Community Health Care Workers Research Articles

COVID-19: Perceived Infection Risk and Barriers to Uptake of Pfizer-BioNTech and Moderna Vaccines Among Community Healthcare Workers

BackgroundThe health and economic ramifications of the coronavirus pandemic have prompted the need for a timely and effective vaccine development. While the rollout of the COVID-19 vaccine in record time is being hailed as a scientific feat, skepticism about the safety, side effects, and even its long-term effects remain. Acceptance of the vaccine may therefore be a challenge among healthcare workers (HCWs), whose role is considered a proxy to determining the COVID-19 vaccine uptake response by the general population.MethodsIn December 2020, prior to the arrival and receipt of the Pfizer-BioNTech and Moderna COVID-19 vaccine, we conducted a cross-sectional survey to assess the readiness for vaccine uptake among HCWs at three community-based, university-affiliated health centers.ResultsA total of 205 (82%) respondents out of 250 completed the questionnaire. Fifty-four percent of respondents agreed to receive vaccine once available. Females (odds ratio (OR) =0.22, p=0.014), non-Hispanic Blacks (OR=0.066, p=0.010), and Hispanics (OR=0.11, p=0.037) were less likely to accept the vaccine. Respondents with moderate-risk perception were more likely to accept (OR=2.79, p=0.045) compared to those with low-risk perception while no association was found between high-risk perception and vaccine acceptance (p=0.226). After adjusting for perceived risk, sex, race/ethnicity, and age, acceptance in non-Hispanic Black population remained statistically significant (adjusted OR=0.07, p=0.014), with Hispanic (AOR=0.12, p=0.051) showing a trend.ConclusionsEnthusiastic acceptance of the COVID-19 vaccine is lacking among surveyed HCWs of certain racial/ethnic groups. Provision of resources and public health interventions targeting underserved, minority populations are necessary to halt opposition to vaccine uptake.

Development and Implementation of Couple-Based Collaborative Management Model of Type 2 Diabetes Mellitus for Community-Dwelling Chinese Older Adults: A Pilot Randomized Trial.

Background: To mobilize family's positive involvement in improving and sustaining self-management activities of older adults with diabetes, we developed a couple-based collaborative management model (CCMM) for community-dwelling older Chinese.Methods: The model was developed stepwise through applying theoretical models, interviewing older couples and community healthcare workers, as well as incorporating expert reviews. A 3-month pilot study was conducted to test the model's feasibility and its treatment effects by linear regression on 18 pairs of older couples aged 60 years+, who were equally divided into a couple-based intervention arm and a patient-only control arm.Results: The developed CCMM covered four theory-driven intervention modules: dyadic assessment, dyadic education, dyadic behavior-change training, and dyadic monitoring. Each module was delivered by community healthcare workers and targeted at older couples as the management units. Based on interviews with older couples and healthcare workers, 4 weekly education and training group sessions and 2-month weekly behavior change booster calls were designed to address older adults' main management barriers. These modules and session contents were evaluated as essential and relevant by the expert panel. Furthermore, the CCMM showed good feasibility and acceptability in the pilot, with non-significant yet more positive changes in physiological outcomes of diabetic participants and couples' well-being and exercise levels of these in the intervention arm than their controlled counterparts.Conclusion: We systematically developed a couple-based collaborative management model of diabetes, which was well-received by healthcare practitioners and highly feasible among older Chinese couples living in the community. The model's treatment effects need to be verified in fully powered randomized controlled trials.Clinical Trial Registration: http://www.chictr.org.cn/showproj.aspx?proj=42964, identifier: ChiCTR1900027137.

Care for the Carers: An Evaluation of Job Satisfaction of Community Healthcare Workers in Charge of Infectious Disease Prevention and Control in Vietnam.

PurposeThis study explored job satisfaction and associated factors among community healthcare workers (HCWs) during the COVID-19 pandemic.MethodsA cross-sectional study was conducted among 319 HCWs in charge of infectious disease prevention and control activities at all commune healthcare centers in Ho Chi Minh City. Participants completed a self-administered questionnaire which included the 36-item Job Satisfaction Survey (JSS).ResultsMost participants were male (56.7%), and the mean age was 34.7 (SD=7.1) years. The overall job satisfaction was relatively low. Among 9 aspects measured, coworker was found to have the highest level of satisfaction (19.6±3.9), followed by supervision (19.3±4.1). In contrast, the lowest level of satisfaction was observed in operating condition (11.4±3.4) and contingent rewards (14.3±3.8). The total score of the JSS indicated that only half of HCWs were satisfied with their job in general. Older male HCWs who were married and those who had higher income reported a higher level of job satisfaction in several aspects measured. However, there was no association between job satisfaction and other HCW’s characteristics, including specialty, occupation type, and working experience.ConclusionSince this is the crucial workforce in the battle against infectious diseases, urgent interventions are needed to increase job satisfaction in this population.

Prevalence of iron and folic acid supplements consumption and associated factors among pregnant women in Eswatini: a multicenter cross-sectional study

BackgroundDuring pregnancy, nutritional requirements increase and if not met, pregnancy-related complications may manifest. To prevent these undesirable outcomes, the World Health Organization recommends daily oral iron and folic acid (IFA) supplementation as part of antenatal care. Despite this recommendation, the use of IFA supplements is still very low in several developing countries. Additionally, no prior information exists regarding the level of consumption of IFA in Eswatini. Thus, this study aimed to determine the prevalence of consumption of IFA supplements and to identify factors associated with the consumption of IFA supplements among pregnant women in Eswatini.MethodsA cross-sectional questionnaire survey was conducted among 330 pregnant women aged ≥ 18 years in their third trimester in Eswatini. Participants were recruited from eight purposively selected healthcare facilities from July 2019 to October 2019. Good consumption was defined as consuming all or almost all IFA supplements throughout pregnancy.ResultsDuring the first trimester, 10.3 % of the participants consumed all or almost all IFA supplements. In the second and third trimesters, those who consumed all or almost all supplements were 37 and 39.7 %, respectively, for iron and 37.6 and 40.9 %, respectively, for folic acid. Barriers, including side effects, forgetfulness, safe previous pregnancies without IFA, others’ advice against consumption, IFA stock-outs, inability to meet transport costs, and inadequate supply of IFA tablets, contribute to low consumption of IFA. Multivariate logistic regression models showed that the barriers were inversely associated with good consumption of IFA supplements. Better knowledge and attitude toward IFA and older maternal age were positively associated with good consumption of IFA supplements.ConclusionsLow consumption of IFA supplements in overall pregnancy is mainly owing to the late antenatal care attendance. Strategies such as establishing a preconception care unit and school-based provision of IFA may be helpful. It is evident that most women still lack knowledge, and some have negative attitudes about IFA supplements. Health education to raise awareness and emphasize the importance of starting antenatal care early as well as consuming supplements on time should be revisited and intensified. Multiple strategies such as including community health care workers for distributing IFA supplements, discussing with clients about the measures to reduce forgetfulness, advising ways to prevent and manage the side effects, providing subsidies to cover transport costs, and ensuring adequate supply of IFA supplements in facilities may need to be employed to reduce the identified barriers.

Evaluation of Health Care Workers’ Knowledge about Immunity and Vaccination at Primary Health Care Centers in Al-Hilla City

Background: Immunizations are one of the most effective health initiatives of the twentieth century, but many people do not receive sufficient immunizations in several parts of the world. Every year, about three million people around the world die from diseases that can be prevented by vaccines; half of the dead were infants and children. However, community health care workers have become increasingly recognized and acknowledged as an important and efficient intervention essential for increasing community-centered health services, especially in deprived areas. 
 Aims of the study: To evaluate the level of health care workers' knowledge about immunity and vaccination at primary health care centers. 
 Methodology: A cross-sectional descriptive study design conducted for the periods 27 \ September \ 2020 to 25 \ April \ 2021, among (315) health care workers who are selected by non-probability sampling (convenience sample), self-administered questionnaire, the scores obtained for answers to closed-ended questions were used to determine the level of knowledge, reverse questions were used, several statistical measures were used by using Statistical Package of Social Sciences version 24, in order to analyze and evaluate the results of the study. 
 Results: The findings showed that health care workers have a moderate level of knowledge about immunity and vaccination. 
 Conclusion: There was a moderate level of knowledge about immunity and vaccination among health care workers. In addition, the greatest part of participants in this study is medical assistants and nurses. 
 Recommendations: The researcher recommends implementing an educational program designed for health care workers about immunity and vaccination in all primary health care centers

Community-based delivery of intermittent preventive treatment of malaria in pregnancy in Burkina Faso: a qualitative study

BackgroundBurkina Faso is among ten countries with the highest rates of malaria cases and deaths in the world. Delivery and coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) is insufficient in Burkina Faso; In a 2016 survey, only 22% of eligible women had received their third dose of IPTp. It is also an extremely rural country and one with an established cadre of community healthcare workers (CHWs). To better meet the needs of pregnant women, an enhanced programme was established to facilitate distribution of IPTp at the community level by CHWs.MethodsIn order to assess the perceptions of CHWs and facility healthcare workers (HCWs) involved in this programme rollout, semi-structured interviews were conducted at three high malaria burden health districts in Burkina Faso. Interviews were conducted at baseline with 104 CHWs and 35 HCWs prior to the introduction of community based IPTp (c-IPTp) to assess capacity and any areas of concern. At endline, interviews were conducted with 29 CHWs and 21 HCWs to identify key facilitators and suggestions for further implementation of the c-IPTp programme.ResultsCHWs reported feeling capable of supporting c-IPTp delivery and facilitating linkage to antenatal care (ANC). They noted that the opportunity for enhanced training and close and ongoing connections with facility HCWs and supportive supervision were imperative. Both CHWs and HCWs perceived this approach as acceptable to community members and noted the importance of close community engagement, monthly meetings between CHWs and facility HCWs, and maintaining regular supplies of sulfadoxine–pyrimethamine (SP). Those interviewed noted that it was beneficial to have the involvement of both female and male CHWs.ConclusionsCommunity-based delivery of IPTp was feasible and acceptable to both facility HCWs and CHWs. This approach has the potential to strengthen delivery and uptake of IPTp and ANC both in Burkina Faso and across the region.

Frontline community health care workers’ intervention for diabetes management in resource limited settings: a qualitative study on perspectives of key stakeholders

Background Diabetes mellitus (DM) is a global public health concern, with significant increase in the transitioning low- and middle-income countries (LMICs), such as India, with limited resources and poor health care systems. Recognising the need for innovative, feasible, targeted interventions for diabetes care, a non-randomized, controlled, phase II clinical trial was conducted in a rural revenue block in Tamil Nadu, India. This pilot trial tested the non-inferiority of the trained community health workers (CHWs) in delivering education, screening for diabetes complications using a protocol-based referral for physician consultation for management, assisted by an android application (App) for patient tracking. Understanding the perceptions of key stakeholders including patients and health workers is crucial for upscaling and sustaining these novel interventions for diabetes care. This study explored the perspectives and views of patients with DM and diabetes CHWs who participated in the pilot trial. Methods Using qualitative research methodology, individual in-depth interviews were conducted in the local vernacular (Tamil) language among the two diabetes CHWs and purposively chosen 24 patients until the data saturation was reached. Participant information sheets, consent forms and a detailed topic guide were developed. Interviews were transcribed verbatim, translated into English and thematic analysis was conducted. Results Five main themes emerged during interviews with diabetes CHWs: deeper understanding of the disease; belonging and strengthening; ease of use of digital technology and a timesaver for patient tracking; cultural sensitivity; stigma and change in attitudes over time. Interviews with patients highlighted four major themes: convenience; cost reduction; improved knowledge and perceptions on health. Benefits were perceived by both patients and diabetes CHWs, in the domains of convenience, access, cost and knowledge. Perceptions of changes in health were mixed with room for improvement in the digital App. Conclusions Training CHWs in resource limited settings in supporting community diabetes care, assisted by digital technology for tracking is acceptable to the patients and will help shift the care pathway for Diabetes closer to the patients in a rural setting. This qualitative study identified a number of areas for improvement and potential barriers that will need to be addressed prior to scaling up in similar resource constrained settings.

COVID-19 AND ATTITUDES OF GROUND-LEVEL PUBLIC HEALTH STAFF IN SRI LANKA

Introduction: Health care workers (HCW) face considerable mental and physical stress caring for patients with Covid-19. Their attitudes towards COVID-19 are important both in the prevention as well treatment of the disease. Aims: To assess the attitudes toward coronavirus disease-2019 (COVID-19) among community healthcare workers at Regional Director of Health Services area Galle district, Sri Lanka. Settings and Design: A cross-sectional study was carried out between August 2020 and January 2021 at the Regional Director of Health Services area Galle district, Sri Lanka. Methods and Material: All community healthcare workers who were directly involved in COVID-19 in Galle district, Sri Lanka were recruited for the study, and the data was collected through a self-administered questionnaire. Descriptive analysis was done to describe the demographic factors and attitudes Chi-square test was used to assess the relationship between the level of attitude and demographic factors. Statistical analysis used: Chi-square test. Results: Of the community health workers 71%(n=84) had a positive attitude indicating a good attitude regarding the COVID-19 prevention strategies. Nearly 91%(n=107) of the population agreed to vaccination against COVID-19. There was no statistically significant association between attitude on COVID-19 with sex, age, marital status, educational level, service period, and category of occupation. Conclusions: A majority of healthcare workers had positive attitudes toward COVID-19. Additional awareness and continuous knowledge updates are required for healthcare workers to sustain positive attitudes during the pandemic.

Implementation of the PIERS on the Move mHealth Application From the Perspective of Community Health Workers and Nurses in Rural Mozambique.

Background:mHealth is increasingly regarded as having the potential to support service delivery by health workers in low-resource settings. PIERS on the Move (POM) is a mobile health application developed to support community health workers identification and management of women at risk of adverse outcomes from pre-eclampsia. The objective of this study was to evaluate the impact of using POM in Mozambique on community health care workers' knowledge and self-efficacy related to caring for women with pre-eclampsia, and their perception of usefulness of the tool to inform implementation.Method: An evaluation was conducted for health care workers in the Mozambique Community Level Intervention for Pre-eclampsia (CLIP) cluster randomized trial from 2014 to 2016 in Maputo and Gaza provinces (NCT01911494). A structured survey was designed using themes from the Technology Acceptance Model, which describes the likelihood of adopting the technology based on perceived usefulness and perceived ease of use. Surveys were conducted in Portuguese and translated verbatim to English for analysis. Preliminary analysis of open-ended responses was conducted to develop a coding framework for full qualitative analysis, which was completed using NVivo12 (QSR International, Melbourne, Australia).Results: Overall, 118 community health workers (44 intervention; 74 control) and 55 nurses (23 intervention; 32 control) were surveyed regarding their experiences. Many community health workers found the POM app easy to use (80%; 35/44), useful in guiding their activities (68%; 30/44) and pregnant women received their counseling more seriously because of the POM app (75%; 33/44). Almost a third CHWs reported some challenges using the POM app (30%; 13/44), including battery depletion after a full day's activity. Community health workers reported increases in knowledge about pre-eclampsia and other pregnancy complications and increases in confidence, comfort and capacity to advise women on health conditions and deliver services. Nurses recognized the increased capacity of community health workers and were more confident in their clinical and technological skills to identify women at risk of obstetric complications.Conclusions: Many of the community health workers reported that POM improved knowledge, self-efficacy and strengthened relationships with the communities they serve and local nurses. This helped to strengthen the link between community and health facility. However, findings highlight the need to consider program and systematic challenges to implementation.

Fear psychosis for the medical physicists' profession in the worldwide COVID-19 crisis

Background: The coronavirus infectious disease 2019 (COVID-19) has spread over 213 countries around the world and two international conveyances. This has become a cause of public health emergencies as well as a crisis internationally. Realising its deadlier effects the World Health Organisation has already declared this crisis as a pandemic on 11th, March, 2020. Material and Methods: Hospitals authority mostly do not provide complete personal protective equipment (PPE) for medical physicists every day as in general, they do not come in direct contact with patients frequently, shortages of PPE and economic barriers. Results: In this commentary, we have highlighted different aspects of fear psychosis dominantly acting on medical physicists working in the hospital where both confirmed and suspected COVID-19 patients are being treated during this pandemic. Further, a series of novel methods are proposed to reduce the risk of viral exposure for medical physicist community and other health care workers, and patients. Conclusion: In the absence of proper PPE, medical physicists should maintain proper physical distancing along with wearing the available protective devices (gloves and face mask) avoid casual touching of the mouth and nose to reduce the risk of infection.

Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa.

Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers.Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.

Awareness of COVID-19, Protective Measures and Attitude Towards Vaccination among University of Jeddah Health Field Community: A Questionnaire-Based Study

This cross-sectional study aimed to measure the awareness, and attitude towards COVID-19 disease as well as new vaccine acceptance, among health field community (healthcare workers, health fields teaching staff and students) at the University of Jeddah, Jeddah Saudi Arabia. The questionnaire was designed in English language and included a set of 44 multiple-choice close-ended questions that covered demographic profile of participants, awareness of symptoms and practice against COVID-19. It also included a set of questions that attempted to investigate the attitudes and perceptions towards the uptake of vaccine. Out of the total 186 who participated in this study, 48.4% were 24 years old or younger and 55.9% were health field students. The results showed that majority of participants were aware of most common symptoms and causes of COVID-19 and had positive attitude toward the protective measures against the disease. Regarding the acceptability of vaccination against COVID-19, around 44% of the total participants showed hesitancy to uptake the vaccine of whom, 68.3% were concerned about the adverse effects of the vaccine. Significant differences were found between gender and current position at university of Jeddah in term of vaccine acceptance with p-values of < 0.001. Despite this high level of awareness, health field community at the university of Jeddah have medium acceptance level of disease vaccine. Thus, health educational programs are important to increase the acceptance level among such societies which will contribute to increase the acceptance level among the whole society.

Community engagement and linkage to care efforts by peer community-health workers to increase PrEP uptake among sexual minority men.

PurposePre‐exposure prophylaxis (PrEP) prevents HIV yet uptake remains suboptimal across the United States. This paper evaluates the impact of outreach activities led by nurse supervised community healthcare workers (CHWs) on the PrEP care cascade.MethodsThis is an observational programmatic evaluation of LGBTQ + community outreach between March 1, 2016, to March 31, 2020, as part of a public health initiative. Descriptive statistics are used to characterize the data by outreach type.Results2,465 participants were reached. Overall, a PrEP appointment was scheduled for 94 (3.8%) with 70 (2.8%) confirmed to have completed a PrEP visit. Success for each type of community outreach activity was evaluated with virtual models outperforming face‐to‐face. Face‐to‐face outreach identified nine persons among 2,188 contacts (0.41%) completing an initial PrEP visit. The website prepmaryland.org identified 4 among 24 contacts (16.7%) and the PrEP telephone/text warm‐line identified 18 among 60 contacts (30%). The PrEPme smartphone application identified 39 among 168 contacts (23.2%).ConclusionsFace‐to‐face community outreach efforts reached a large number of participants, yet had a lower yield in follow‐up and confirmed PrEP visits. All virtual platforms reached lower total numbers, but had greater success in attendance at PrEP visits, suggesting enhanced linkage to care.

The Crisis of Sickle Cell Disease in Africa from Insights into Primary Prevention in Ghana and Nigeria: Notes from the Field.

Sickle cell disease (SCD), an inherited blood disorder, impacts 2% of newborns in Nigeria and Ghana. Despite devastating health consequences, SCD prevention is not a priority in either country. This article describes our U.S. research team's feasibility assessment for adapting CHOICES, a computer-based SCD education program, for use in Ghana and Nigeria. We identified indigenous collaborators by reviewing published research and investigating advocacy organizations online. This led to a fact-finding trip to Africa to discuss SCD prevention with local boards of advisors. Three major recommendations emerged from the group discussions: design a culturally appropriate intervention; enlist community healthcare workers to deliver the CHOICES program; and collaborate with religious and community leaders and elders in public awareness campaigns. Based on extensive advisor input, we will modify the content and delivery of the CHOICES intervention to meet the needs of those impacted by SCD in Ghana and Nigeria.

The Design and Evaluation of a Mobile System for Rapid Diagnostic Test Interpretation

Rapid diagnostic tests (RDTs) provide point-of-care medical screening without the need for expensive laboratory equipment. RDTs are theoretically straightforward to use, yet their analog colorimetric output leaves room for diagnostic uncertainty and error. Furthermore, RDT results within a community are kept isolated unless they are aggregated by healthcare workers, limiting the potential that RDTs can have in supporting public health efforts. In light of these issues, we present a system called RDTScan for detecting and interpreting lateral flow RDTs with a smartphone. RDTScan provides real-time guidance for clear RDT image capture and automatic interpretation for accurate diagnostic decisions. RDTScan is structured to be quickly configurable to new RDT designs by requiring only a template image and some metadata about how the RDT is supposed to be read, making it easier to extend than a data-driven approach. Through a controlled lab study, we demonstrate that RDTScan's limit-of-detection can match, and even exceed, the performance of expert readers who are interpreting the physical RDTs themselves. We then present two field evaluations of smartphone apps built on the RDTScan system: (1) at-home influenza testing in Australia and (2) malaria testing by community healthcare workers in Kenya. RDTScan achieved 97.5% and 96.3% accuracy compared to RDT interpretation by experts in the Australia Flu Study and the Kenya Malaria Study, respectively.

Measuring quality of care at the community level using the contraceptive method information index plus and client reported experience metrics in Bangladesh.

BackgroundLow rates of contraceptive continuation in Bangladesh are a symptom of poor quality family planning (FP) counseling. Improving family planning counseling by the country’s community health care workers (CHWs) could improve contraceptive continuation. This study explores client experiences of care from CHWs, as measured by the method information index plus (MII+) and communication quality metric.MethodsConducted in a peri-urban sub-district with low contraceptive use rates, this mixed methods study explores FP client experiences with community-based counseling and referrals by Family Welfare Assistants (FWAs), a CHW cadre providing FP services. Client- and patient-reported experience with community FP services was measured by the MII+ and communication quality metric. A quantitative post-service exit survey was coupled with observations of the interactions between 62 FWAs and 692 female clients to measure FWA and client FP knowledge, FWA capacities, attitudes, quality of FP communication, FP referrals, and contraceptive uptake.ResultsSummary MII+ scores suggest that only 20% of clients reported adequate provision of information for informed decisions. Observations and self-reporting alike suggest moderate to high quality of communication during FWA and client interactions. Despite FWAs’ theoretical knowledge of long-acting reversible and permanent FP methods, few clients were referred to facilities for them; 81% of clients who preferred a pill received it, while only 34% of clients seeking long-acting methods received needed referrals.ConclusionsQuality community-based FP counseling could help address rising contraceptive discontinuation rates in Bangladesh. While MII and MII+ scores in this study were low, and FWA evinced numerous misconceptions, FWAs demonstrated strong communication skills that facilitate rapport and trust with their clients and communities. Bangladesh’s policy and programs should capitalize upon these relationships and enhance CHWs’ knowledge of all method types, and side effects management, with updated job aids, refresher training, and supervision.

Community intervention for child tuberculosis active contact investigation and management: study protocol for a parallel cluster randomized controlled trial

BackgroundThere are major gaps in the management of pediatric tuberculosis (TB) contact investigation for rapid identification of active tuberculosis and initiation of preventive therapy. This study aims to evaluate the impact of a community-based intervention as compared to facility-based model for the management of children in contact with bacteriologically confirmed pulmonary TB adults in low-resource high-burden settings.Methods/designThis multicenter parallel open-label cluster randomized controlled trial is composed of three phases: I, baseline phase in which retrospective data are collected, quality of data recording in facility registers is checked, and expected acceptability and feasibility of the intervention is assessed; II, intervention phase with enrolment of index cases and contact cases in either facility- or community-based models; and III, explanatory phase including endpoint data analysis, cost-effectiveness analysis, and post-intervention acceptability assessment by healthcare providers and beneficiaries. The study uses both quantitative and qualitative analysis methods. The community-based intervention includes identification and screening of all household contacts, referral of contacts with TB-suggestive symptoms to the facility for investigation, and household initiation of preventive therapy with follow-up of eligible child contacts by community healthcare workers, i.e., all young (< 5 years) child contacts or older (5–14 years) child contacts living with HIV, and with no evidence of TB disease. Twenty clusters representing TB diagnostic and treatment facilities with their catchment areas are randomized in a 1:1 ratio to either the community-based intervention arm or the facility-based standard of care arm in Cameroon and Uganda. Randomization was stratified by country and constrained on the number of index cases per cluster. The primary endpoint is the proportion of eligible child contacts who initiate and complete the preventive therapy. The sample size is of 1500 child contacts to identify a 10% difference between the arms with the assumption that 60% of children will complete the preventive therapy in the standard of care arm.DiscussionThis study will provide evidence of the impact of a community-based intervention on household child contact screening and management of TB preventive therapy in order to improve care and prevention of childhood TB in low-resource high-burden settings.Trial registrationClinicalTrials.gov NCT03832023. Registered on 6 February 2019

An integrated community and primary healthcare worker intervention to reduce stigma and improve management of common mental disorders in rural India: protocol for the SMART Mental Health programme

BackgroundAround 1 in 7 people in India are impacted by mental illness. The treatment gap for people with mental disorders is as high as 75–95%. Health care systems, especially in rural regions in India, face substantial challenges to address these gaps in care, and innovative strategies are needed.MethodsWe hypothesise that an intervention involving an anti-stigma campaign and a mobile-technology-based electronic decision support system will result in reduced stigma and improved mental health for adults at high risk of common mental disorders. It will be implemented as a parallel-group cluster randomised, controlled trial in 44 primary health centre clusters servicing 133 villages in rural Andhra Pradesh and Haryana. Adults aged ≥ 18 years will be screened for depression, anxiety and suicide based on Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorders (GAD-7) scores. Two evaluation cohorts will be derived—a high-risk cohort with elevated PHQ-9, GAD-7 or suicide risk and a non-high-risk cohort comprising an equal number of people not at elevated risk based on these scores. Outcome analyses will be conducted blinded to intervention allocation.Expected outcomesThe primary study outcome is the difference in mean behaviour scores at 12 months in the combined ‘high-risk’ and ‘non-high-risk’ cohort and the mean difference in PHQ-9 scores at 12 months in the ‘high-risk’ cohort. Secondary outcomes include depression and anxiety remission rates in the high-risk cohort at 6 and 12 months, the proportion of high-risk individuals who have visited a doctor at least once in the previous 12 months, and change from baseline in mean stigma, mental health knowledge and attitude scores in the combined non-high-risk and high-risk cohort. Trial outcomes will be accompanied by detailed economic and process evaluations.SignificanceThe findings are likely to inform policy on a low-cost scalable solution to destigmatise common mental disorders and reduce the treatment gap for under-served populations in low-and middle-income country settings.Trial registrationClinical Trial Registry India CTRI/2018/08/015355. Registered on 16 August 2018.

Digital health literacy intervention to support maternal, child and family health in primary healthcare settings of Pakistan during the age of coronavirus: study protocol for a randomised controlled trial

IntroductionThere is a need to continue primary healthcare services through digital communication for disadvantaged women living in underdeveloped areas of Pakistan, especially in the age of the coronavirus pandemic, social...

Understanding the awareness, perception and practices of community healthcare workers for high risk antenatal cases: A survey conducted in India

ObjectivesAccording to WHO, almost 15% pregnant women face the risk of developing complications during their gestational period. Although, the UN-mandated Millennium Development goal has prompted India to move towards achieving lower Maternal Mortality Ratio, almost 44,000 women die annually from high-risk pregnancy. MethodsThe study delves into investigation with respect to the conditions of anemia, gestational diabetes mellitus and preeclampsia, which are most common and critical in such cases of high-risk pregnancy. The score-based questionnaire is used as a study instrument to assess the perception of ASHA workers towards these particular conditions. Data was recorded for all 90 ASHA workers who interact on a regular basis with pregnant women. ResultsOur study showed that ASHA workers had average perception in GDM and preeclampsia, and above average perception in the condition of anemia. Knowledge gaps were observed in the referral management and practices of healthcare workers towards severely anemic patients. The healthcare workers had inadequate knowledge in the condition of GDM, its risk factors, the screening tests and threshold values to identify diabetes. Healthcare workers were not highly acquainted with the measurement of blood pressure, its standard reading, repeated measurement techniques, follow up urine tests for high blood pressure inflicted patients. ConclusionsThe results suggest ASHA workers have limited knowledge in high-risk pregnancy cases and there might be a need for better training among healthcare workers and almost 90% of them had responded positively to the necessity of a portable screening device. There was observed no significant difference in the mean perception scores amongst subjects with respect to their age, education level and experience in the profession.