

Human capital management and performance of community-based health planning and service (CHPS): a mediator analysis

Purpose This paper aims to examine the complexity of the relationship between human capital management (HCM) and the performance of community-based health planning and services (CHPS) from an emerging market perspective. It further explores the mediating role of community orientation; institutional intervention and capability of resources in the hypothesized relationship between HCM and the performance of CHPS. Design/methodology/approach Quantitative data was collected (through a survey) from 210 health volunteers using a systematic random sampling technique. A 95% response rate was realized and the data was analyzed using exploratory and confirmatory factor analysis and hierarchical multiple regression. Findings HCM has a direct relationship with the performance of the CHPS model. It also emerged that institutional intervention and capability of resources partially mediate the relationship between HCM and CHPS performance; while community orientation fully mediates the same relationship. Practical implications Capacity building for staff must be wired into the workings of the CHPS model to yield the maximum impact. This points to the need for training packages that focus on building both social and cultural competence for staff working among locals under the CHPS model. Effective planning is, thus, needed to ensure a seamless allocation of adequate resources to boost performance. Also, community engagement is critical to the success of the CHPS model as it could serve as a platform for awareness creation among locals. Originality/value This paper introduces community orientation, institutional intervention and capability of resources as mediating variables to investigate the hypothesized relationships. It offers a developing country insight into how HCM-related factors might be impacting the performance of community-based health programs.

Understanding patient health-seeking behaviour to optimise the uptake of cataract surgery in rural Kenya, Zambia and Uganda: findings from a multisite qualitative study.

BackgroundCataract is a major cause of visual impairment globally, affecting 15.2 million people who are blind, and another 78.8 million who have moderate or severe visual impairment. This study was designed to explore factors that influence the uptake of surgery offered to patients with operable cataract in a free-of-charge, community-based eye health programme.MethodsFocus group discussions and in-depth interviews were conducted with patients and healthcare providers in rural Zambia, Kenya and Uganda during 2018–2019. We identified participants using purposive sampling. Thematic analysis was conducted using a combination of an inductive and deductive team-based approach.ResultsParticipants consisted of 131 healthcare providers and 294 patients. Two-thirds of patients had been operated on for cataract. Two major themes emerged: (1) surgery enablers, including a desire to regain control of their lives, the positive testimonies of others, family support, as well as free surgery, medication and food; and (2) barriers to surgery, including cultural and social factors, as well as the inadequacies of the healthcare delivery system.ConclusionsCultural, social and health system realities impact decisions made by patients about cataract surgery uptake. This study highlights the importance of demand segmentation and improving the quality of services, based on patients’ expectations and needs, as strategies for increasing cataract surgery uptake.

EFFECT OF BRISK WALKING WORKPLACE PROGRAMME ON CARDIORESPIRATORY FITNESS IN YOUNG MEN WITH CARDIOVASCULAR RISKS

Community-based health programmes at workplace involves planning, implementation and evaluation with the aim of empowering employees to gain control over their health. Brisk walking was a form of exercise that was acceptable to most people and may be integrated easily into daily routine. The aim of this study was to evaluate the improvement of cardiorespiratory fitness (CRF) through a pedometer-based walking programme at the workplace. A total of 70 young men who were sedentary, achieving less than 5,000 steps/day in casual walking with 2 or more cardiovascular risk factors were recruited. Subjects were randomly assigned to a control (CG) (n=34; no change in walking) and pedometer group (PG) (n=36; minimum target: 8,000 steps/day). Blood lipid profile, anthropometric and CRF were measured at baseline and after 12 weeks. At post intervention, the PG increased step count and results for lipid and anthropometrics variables were significantly improved for time and group effect (p<0.001). In PG, the CRF was significantly increased for time and effect (p<0.01) for VO2peak from 31.54 ± 9.66 to 40.15± 9.55(ml/kg/min but no change in CG (31.46 ± 6.15 vs 31.60 ± 8.99 ml/kg/min). The walking programme improved health status in terms of improving biophysical profiles and cardiorespiratory fitness.

Effects of Community-Based Programs on Integration into the Mental Health and Non-Mental Health Communities.

Aims: The purpose of this study was to verify how integration into the mental health community, a subculture of persons with mental illness, affects the integration into the non-mental health community. Thus, we analyzed the effect of community-based mental health service programs on non-mental health community integration, mediated by mental health community integration. Methods: In total, 190 persons with mental illness (M age = 42.78; SD = 11.3; male, 54.7%; female, 45.3%), living in local communities and using community-based mental health programs, participated in the study. We measured their sociodemographic and clinical variables, the environmental variables of mental health service programs, and the level of integration of the mental health and non-mental health communities. The data collected were analyzed to test the proposed hypotheses using Structural Equation Modeling (SEM). Results: The common significant predictors affecting the two types of community integration were symptoms and resource accessibility: the more accessible the various community resources and the less severe the psychiatric symptoms were, the higher the level of the two types of community integration was. In path analysis, the program’s atmosphere and the participation of people with mental illness (program involvement) significantly predicted the level of integration into the mental health community. This, in turn, had a positive effect on their physical integration, social contact frequency, and psychological integration into the non-mental health community, mediated by the integration of the mental health community. Conclusion: Based on the results, we emphasize the importance of mental health communities and suggest strategies to support the integration of mental health communities.

Repackaging Primary Healthcare in Odisha: Can ‘Task Shifting’ to AYUSH Doctors Address Human Resources Deficit?

Provision of primary healthcare in India received thrust of National Health Policy 2017. Vacancy, chronic absenteeism and non-availability of allopathic doctors is a chronic problem of the public health system. Engagement of alternative human resources could get the ailing health system rid of this shortage. AYUSH doctors in Odisha are involved in clinical and public health activities since 1970s. This study aims to examine perspectives of key stakeholders on ‘task shifting’ as a possible policy alternative. We reviewed the policies and guidelines of government of Odisha on human resources deployment, recruitment, retention and terms of reference of their engagement in the public health sector. Further, 76 AYUSH doctors and 30 key informants were interviewed. Ethical clearance was obtained beforehand. Most AYUSH doctors were involved in monitoring and supervising community-based public health programmes and village-level health service providers, respectively. Their involvement in the implementation of national health programmes was found to range from 8% to 62%. A sizeable proportion of AYUSH doctors had not been trained on management of national vector borne disease control, Tuberculosis control, immunisation (RI) and disease surveillance. More than 70% of respondents showed interest in implementing and managing public health programmes. Almost all key informants recommended for improved involvement of AYUSH doctors in public health activities. Inadequate logistics support, insufficient training on public health and unequal administrative authorities was perceived to be systemic bottlenecks. Job enrichment, management capacity development, and pre-deployment orientation of AYUSH doctors may precede the opportunity of ‘task-shifting’ of public health functions.

215Impact of Brazilian Family Health Strategy on Reproductive Health: Analysis at Individual and Population Levels

Abstract Background Family Health Strategy (FHS) is the largest community-based health program in Brazil. There is limited evidence about its effectiveness, especially about adolescents. We aimed to access its effects on adolescents’ reproductive health. Methods We estimate its effects on contraception at individual level using data from a national health survey carried out in 2013 and applying propensity score matching combined with complex survey weights. We employed a differences-in-differences approach for evaluate its effects on adolescent maternity rate at municipal level between 1996 and 2016. Results FHS has positive effects on the probability of using contraceptives. The highest effect was over the concomitant use of pills and male condom (increase of 12 percentage points). For households with female adolescents, it was even higher (26 percentage points). We found a monotonous decrease on adolescent maternity rate following exposure time to FHS, especially in the poorest regions. Conclusions Even not being focused on reproductive health, FHS has positive effects on it. We interpret the negative impact on adolescent maternity rates to be linked to an increased use of contraceptive methods. Key messages Programs such as FHS can be extremely important in promoting knowledge about family planning, especially for adolescents living in social vulnerability. We believe our findings to be important inputs for the discussion in countries where early childbearing is more prevalent, and inequalities are particularly striking..

Application of the Ultra-Poverty Graduation Model in understanding community health volunteers\u2019 preferences for socio-economic empowerment strategies to enhance retention: a qualitative study in Kilifi, Kenya

BackgroundA significant shortage of healthcare workforce exists globally. To achieve Universal Healthcare coverage, governments need to enhance their community-based health programmes. Community health volunteers (CHVs) are essential personnel in achieving this objective. However, their ability to earn a livelihood is compromised by the voluntary nature of their work; hence, the high attrition rates from community-based health programmes. There is an urgent need to support CHVs become economically self-reliant. We report here on the application of the Ultra-Poverty Graduation (UPG) Model to map CHVs’ preferences for socio-economic empowerment strategies that could enhance their retention in a rural area in Kenya.MethodsThis study adopted an exploratory qualitative approach. Using a semi-structured questionnaire, we conducted 10 Focus Group Discussions with the CHVs and 10 Key Informant Interviews with County and Sub-county Ministry of Health and Ministry of Agriculture officials including multi-lateral stakeholders’ representatives from two sub-counties in the area. Data were audio-recorded and transcribed verbatim and transcripts analysed in NVivo. Researcher triangulation supported the first round of analysis. Findings were mapped and interpreted using a theory-driven analysis based on the six-step Ultra-Poverty Graduation Model.ResultsWe mapped the UPG Model’s six steps onto the results of our analyses as follows: (1) initial asset transfer of in-kind goods like poultry or livestock, mentioned by the CHVs as a necessary step; (2) weekly stipends with consumption support to stabilise consumption; (3) hands-on training on how to care for assets, start and run a business based on the assets transferred; (4) training on and facilitation for savings and financial support to build assets and instil financial discipline; (5) healthcare provision and access and finally (6) social integration. These strategies were proposed by the CHVs to enhance economic empowerment and aligned with the UPG Model.ConclusionThese results provide a user-defined approach to identify and assess strategic needs of and approaches to CHVs’ socio-economic empowerment using the UPG model. This model was useful in mapping the findings of our qualitative study and in enhancing our understanding on how these needs can be addressed in order to economically empower CHVs and enhance their retention in our setting.

'You have to be almost dead before they ever really work on you in prison': A qualitative study of formerly incarcerated women's health care experiences during incarceration in Louisiana, U.S.

Globally, the rate of incarceration among women is rising, and in the U.S., women's incarceration has grown at twice the rate for men over the last four decades. Louisiana has the second highest rate of incarceration in the U.S. There is evidence that men in Louisiana prisons do not receive adequate healthcare, but little is known about their women counterparts. We aimed to document formerly incarcerated women's experiences with receiving healthcare during incarceration in Louisiana to inform policy and practice change. In partnership with two community-based organisations in New Orleans, Louisiana, between August 2016 and April 2018, we conducted semi-structured 1-hr interviews with 22 formerly incarcerated women who had been incarcerated in the state for at least one consecutive year. A convenience sample of participants was recruited through community-based organisations' re-entry and health programmes. Our interview guide included questions about experiences with accessing care, reproductive health needs, interactions with providers and preventive care during incarceration. We used applied thematic analysis techniques to interpret data. Over 90% of interviewees identified as Black. Their mean age was 50.7. The average length of incarceration was 8.4years. Participants reported multiple barriers to accessing care including punishment for seeking care, long wait times, costs, lack of respect from providers and health concerns being dismissed. Participants reported limited mental health, preventive and dental services; an insufficient number of providers; and poor health outcomes as a result of delayed care. Overall, women did not have access to adequate, timely care during incarceration. Findings suggest a need for policy changes related to the provision of carceral healthcare services and external oversight of prison conditions and healthcare delivery. Further research into women's experiences of ageing during incarceration and tailored transitional health models is needed.

Is it possible to engage adolescents in community-based non-communicable disease programs?: A case study in a rural area in Yogyakarta

Adolescents are a potential segment of society to be involved in health programs. However, adolescent involvement in community-based health programs is limited, especially for non-communicable diseases. This study explores adolescents’ participation in community-based non-communicable disease programs in a rural area of Indonesia, and factors that enable or hinder their engagement. This was a qualitative case study using the data of the Hypertension Responsive Village Movement (HRVM) Program, a community empowerment program for hypertension control in Sleman Regency, Yogyakarta. Participants consisted of adolescents aged 12 to 25 years old who are involved in HRVM. The data analyzed consisted of attendance lists and meeting/activity minutes of 6 adolescents’ programs, transcripts of interviews with 2 community leaders (village head and youth organization leader), resume of a group discussion with adolescents’ representatives, video records of adolescent programs activities and field notes. Thematic data analysis was conducted to describe adolescents’ participation, as well as the barriers and enabling factors. Descriptive analysis of attendance lists and meeting/activity minutes was developed to describe the retention rate of adolescents in the program. Adolescents’ form of participation ranged from being an acceptor to initiator. In the beginning of the program, 20 adolescents participated. However, by the end of the program, only 8 (40%) adolescents remained. Enabling factors for engagement were the community leaders’ supports, the adjustment of program strategies and deliveries with adolescence needs and the availability of social capital in the form of youth organizations. The barriers were adolescents’ limited time and limited adolescents’ participation in youth organization. In conclusion, engaging adolescents in community-based programs is possible even though it provides some challenges because of the limited time adolescents spend in their community. Strengthening stakeholders’ support, adjusting program strategies and deliveries with target characteristics and utilizing social capital are important to engage adolescents in community-based programs.

Depression, Anxiety and Stress among Students amidst COVID-19 Pandemic: A Cross-Sectional Study in Philippines

Background: COVID-19 considered as a global health crisis poses mental health problems among individual and specifics to students.Purpose: This study aimed to determine the depression, anxiety, and stress levels among students amidst COVID-19 pandemic in Philippines.Methods: A cross-sectional study was undertaken in Region 8, Eastern Visayas Philippines. A total of 311 tertiary respondents randomly selected both private and government owned higher education institutions. The data compilation was done using online questionnaires through Google Forms with validated version of the Stress, Anxiety and Depression Scales 21 (DASS21) is used to calculate students' level of stress, anxiety and, depression with their socio-demographic featuresResults: We revealed that depression, anxiety and stress are instituted in 18.6 %, 35.1 % and 2.85% of students, respectively, amidst the COVID – 19 pandemics. The symptoms of disorders were moderate to extremely severe in 6.1%, 23.5%, and 0.6% of the study sample, respectively. Age, gender, marital status and family history of illness are significantly different with age group 20 and below, females, singles, and families with no history of illness displaying high level of anxiety. Results also established an association between anxiety and family’s monthly income and history of illness. The higher the monthly income and no presence of illness of families, the more anxious the person.Conclusion: Finally, the variables used, explained only 1.5% depression, 3.4% anxiety and 1.4% stress in this time of COVID-19 outbreak. It is therefore recommended to essentially develop community-based mental health program for preventive purposes.

Evaluating the Performance of Community Mental Health Centers in Iran: Strengths and Challenges

Objectives: This study aims to evaluate the performance of Community-based Mental Health Centers (CMHCs) in Iran and identifying the strengths and challenges in the provision of mental health services. Methods: This is a qualitative study, conducted using 36 individual interviews and 13 focus group discussions. Content analysis was performed and data were categorized. The findings were presented in terms of the needs for program implementation, achieving the expected goals and outcomes, and the findings of program evaluation. First, the points related to the provision of infrastructure and setting up the centers were mentioned, and then, the features, strengths and challenges facing the program were discussed. Results: Significant successes were achieved in providing infrastructure and implementing the community-based mental health program. Challenges in the implementation of this program included the barriers to attracting more general physicians and the impact of culture and attitudes in each city on the effectiveness of the program. Conclusion: To improve the performance of CMHCs, more attention should be paid to psychiatry and mental health educational programs in the general medicine curriculum, public education about the mental health and providing solutions for better implementation of the program.

Potential Strategies to Increase Gynecologic Oncologist Treatment for Ovarian Cancer.

Evidence shows that treatment by gynecologic oncologists (GOs) increases overall survival among women with ovarian cancer. However, specific strategies for institutions and community-based public health programs to promote treatment by GOs are lacking. To address this, we conducted a literature review to identify evidence-based and promising system- and environmental-change strategies for increasing treatment by GOs, in effort to ensure that all women with ovarian cancer receive the standard of care. We searched for English-language literature published from 2008 to 2018. We used PubMed, PubMed Central, OVID, and EBSCO for peer-reviewed literature and Google and Google Scholar for gray literature related to increasing receipt of care by GOs among ovarian cancer patients. Numerous suggested and proposed strategies that have potential to increase treatment by GOs were discussed in several articles. We grouped these approaches into five strategic categories: increasing knowledge/awareness of role and importance of GOs, improving models of care, improving payment structures, improving/increasing insurance coverage for GO care, and expanding or enhancing the GO workforce. We identified several strategies with the potential for increasing GO care among ovarian cancer patients, although currently there is little evidence regarding their effectiveness across US populations. Public health programs and entities that measure delivery of quality health care may pilot the strategies in their populations. Certain strategies may work better in certain environments and a combination of strategies may be necessary for any one entity to increase GO ovarian cancer care. Findings, lessons learned, and recommendations from implementation projects would inform community and public health practice.

A decision-making model to optimize the impact of community-based health programs

Hospitals and clinics are increasingly interested in building partnerships with community-based organizations to address the social determinants of health. Choosing among community-based health programs can be complex given that programs may have different effectiveness levels and implementation costs. This study develops a decision-making model that can be used to evaluate multiple key factors that would be relevant in resource allocation decisions related to a set of community-based health programs. The decision-making model compares community-based health programs by considering funding limitations, program duration, and participant retention until program completion. Specifically, the model allows decision makers to select the optimal mix of community-based health programs based on the profiles of the population given the above constraints. The model can be used to improve resource allocation in communities, ultimately contributing to the long-term goal of strengthening cross-sector partnerships and the integration of services to improve health outcomes.

\u201cFrom experts to locals hands\u201d healthcare service planning in sub-Saharan Africa: an insight from the integrated community case management of Ghana

BackgroundAlthough community participation remains an essential component globally in healthcare service planning, evidence of how rural communities participate in the planning of rural-based healthcare programs has less been explored in Sub-Saharan Africa.ObjectiveWe explored communities’ participation in health care planning in hard-to-reach communities, within the context of Integrated Community Case Management (iCCM), a community-based health program implemented in Ghana.MethodsQualitative data were collected from eleven (11) hard-to-reach communities through Focus Group Discussions (FGDs), Key Informant Interviews (KIIs) as well as district-level studies (Nadowli-Kaleo, and WA East districts of Ghana). The Rifkin’s spider-gram, framework, for measuring and evaluating community participation in healthcare planning was adapted for the study.The resultsThe study found that community participation was superficially conducted by the CHOs. A holistic community needs assessment to create awareness, foster a common understanding of health situations, collaboration, acceptance and ownership of the program were indiscernible. Rather, it took the form of an event, expert-led-definition, devoid of coherence to build locals understanding to gain their support as beneficiaries of the program. Consequently, some of the key requirements of the program, such as resource mobilization by rural residents, Community-based monitoring of the program and the act of leadership towards sustainability of the program were not explicitly found in the beneficiaries’ communities.Conclusion and recommendationThe study concludes that there is a need to expand the concept of community involvement in iCCM to facilitate communities’ contribution to their healthcare. Also, a transdisciplinary approach is required for engineering and scaling up community-based health programs, empowering VHCs, CBHVs and CHAs to realize success.

A machine learning approach for identifying predictors of success in a Medicaid-funded, community-based behavioral health program using the Child and Adolescent Needs and Strengths (CANS)

IntroductionThe CANS is the most popular measurement tool in the System of Care (SoC), with the potential to generate an estimated 1.9 million evaluations per year in the United States. This dataset has broad potential for decision support and outcomes monitoring, yet many SoC services do not yet leverage this information asset. We report here the results of a pilot project in which we applied machine learning methods to CANS data for the purpose of identifying clinical profiles associated with improvement in a public community-based behavioral health program in Pennsylvania. MethodsWe analyzed over 7,000 CANS from 3,385 children who participated in Pennsylvania’s Medicaid-funded behavioral health rehabilitation services (BHRS) program during 2013–2019. A gradient boosting classifier was developed to identify children most likely to experience a total score improvement on the CANS while participating in BHRS. Separate models were constructed for children with and without autism spectrum disorder (ASD). CANS-based clinical profiles associated with improvement were also identified. Analyses were run using Python Sci-Ki version 0.20.3 and Linearly Interpretable Model-agnostic Explanations (LIME) version 0.1.1.33. ResultsThe mean age of BHRS participants was 9.85 years (standard deviation: 3.47) and the majority were white (54%) or African American (11.5%). The median length of stay was 963 days (range: 541–2,008) and 39% (N = 1,330) had a diagnosis of ASD. A total of 49.9% of children had a CANS total score improvement. Precision of the gradient boosting classifier was 70% and 79% for children with and without ASD, respectively. Fourteen profiles were associated with improvement in ASD (mean probability of improvement per profile = 0.95, range: 0.88–1.0) and 55 such profiles were identified in children without ASD (mean probability of improvement: 0.91, range: 0.86–1.0). ConclusionMachine learning can be applied to the CANS to identify children who have high probability of improvement in BHRS. These methods may have utility as an adjunct to existing decision support systems for SoC services.

The impact of COVID-19 on mental health outcomes among hospital fever clinic attendants across Nepal: A cross-sectional study.

BackgroundThe COVID-19 pandemic has been creating a panic and distressing situations among the entire population globally including Nepal. No study has been conducted assessing the psychological impact of this pandemic on the general public in Nepal. The objective of this study is to assess the mental health status during COVID-19 outbreak and explore the potential influencing factors among the population attending the hospital fever clinics with COVID–19 symptoms.MethodsA cross-sectional survey was conducted between May—June, 2020 with a sample of 645 participants aged 18 and above in 26 hospitals across Nepal. Telephone interviews were conducted using a semi-structured questionnaire along with a validated psychometric tool, the Depression, Anxiety and Stress (DASS-21) scale. The metrics and scores of symptoms and their severity were created and analyzed. Multivariate logistic regression was used to determine the association of potential covariates with outcome variables.ResultsThe prevalence of anxiety, depression and stress were 14%, 7% and 5% respectively. In reference to Karnali, participants from Bagmati province reported higher level of anxiety (OR 3.44, 95% CI 1.31–9.06), while stress (OR 4.27, 95% CI 1.09–18.32) and depressive symptoms (OR 3.11, 95% CI 1.05–9.23) observed higher among the participants in Province 1. Women were more at risk of anxiety (OR 3.41, 95% CI 1.83–6.36) than men. Similarly, people currently living in rented houses reported more stress (OR 2.97, 95% CI 1.05–8.43) and those living far from family reported higher rates of depressive symptoms (OR 3.44, 95% CI 1.03–11.46).ConclusionThe study identified increased prevalence of stress, anxiety and depressive symptoms during the initial stage of COVID-19 pandemic in Nepal. Considering the findings, there is urgent need to develop and implement appropriate community-based mental health programs targeting individuals who have had COVID-19 symptoms and who are prone to develop adverse mental health outcomes.

Effect of an exercise program targeting knee pain on medical costs of elderly community-dwelling adults

Objectives The aim of this study was to examine the effect of an exercise program targeting knee pain on longitudinal medical costs (MC) of elderly community-dwelling adults.Methods A community-based health program using specific exercises for improving knee pain was held from January to February, 2015. Twenty-eight individuals participated in the program (intervention group) and seventy individuals were selected from the respondents of a health and lifestyle survey by matching age, sex, and baseline value of severity of knee pain as a control group. Twenty individuals from the intervention group and twenty-nine from the control group were included in the final analysis. The changes in MC from 2014 to 2018 were compared between the two groups using a linear mixed-effects model.Results The effect of the program on MC, estimated as a change from the baseline in 2014, showed a reduction of -5.6×103 yen/person (95% CI: -39.2-28.0) for the entire four-year period after the intervention. However, this difference was not significant. The changes in MC each year after the intervention were 9.3×103 yen/person (95% CI: -39.6-58.3) in 2015, -2.0×103 yen/person (95% CI: -44.4-40.5) in 2016, -10.3×103 yen/person (95% CI: -42.5-21.9) in 2017, and 8.2×103 yen/person (95% CI: -39.1-55.4) in 2018.Conclusion The exercise program did not show a clear benefit in reducing the MC of elderly community-dwellers during the four years after the intervention. Further research with longer study durations and larger sample populations would be necessary to determine the effect of such intervention programs on MC.