Community Health Volunteers Research Articles

Factors influencing vaccination up-take among nomadic population in four regions of Ghana: a qualitative study

BackgroundVaccination has contributed to the reduction in vaccine preventable diseases. Despite, improved global coverage, vaccination among nomadic populations is still low especially in Africa. This study explored factors influencing vaccination uptake among pastoralist nomads in Ghana.MethodsWe conducted key informant interviews (KII) in 11 districts across four regions of Ghana, using grounded theory qualitative research approach. One hundred and eighty-two KII were conducted among pastoralist nomads, community opinion leaders, community health volunteers, security services personnel, local government personnel and health workers. Guided by the WHO health systems building blocks, data was coded using Nvivo 12 and analysed thematically. Results were presented as narratives with excerpts to support the findings.ResultsCommunity leaders support vaccination among pastoralist nomads as part of their leadership and governance responsibilities. Language barrier between health workers and pastoralist nomads affects service delivery. Also, healthcare providers fear being attacked by pastoralist nomads hence are hesitant to visit their settlements for vaccination. With regards to health workforce, healthcare providers’ perceived use of derogatory words and discrimination against pastoralist nomads influence their vaccination uptake. On medical product, the lack of knowledge about diseases, severity and perceived negative effects about vaccines influence vaccination uptake. Inadequate funds and logistics at the district health directorates affects outreach to nomads during vaccinations. Leveraging existing partnership between the health services and community leaders, information centers, volunteers and butchers to send health information to pastoralist nomads influence vaccination uptake.ConclusionCommunity leaders support vaccination among pastoralist nomads. Nomadic pastoralist miss vaccination dues to language barrier, feel discriminated against, and lack information about diseases and vaccinations. Strengthening Ghana Health Service collaboration with leaders of pastoralist nomads could build trust, create awareness and overcome language barrier between healthcare providers and pastoralist nomads.

Perceptions of stakeholders on the use of a simplified, combined protocol for treatment of acute malnutrition in Central African Republic.

Treatment of acute malnutrition requires novel approaches to improve coverage, reduce costs and improve the efficiency of standard protocols that separate the management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of simplified, combined protocols to treat both MAM and SAM has drawn research and policy interest among global, regional and national stakeholders. However, the perspectives of local communities and health care workers regarding the use of protocols to treat acute malnutrition in a routine health care system are generally lacking. This was a cross-sectional mixed-methods study aimed at assessing the perceptions of different stakeholders on the use of a simplified, combined protocol in two districts in the Central African Republic. Most of the respondents preferred the simplified, combined protocol over the standard protocol. They generally agreed that the protocol was easy to understand, allowed more children to receive treatment and was effective in treating acute malnutrition. The protocol modifications were well received, including the expanded admission criteria, use of mid-upper arm circumference (MUAC) only for admission and discharge criteria and reduced and simplified ready-to-use therapeutic food quantity to treat MAM and SAM. Some caregivers expressed concern with the use of MUAC only to declare recovery, flagging that underlying illnesses could still be present. The caregivers recommended the provision of other food basket interventions to improve the treatment. The support by caregivers and health care workers on the idea of training community health volunteers to treat acute malnutrition points to the potential of scaling up decentralized treatment to increase coverage in remote areas.

Bridging the gap: financing health promotion and disease prevention in Indonesia

BackgroundSpending on preventive care in low- and middle-income countries (LMICs), including Indonesia, is much lower than spending on curative care. There has been a pressing need to develop a clear pathway to increase spending on preventive care. This study aimed to assess the current financing landscape for health promotion and disease prevention in Indonesia and, subsequently, to develop a framework and recommendations for future health promotion financing in the country.MethodsWe adopted a mixed-method approach to gather information from all relevant stakeholders from December 2022 to June 2023. For the qualitative approach, we conducted (a) in-depth interviews (IDIs) and (b) focus group discussions (FGDs) with government officials at national and district levels, academics, professional organizations, healthcare workers in primary healthcare centres (PHCs), community health volunteers, non governmental organizations and private companies. For the quantitative approach, we applied a national online survey to healthcare workers involved in health promotion in PHCs. IDIs and FGDs were conducted with purposefully selected resource persons at the national level, five selected districts across Indonesia, and within 15 primary health offices and their communities. All qualitative data were recorded, transcribed, coded, interpreted, and then triangulated with national survey findings to develop the financing framework.ResultsWe identified gaps between the theory and practice of health promotion and disease prevention. These included the limited scope of health promotion initiatives, lack of direction and coordination between ministries, agencies and government levels, limited availability and capacity of health promoters, various yet uncoordinated funding resources and inflexibility in using the funds. To bridge the gap, the framework we developed suggests strengthening the legal and regulatory basis, strategically prioritizing financing arrangements, promoting evidence-based health promotion activities, developing the capacity of health promoters, enhancing the health financing information system and improving monitoring and evaluation.ConclusionsIdentified gaps and challenges in health promotion and disease prevention initiatives inform the development of our framework for future health promotion financing. This framework assists the national government in organizing national health promotion financing strategies and potentially serves as a valuable model for other LMICs.

Utilizing intricate care networks: An ethnography of patients and families navigating palliative care in a resource-limited setting.

The increase in non-communicable disease burdens and aging populations has led to a rise in the need for palliative care across settings. In resource-limited settings such as Indonesia, however, notably in rural areas, there is a lack of professional palliative care. Little is known about specific palliative care navigation, as previous studies have mostly focused on cancer care navigation. A locally tailored approach is crucial. To explore how patients and families navigate palliative care and the problems they experience. An ethnographic study using in-depth interviews and observations, analyzed using reflexive thematic analysis. Interviews with 49 participants (patients, family caregivers, and health professionals) and 12 patient-family unit observations in Banyumas, Indonesia. Patients and families navigated palliative care through different strategies: (1) helping themselves, (2) utilizing complementary and alternative medicine, (3) avoiding discussing psychological issues, (4) mobilizing a compassionate and advocating community, and (5) seeking spiritual care through religious practices. Our participants used intricate care networks despite limited resources in navigating palliative care. Several problems were rooted in barriers in the healthcare system and a lack of palliative care awareness among the general public. Local primary health centers could be potential palliative care leaders by building upon pre-existing programs and involving community health volunteers. Cultivating a shared philosophy within the community could strengthen care collaboration and support.

The reasons for and influences of unintended teenage pregnancy in Kericho county, Kenya: a qualitative study.

Unintended teenage pregnancies are associated with greater health and socio-economic risks for teenage mothers and newborns. In Kenya, the government has declared a target for ending teenage pregnancy by 2030. However, the prevalence of teenage pregnancy has only decreased slightly, demonstrating the need for further efforts. Understanding teenage mothers' own experiences and perspectives is necessary to design appropriate interventions. A community-based qualitative study was conducted from March to May 2023. Two focus group discussions were conducted with community health volunteers and the mothers of teenage girls. Semi-structured interviews were conducted on the case histories of 19 teenage mothers and 18 key informants. Thematic analysis was subsequently performed using MAXQDA 2022. Four major reasons emerged for unintended teenage pregnancies: (1) lack of knowledge or awareness about the human reproductive system, (2) lack of knowledge about family planning (FP), (3) financial challenges, and (4) low access to FP. At the study site, cultural norms and stereotypes, such as "infertility caused by FP," "freedom of sex by promoting FP," and "cultural taboos on having sex before marriage and talking about sexuality," were observed as barriers in promoting FP to teenagers. In addition, teenagers from low socio-economic backgrounds were found to be more vulnerable because they can be easily exploited by men who can afford to provide for some of their basic needs. Regarding the influences of unintended teenage pregnancy on teenage mothers' lives, the 19 cases were classified into four categories: (1) dropping out of school, (2) financial challenges, (3) changing relationships with parents, and (4) no major influence. Crucially, unintended teenage pregnancies negatively influenced most study participants. Continuing education, supportive parental attitudes, positive perceptions of the relationship with the child's father, and having future perspectives were identified as factors mitigating the negative influences. Strengthening culturally appropriate comprehensive sexuality education and the school re-entry policy with a supportive environment may prevent unintended teenage pregnancy and mitigate its negative influences. As financial challenges can be both a reason for and a negative influence of unintended teenage pregnancy, economic empowerment interventions are necessary.

Lessons for Strengthening a Resilient Health System from the View of Health Facilities During the COVID-19 Pandemic: A Qualitative Study.

Coronavirus disease 2019 caused significant negative damage to the health status of populations and health systems globally. In Uganda, our previous study revealed that the strict Public Health and Social measures (PHSMs) and the closure of Entebbe Regional Referral Hospital (ERRH) led to missed healthcare access among the citizens in the Entebbe municipality. Limited studies, however, exist on the impact of the response measures on the local health systems. This study aims to explore the impacts of these measures on the local health service provision from the views of health facilities in Entebbe. We used a thematic framework method, grounded by the health systems resilience framework consisting of five components: (1) health service delivery; (2) medical products and technology; (3) health workforce; (4) public health functions; and (5) governance and financing. Key informant interviews with eight representatives from four private hospitals and four health centers were conducted from September to October 2022. Fifteen themes and 25 subthemes were identified. With the closure of the ERRH and the strict PHSMs, the citizens faced various difficulties in accessing the needed health services. The facilities received an overwhelming number of patients and faced various challenges, such as a lack of medicine, healthcare workers, facility capacity, and no means to transfer patients. Nevertheless, the facilities made efforts to maintain the required services. Moreover, mobilizing vertical and horizontal actors through a flexible network, from the district health office to community health volunteers, helped to coordinate the medicines, transportation for both patients and healthcare workers, conduct patient tracking, etc. Our study suggested the importance of an integrated system of public health and health service delivery systems, the formalization of a vertical cooperative mechanism, and the introduction of public health insurance for strengthening resilient health systems. These insights may benefit other sub-Saharan cities.

The potential effectiveness of community health and nutrition volunteers on mothers’ infant and young children feeding knowledge and practice in remote areas, Hajjah, Yemen

BackgroundThe Infant and young child feeding (IYCF) practices directly affect the health, development and nutritional status of children under two years of age. However, IYCF counseling is one of the Community Health and Nutrition Volunteers (CHNVs) activities provided, which may contribute to improving the IYCF knowledge and practice among mothers. Since establishment of the CHNVs program in Yemen, its outcome has never been evaluated. Therefore, the aim of this study was to evaluate the role of CHNVs in improving the IYCF knowledge and practice among mothers in Hajjah governorate.MethodsA comparative cross-sectional study design was conducted in Bani Qais and Al-Maghrabah districts, Hajjah governorate between January and April 2023. A three-stage cluster sampling method was used to select districts, volunteer villages and households. A total of 926 mothers were interviewed. A pre-tested structured questionnaire was used to collect data. SPSS 26 was used for data analysis. The multinomial logistic regression and Chi-Square test were used to compare the IYCF knowledge and practices among mothers between the volunteer and non-volunteer villages. Odds Ratio (OR) with 95% Confidence Interval (CI) were calculated. A p-value < 0.05 was considered statistically significant.ResultsThe mothers in volunteer villages had significantly better breastfeeding and complementary feeding (CF) knowledge than mothers in non-volunteer villages. The OR of having good and moderate knowledge of breastfeeding were 3.5 (95%CI: 2.4–5.2) and 1.6 (95% CI: 1.2–2.2), respectively. The OR for good and moderate knowledge of CF were 1.7 (95% CI: 1.1–2.7) and 2.2 (95% CI: 1.5-3.0), respectively. Moreover, there is a statistically significant association in prevalence of Exclusively breastfed for the first two days after birth (EBF2D), Mixed milk feeding under six months (MixMF) and Bottle feeding 0–23 months (BoF) between volunteer and non-volunteer villages [(OR = 1.4, 95% CI: 1.0-1.8), (OR = 0.4, 95% CI: 0.2–0.8) and (OR = 0.5, 95% CI: 0.4–0.7), respectively].ConclusionsThe study found that CHNVs play a significant effect in improving the breastfeeding and CF knowledge, and prevalence of EBF2D, MixMF and BoF practices among mothers in their villages compared to non-volunteer villages. Future follow-up study and expansion to other settings in different governorates is recommended.

Intervention model in reducing the unmet need for contraception: a systematic literature review on technology-based, community, and health worker interventions

The unmet need for contraception is a serious public health problem, and efforts to reduce the unmet need for family planning are a challenge due to the many and complex factors that contribute to the unmet needs. The aim of this study was to systematically review scientific evidence on intervention models that effectively reduce the unmet need for contraception. This study used a systematic review to identify relevant scientific articles. The article search was based on the PICO approach and used a database from https://www.scopus.com/, https://www.sciencedirect.com/, https://pubmed.ncbi.nlm.nih.gov/, https://www.mdpi.com/, https://www.jstor.org/, https://www.nature.com/, https://link.springer.com/. The reviewed material was full-text articles and open-access articles published from 2013 to 2023. Data extraction included author, country, type of intervention, research design, sample, and main research findings. Twelve studies were included in our qualitative synthesis. Technology-based interventions, such as mobile phone instant messaging apps, were implemented in countries like Tajikistan, Bolivia, and Mozambique. Community-based interventions included the Community Family Health=Family Wealth program in Uganda, the Tékponon Jikuagou (TJ) program in Benin, and the Married Adolescent Girls Club (MAG club) and Participatory Women's Group Intervention in Bangladesh. Health worker-led interventions involved community health volunteers in Nepal, postpartum contraceptive counseling, contraceptive counseling for all ages, structured counseling for childbearing couples in Indonesia, and the "Consult and Choose" client-centered family service in Jordan. The findings underscore that varying intervention models can significantly enhance contraceptive use, tailored to specific cultural and regional contexts. These interventions, therefore, hold substantial implications for public health practices aiming to address and reduce the global unmet need for contraception. This systematic review provides valuable insights into the effectiveness of diverse interventions and suggests avenues for public health strategies to expand contraceptive access and use globally.

Linkage of Hospital and Community level records for Epidemiological Research: Experiences from Kagando Health and Demographic Surveillance System in Western Uganda

BackgroundLinkage of census data and hospital records is crucial in conducting epidemiological research to inform public health decisions. In this study, we share our experiences in linking community-level data collected through census with hospital records and highlight the challenges and opportunities from our engagements with stakeholders. MethodologyWe undertook engagements with Uganda Christian University Ethics Research Committee, Hospital Management, and Community Health Volunteers to set up a platform to integrate hospital and census records using key identifiers. Trained data clerks prospectively linked data during patients’ visits following the data protection guidelines. ResultsFrom a population of approximately 30,000 people, we managed to link 1000 records within three months. Lessons learnt and opportunities: It is possible to link data with a set of identifiers, not only relying on common identifiers, especially for communities where ownership of a national identity card or birth certificate is not universal. Building stakeholder partnerships is essential, and frequent meetings with the hospital staff, epidemiologists and data programmers helped to identify problems and solutions. ChallengesLack of local capacity at the health facilities to develop linkage platforms. However, after development they can efficiently run the program. Frequent changes in the versions of the electronic system were later resolved. RecommendationsThere is a need to conduct regular capacity building for stakeholders to help them understand the importance of data linkage. ConclusionPublic engagement is an ethical imperative that enhances the quality, credibility, and long-term impact of research by incorporating the perspectives of the communities being studied.

P213 UNDERSTANDING THE INFLUENCE OF SOCIAL SUPPORT ON ANTIHYPERTENSIVE MEDICATION ADHERENCE IN URBAN NEPAL: A QUALITATIVE STUDY

Background and objective: Hypertension is a critical public health challenge in Nepal, particularly in urban settings, contributing to the high morbidity and mortality from cardiovascular diseases. Despite the presence of effective treatment options, adherence to antihypertensive medication remains suboptimal. Emerging evidence suggests that social support plays a crucial role in improving medication adherence. This study aims to explore the influence of social support on antihypertensive medication adherence among hypertensive patients in urban Nepalese communities, specifically within the Community-based management of non-communicable disease in Nepal (COBIN cohort) located in the eastern part of Pokhara Metropolitan City, Nepal. Methods: A qualitative study was conducted involving in-depth interviews with 19 hypertensive patients. An individual was eligible if 318 years old, taking antihypertensive medications for 3 two months and living in Lekhnath area of Pokhara. Interviews were conducted by an English-speaking researcher, with support from translator speaking both English and Nepali, using the interview guide. The study utilized a thematic analysis to explore patients’ perceptions and experience related to social support while taking antihypertensive medicines regularly. Results: The findings revealed a complex interplay of positive and negative influences of social support on antihypertensive medication adherence. Positive influence, being reminders from family members and healthcare providers, appeared to improve participants’ self-esteem and self-efficacy on adhering to medications. In contrast, social interactions including suggestions of taking traditional remedies and misinformation about prescribed antihypertensive medications appeared to diminish medication adherence. The role of Female Community Health Volunteers (FCHVs) was overall positive, bridging the gap between healthcare services and community needs, however its sustainability needs to be addressed. Conclusion: Social support is perceived to be pivotal in enhancing medication adherence among hypertensive patients in urban Nepal. Strengthening such support through community-based interventions and enhancing the role of FCHVs could significantly improve health outcomes. This study underscored the need for comprehensive strategies that integrate social support into hypertension management programs in low-resource settings.

P029 PERCEPTIONS AND PERSPECTIVES OF RURAL NEPALESE PATIENTS WITH HYPERTENSION: A QUALITATIVE STUDY GUIDED BY THE LEVESQUE FRAMEWORK

Background and objective: High blood pressure is a major risk factor for heart disease and stroke. These diseases can be reduced if hypertension is identified, managed and controlled. Disease burden in Nepal is high, resources are limited, and the population is socioeconomically vulnerable. Developing tailored interventions for hypertension management requires understanding of challenges and facilitators of healthcare. This qualitative study investigated barriers and facilitators impacting treatment and control of patients with hypertension in rural Nepal. Methods: We conducted in-depth interviews among hypertensive patients(n=15), medical officers(n=3), Female Community Health Volunteers(FCHVs)(n=9), Frontline Health Workers(FLHWs)(n=15), medical officers(n=3), and local government representatives(n=5) from Panchkhal and Bethanchowk municipalities of Kavrepalanchok district, Nepal. Focus group discussions with FCHVs(n=7) were also conducted. Recordings were coded, transcribed and themes were identified. Patients with hypertension were approached door-to-door by FCHVs. FCHVs and FLHWs were accessed through health facilities. The framework developed by Levesque et al., was used to conceptualize access to care from the viewpoints of various stakeholders. Emerging themes were mapped as the ability to-perceive, seek, reach, pay and engage. Results: Most participants felt the need for care after experiencing symptoms like headaches, dizziness, and blurred vision. Trust in health facilities facilitated care, although unavailability of medicines and insufficient qualified staff were important obstacles. Some used homemade therapies for hypertension control highlighting a gap in awareness of treatment methods. Geographical inaccessibility of health facilities, as well as financial difficulties, were other important barriers identified. Patient's expected prompt service and reduced out-of-pocket expenditure. Medication-taking behavior was influenced by factors including forgetfulness, perceived need and side effects. Support from family, community, and local levels was identified as crucial for hypertension management. Conclusions: This qualitative study highlights the multifaceted challenges for hypertension treatment and control in rural Nepal. Addressing identified barriers and leveraging facilitating factors are essential for reducing hypertension.

Identification of mothers with mental health problems is accidental: perceptions of health care providers on availability, access, and support for maternal mental health care for adolescent mothers in Malawi

BackgroundIntegration of maternal mental health into primary health care is considered a strategy to improve access to mental health support in low- and middle-income countries (LMICs). Health care workers’ (HCWs) and traditional practitioners’ (traditional healers, herbalists, traditional birth attendants, spiritual healers, prophets, and community health volunteers) perceptions of the availability and management of adolescent mothers’ maternal mental health care were explored in rural Malawi. Recognizing and identifying the barriers associated with access to maternal mental health support is essential to improving the mental health of adolescent mothers.MethodsA descriptive qualitative design (DQ) was used to explore HCWs’ and traditional practitioners’ perceptions of maternal mental health services for adolescent mothers. In-depth interviews were conducted with HCWs (n = 6), and three focus group discussions were conducted with 30 community-based traditional practitioners. Participants were purposefully recruited because they provide formal or informal health services to adolescent mothers during the postnatal period at Mitundu Rural Hospital and its catchment area in Lilongwe District, in Malawi. Interviews were analyzed using reflective thematic analysis and inductive thinking.ResultsThematic analysis found four themes to describe access to maternal mental health care for adolescent mothers. Participant perceptions were themed around health system challenges and how cultural background and beliefs influence access to mental health care and support. The themes were: (1) Inadequate staff development; (2) Limited resources (medication and infrastructure); (3) Limited policy and guidelines implementation; and (4) Cultural background and belief influence on help-seeking. HCWs suggested improving pre-service and in-service training to improve mental health assessment of mothers, while traditional practitioners wanted to increase their awareness of mental health issues.ConclusionParticipants emphasized that multifaceted factors influenced access to mental health support. These factors affect the assessment, treatment, and support of adolescent mothers and help-seeking by mothers. Therefore, strengthening the healthcare system and empowering providers with the knowledge and skills to recognize at-risk mothers and provide timely support is essential.

The impact of digital interventions on health insurance coverage for reproductive, maternal, newborn and child health services utilization in Kakamega, Kenya: a cluster randomized controlled trial.

The National Hospital Insurance Fund (NHIF) of Kenya was upgraded to improve access to healthcare for impoverished households, expand universal health coverage, and boost the uptake of essential reproductive, maternal, newborn and child health (RMNCH) services. However, premiums may be unaffordable for the poorest households. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) programme targets low-income women and their households to improve their access to and utilization of quality healthcare, including RMNCH services, by providing subsidized, mobile phone-based NHIF coverage in combination with enhanced, digital training of community health volunteers and upgrading of health facilities. This study evaluated whether expanded NHIF coverage increased the accessibility and utilization of quality basic RMNCH services in areas where i-PUSH was implemented using a longitudinal cluster randomized controlled trial in Kakamega, Kenya. A total of 24 pair-matched villages were randomly assigned either to the treatment or the control group. Within each village, 10 eligible households (i.e. with a woman aged 15-49 years who was either pregnant or with a child <4 years old) were randomly selected. The study applied a difference-in-difference methodology based on a pooled cross-sectional analysis of baseline, midline and endline data, with robustness checks based on balanced panels and Analysis of Covariance methods. The analysis sample included 346 women, of whom 248 had had a live birth in the 3 years prior to any of the surveys, and 424 children aged 0-59 months. Improved NHIF coverage did not have a statistically significant impact on any of the RMNCH outcome indicators at midline nor endline. Uptake of RMNCH services, however, improved substantially in both control and treatment areas at endline compared to baseline. For instance, significant increases were observed in the number of antenatal care visits from baseline to midline (mean = 2.62-2.92, P < 0.01) and delivery with a skilled birth attendant from baseline to midline (mean = 0.91-0.97, P < 0.01). Expanded NHIF coverage, providing enhanced access to RMNCH services of unlimited duration at both public and private facilities, did not result in an increased uptake of care, in a context where access to basic public RMNCH services was already widespread. However, the positive overall trend in RMNCH utilization indicators, in a period of constrained access due to the COVID-19 pandemic, suggests that the other components of the i-PUSH programme may have been beneficial. Further research is needed to better understand how the provision of insurance, enhanced community health volunteer training and improved healthcare quality interact to ensure pregnant women and young children can make full use of the continuum of care.

Nepal Needs A Two-Pronged Approach to Secure Future of Its Female Community Health Volunteers (FCHVs)

Nepal Needs A Two-Pronged Approach to Secure Future of Its Female Community Health Volunteers (FCHVs)

The role of community health and nutrition volunteers in improving the health and nutrition status of infant and young children in remote areas, Hajjah, Yemen

BackgroundIn Yemen, morbidity and malnutrition are major public health problems. The Community Health and Nutrition Volunteers (CHNVs) program was launched to tackle these problems through providing services to mothers and their children residing in remote villages. Since establishment of the CHNVs program in Yemen, its outcome has never been evaluated. Therefore, the aim of this study was to assess the role of CHNVs in improving the immunization, morbidity and nutritional status of infant and young children (IYC).MethodsA comparative cross-sectional study design was conducted in Al-Maghrabah and Bani-Qais districts, Hajjah governorate. It was carried out between January and April 2023. A three-stage cluster sampling method was used. A total of 926 IYC with their mothers were interviewed using a pre-tested questionnaire. SPSS 26 was used for data analysis. The multinomial logistic regression and chi-square or fisher exact tests were used to compare the vaccination, morbidity and nutritional status of IYC between the volunteer and non-volunteer villages. Odds Ratio (OR) with 95% Confidence Interval (CI) were calculated. A p value < 0.05 was considered statistically significant.ResultsThe IYC in volunteer villages were more likely to be fully or partially vaccinated compared to those in non-volunteer villages [OR = 2.3, 95% CI: 1.5–3.7, p < 0.0001, and OR = 1.9, 95% CI: 1.3–2.8, p = 0.001, respectively]. The specific coverage rates for BCG, and the 1st and 2nd doses of OPV/Pentavalent/Pneumo/Rota vaccines were significantly higher in the volunteer compared to non-volunteer villages [(OR = 1.8, 95% CI: 1.3–2.5, p < 0.0001), (OR = 1.5, 95% CI: 1.2–2.1, p = 0.003), and (OR = 1.5, 95% CI: 1.2-2.0, p = 0.002), respectively]. Moreover, the prevalence of diarrhea and fever among IYC was significantly lower in the volunteer compared to non-volunteer villages [(OR = 0.7, 95% CI: 0.5–0.9, p = 0.004) and (OR = 0.7 95% CI: 0.5–0.9, p = 0.045), respectively].ConclusionsThe study found that CHNVs play a significant role in improving vaccination status and the coverage rate for BCG, and 1st and 2nd doses of OPV/Pentavalent/Pneumo/Rota vaccines, and reducing the prevalence of diarrhea and fever among IYC in their villages compared to non-volunteer villages, in Hajjah governorate. Future follow-up study and expansion to other settings in different governorates is recommended.

Treatment of moderate acute malnutrition through community health volunteers is a cost-effective intervention: Evidence from a resource-limited setting.

Treatment outcomes for acute malnutrition can be improved by integrating treatment into community case management (iCCM).However, little is known about the cost-effectiveness of this integrated nutrition intervention. The present study investigates the cost-effectiveness of treating moderate acute malnutrition (MAM) through communityhealth volunteer(CHV) and integrating it with routine iCCM. A cost-effectiveness model compared the costs and effects of CHV sites plus health facility-based treatment (intervention) with the routine health facility-based treatment strategy alone (control). The costing assessments combined both provider and patient costs. The cost per DALY averted was the primary metric for the comparison, on which sensitivity analysis was performed. Additionally, the integrated strategy's relative value for money was evaluated using the most recent country-specific gross domestic productthreshold metrics. The intervention dominated the health facility-based strategy alone on all computed cost-effectiveness outcomes. MAM treatment by CHVs plus health facilities was estimated to yield a cost per death and DALY averted of US$ 8743 and US$ 397, respectively, as opposed to US$ 13,846 and US$ 637 in the control group. The findings also showed that the intervention group spent less per child treated and recovered than the control group: US$ 214 versus US$ 270 and US$ 306 versus US$ 485, respectively. Compared withfacility-based treatment, treating MAM by CHVs and health facilities was a cost-effective intervention. Additional gains could be achieved if more children with MAM are enrolled and treated.

Formative research to understand food beliefs and practices relating to pregnancy on Kei Besar Island, Eastern Indonesia

BackgroundFood-related beliefs and practices during pregnancy may contribute to the high prevalence of chronic energy deficiencies (CED) in Eastern Indonesia, particularly in Southeast Maluku regency, where 21.33% of pregnant women experience CED. Currently, little information on these issues is available. This study investigates food beliefs and practices related to pregnancy on Kei Besar Island in the Maluku province of Eastern Indonesia.MethodsA qualitative study was conducted utilizing in-depth interviews, free lists, and pile sort exercises. Data collection was conducted in January 2023 and involved married pregnant women aged 18 and above (n = 12), community health volunteers (n = 2), and traditional healers (n = 3) from 9 villages in Kei Besar District. All participants must be natives of Kei Besar Island, with community health volunteers and traditional healers being respective figures recommended by the local villagers.ResultsThe need to avoid or minimize consumption of certain foods during pregnancy, such as some kinds of fish, chili and spicy food, soda, pineapples, octopus, squid, and ice was reported by more than one-third of all participants. Consumption of prescribed foods, such as cassava leaves, papaya, coconut water, rice during early pregnancies, moringa leaves, bananas, and katok leaves was reported by five or more participants. These food proscriptions and prescriptions were due to concerns about the risks of miscarriage, adverse effects on the fetus and mother, and complications during labor. Participants also reported other practices, such as eating for two during early pregnancy and reducing food intake in late pregnancy. We found that food beliefs have shaped the dietary patterns of most participants. However, they still consumed food recommended by community health volunteers and midwives.ConclusionsFood beliefs are present and practiced in the Kei Besar community and may impact the nutritional status of women and their infants. Interventions should target training healthcare providers and community health volunteers to provide culturally appropriate health education that incorporates prescribed local ingredients and provides nutritionally adequate substitutes for the proscribed food items.Trial RegistrationNot applicable.

Community Health Volunteers' experiences of implementing COVID-19 vaccine education and promotion in Kenya: a qualitative descriptive study.

Vaccination was a key measure in the COVID-19 pandemic response, though much work was needed to promote vaccine uptake and acceptance. In Kenya, Community Health Volunteers (CHVs) played a key role in vaccine education and promotion. We conducted this study to explore CHVs' experiences of implementing COVID-19 vaccine education and promotion during the pandemic to increase COVID-19 vaccine uptake in two areas of Kenya. In a qualitative descriptive study, we conducted 30 structured in-depth interviews with 20 CHVs and 10 Community Health Assistants from rural Kilifi County and Kangemi, an urban informal settlement of Nairobi County in Kenya between April 2022 and July 2022. Thematic analysis generated five key themes in relation to CHVs' experiences of implementing COVID-19 vaccine education and promotion: Five key themes emerged regarding CHVs' experiences of implementing COVID-19 vaccine education and promotion: (1) vaccine preferences influenced acceptance, (2) the fear of side effects was a barrier, (3) misinformation was widespread (4) lack of trust in government and politicization of vaccines was a barrier, and (5) CHVs' efforts were a facilitator to increased uptake. Extensive community outreach from CHVs contributed to the high uptake of primary vaccines and boosters during the COVID-19 pandemic. CHVs acting as role models by receiving vaccinations first was particularly important in influencing communities to accept vaccinations. Findings provide evidence for prioritizing CHVs in the planning and implementation of future vaccination initiatives in Kenya and other countries.

The proportion and determinants of appropriate health seeking behavior for febrile illness among caregivers of children under-five years in Butula sub-county, Busia county, Kenya

Background Almost 10 million children under the age of five in Kenya, die due to fever-related diseases. In Busia, a county in Kenya, malaria accounts for 13% of all child fatalities under the age of five, a number higher than any other county. This study aimed to determine (a) proportion of appropriate health-seeking behavior and (b) determinants of health-seeking behaviors (HSBs) among their caregivers in Butula Sub-County, Busia County, as reported by the caregivers. Methods This cross-sectional mixed-method study included 271 caregivers, 11 community health volunteers, and health facility workers in Butula Sub-County. Systematic random sampling for participants and purposive sampling for key informants were used. A questionnaire collected the data that was analysed using frequency and percentages and logistic regression. Results 70.1% of caregivers reported seeking care for a child's fever within 24 hours. Individual factors that caregivers reported to influence appropriate health-seeking HSB were unemployment (adjusted odds ratio (aOR) = 0.49, 95% CI: 0.217 – 0.593, p = 0.018), self-medication preference (aOR = 0.14, 95% CI: 0.054 – 0.363, p &lt; 0.001), had atleast two children (aOR = 0.63, 95% CI: 0.425 – 0.937, p = 0.042), and confidence in identifying fever (aOR = 7.0, 95% CI: 2.200 – 22.439, p = 0.001). Health-system factors reported to influence HSBs were facility too far (aOR = 0.86, 95% CI: 0.526 – 0.914, p = 0.027), getting health education (aOR = 1.8, 95% CI: 1.201-4.122, p=0.015), and facility level (aOR = 4.4, 95% CI: 2.015 – 9.750, p &lt; 0.001). Qualitative findings found health system factors related to HSB as stockouts, facility distance, and staff workload. Conclusions Policy and practice efforts should focus on significant individual and health system determinants for HSBs among caregivers of children under five with febrile illness.

Assessing LLIN distribution implementation using evidence-informed intervention core elements: a qualitative study in a resource-constrained setting

BackgroundThe National Malaria Elimination Programme implements the mass LLIN Distribution Campaigns in Ghana. Implementation science promotes the systematic study of social contexts, individual experiences, real-world environments, partnerships, and stakeholder consultations regarding the implementation of evidence-informed interventions. In this paper, we assess the core elements of the mass LLIN distribution campaign in a resource constrained setting to learn best implementation practices. Three core domains were assessed through the application of Galbraith’s taxonomy (i.e., implementation, content, and pedagogy) for evidence-informed intervention implementation.MethodsSix districts in two regions (Eastern and Volta) in Ghana participated in this study. Fourteen Focus Group Discussions (FGDs) were conducted across these communities. Eligible participants were purposively sampled considering age, occupation, gender, and care giving for children under 5 years and household head roles. All audio-recorded FGDs were transcribed verbatim, data was assessed and coded through deductive and inductive processes. NVivo software version 13 was used for the coding process. Themes were refined, legitimized, and the most compelling extracts selected to produce the results.ResultsSixty-nine (69) caregivers of children under 5 years and sixty (60) household heads participated in the FGDs. All caregivers were females (69), whilst household heads included more males (41). Core elements identified under implementation domain of the LLIN distribution campaign in Ghana include the registration and distribution processes, preceded by engagement with traditional authorities and continuous involvement of community health volunteers during implementation. For pedagogy domain, core elements include delivery of intervention through outreaches, illustrations, demonstrations, and the use of multiple communication channels. Core elements realized within the content domain include information on effective malaria prevention, and provision of information to enhance their self-efficacy. Yet, participants noted gaps (e.g., misuse) in the desired behavioural outcome of LLIN use and a heavy campaign focus on women.Conclusion and recommendationsAlthough the implementation of the mass LLIN distribution campaigns exhibit components of core elements of evidence informed interventions (implementation, content and pedagogy), it has not achieved its desired behavioural change intentions (i.e. continuous LLIN use). Future campaigns may consider use of continuous innovative pedagogical approaches at the community level and lessons learnt from this study to strengthen the implementation process of evidence-based health interventions. There is also the need for standardization of core elements to identify the number of core elements required within each domain to achieve efficacy.Ethical approvalEthical clearance was obtained from the Ghana Health Service Ethics Review Committee (GHS-ERC: 002/06/21) before the commencement of all data collection.