Community-level Activities Research Articles

Risk communication with asylum-seekers: Insights from the COVID-19 Pandemic experience in Munich

Abstract Background The COVID-19 pandemic has created a ‘double crisis’ for asylum-seekers, whose lives were already in crisis. Many reports indicated the syndemic consequences on asylum seekers’ health, underscoring the need for their inclusion in risk communication (RC) and community engagement (CE) and infodemic management (IM) actions. This study aims to describe RCCE experience with asylum seekers in Munich during the COVID-19 pandemic from an expert perspective and thus gain a thorough understanding of the requirements for inclusive RCCE. Methods Our qualitative study involved people who conducted COVID-19-related RCCE for asylum-seekers. Volunteers/workers of civil society organizations and health professionals were interviewed using purposeful sampling. After reviewing international guidelines, an interview form was created. The content analysis resulted in themes and categories. Results Four of the interviewees were health managers, while 8 were working in civil society organizations. The first category of the results describes the context in which RCCE occurs; syndemic factors (uncertainty; social exclusion and stigma; precarious housing; limited access to healthcare and unmet mental health needs) and pandemic management. The second category includes determinants of RCCE from both the asylum-seeker (trust; risk perception; health literacy; language; culture and gender) and RCCE member (competences; overburden; continuity) standpoint. The third category focuses on various RCCE-IM measures, including their effectiveness and consequences. Conclusions Syndemic factors hampered the effective implementation of RCCE for asylum seekers in Munich. RCCE determinants show that pre-crisis actions are necessary for an effective response and individual interactions should accompany community-level activities, particularly for female and marginalised migrants. This study’s scope will be expanded by incorporating the IM component.

Barriers to Pro-Environmental Behavior Change: A Review of Qualitative Research

In recent decades, reports of deforestation, mass extinctions, biodiversity loss, and emergencies like floods and droughts have clearly highlighted the impact of human activities on climate change. This underscores the need for significant lifestyle changes to mitigate this impact. Pro-environmental behavior (PEB) change involves adopting actions that protect the environment and reducing environmentally harmful activities to promote sustainability. While qualitative research may provide unique insights into PEB barriers that are challenging to capture through quantitative methods, reports of qualitative studies are scattered across different literatures with little integration. With the present review, we bring together qualitative studies on PEB barriers and examine whether those studies reveal barriers compatible with existing barrier frameworks from environmental psychology. We identified 38 qualitative studies on barriers to PEB change. Our analysis revealed that most of the barriers to individual pro-environmental action identified in qualitative studies align with environmental psychology frameworks. These barriers were experienced not only by individuals in their role as consumer or citizen, but also by community-level actors (e.g., seeking to implement pro-environmental policies) and industrial decision-makers (e.g., aiming to reduce the ecological footprint of their business activities). Our findings underscore the multifaceted nature of barriers to PEB change and emphasize the importance of addressing structural and institutional factors alongside individual-level interventions.

Multidimensional social connectedness of sexual and gender minority midlife and older adults: Findings from the National Health, Aging, and Sexuality/Gender Study (NHAS).

This article introduces the multidimensional properties of social connectedness among sexual and gender minority (SGM) midlife and older adults and examines the relationship between these properties and general health. Data were analyzed from Aging With Pride: National, Aging, and Sexuality/Gender Study, including 2,450 SGM adults aged 50 and older in the United States. The structure, function, and quality of interpersonal relations as well as community-level activities and engagement were measured through a self-administered survey and an in-person interview. Findings indicated that SGM midlife and older adults, on average, had a large social network with high bridging potential and low density, consisting of more nonrelative family members than immediate family members. They also showed frequent availability of social support, moderate or higher satisfaction with interpersonal relations, and moderate SGM community engagement. Properties of social connectedness differed by gender, sexual identity, and gender identity, with SGM men, sexually diverse women, and transgender people showing distinct challenges in interpersonal relations. All aspects of social connectedness were positively associated with good general health, particularly network diversity, outdoor leisure activity engagement, and access to health-related decision support, controlling for age and chronic conditions. Care receiving and loneliness were negatively associated with good general health. Intervention development can target these factors to promote social and community connectivity and reduce the negative health effects of persistent social stressors. This study underscores the necessity of addressing all facets (i.e., structure, function, and quality) of interpersonal relations encompassing both immediate and chosen family as well as community-level social connectedness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Decision making processes and power dynamics in timber production co-management: A comparative analysis of seven Brazilian Amazonian community-based projects

Power asymmetries are a major obstacle to inclusive and robust decision making in collaborative management (or co-management), whereby multiple actors, principally government and local communities, jointly make decisions to achieve natural resource management goals. We compared seven community-based timber projects under different co-management arrangements within three Brazilian Amazonian extractive reserves to illuminate how decision making was organized (structure) and how it actually operated (function) with respect to power dynamics among multiple actors. Over a 15-month field season, we conducted participant observation and 52 semistructured interviews, systematically analyzed over 30 key timber management decision-making meetings, and employed Q-methodology to ascertain diverse actor perspectives of power dynamics. Our overall analysis revealed that decisions across all seven timber projects were gradually made through multiple meetings at community, extractive reserve, and beyond extractive reserve levels – a positive approach that can lead to continuous problem-solving. The 16 Q-sorters perceived decision making in these meetings to be participative, respectful of all actors' rights to speak, and allowed for some knowledge exchange, suggesting that unequal power dynamics (as observed in our study) does not necessarily prevent the opportunity to voice one's opinion. This participation also decentralized decision-making processes, boosting chances that community-level actors used their crucial local knowledge and advocated for their interests. Still, in one reserve, community members were ill prepared to make informed decisions, lacking sufficient technical training and trusted long-term support from non-governmental external actors. Furthermore, some Q-sorters noted insufficient community-level actors in decision-making processes, because deliberative spaces were beyond their physical reach. Yet in two reserves, innovative logistical strategies were developed to compensate and accommodate this challenge. In the third reserve, however, in the absence of intentional and creative solutions to geographical and cultural distances, there were limited interactions among the communities and external actors, giving rise to minimal information flow and weakened representation of community interests in decision making. We also demonstrated that actors in power (government forest administration officers) or those with perceived power (financial or forest technical providers, community leaders), sometimes acted strategically over other actors, particularly those perceived as without power (community residents), to alter their behavior, constrain their choices, and influence their expectations regarding decision outcomes. We conclude that power asymmetries can be overcome in natural resource co-management decision making, using deliberate, thoughtful, and creative participatory approaches.

"Like a broom tied together": A qualitative exploration of social cohesion and its role in community capacity strengthening to support integrated health in Nigeria.

Social cohesion, broadly understood as the degree of connectedness, solidarity, and trust across various community groups and between individuals, is critical for community capacity. This paper examines social cohesion and its role in community capacity strengthening for sustaining integrated health gains in Nigeria. This study took place in the context of a mid-course qualitative evaluation of a Community Capacity Strengthening approach that focuses on engaging Ward Development Committees (WDC) to increase community agency, coordinate and support the ward-level health ecosystem and ensure sustained community-level activities supporting behaviour change for improved health outcomes. This qualitative study was conducted in four selected wards per state in Bauchi and Sokoto states, targeting WDC members, Village Development Committee members, Community Volunteers, local government officials, traditional leaders, and Community Capacity Strengthening project staff. Thematic content analysis findings show that recognition and legitimacy were operationalized through the election of members into committees which in turn gave them a sense of identity and credibility. At the community level, WDCs leveraged the influence of social networks in the community to achieve their goal. Trust was also identified as a prerequisite to the acceptance and accomplishment of social and behaviour change programming. At the institutional level, our findings revealed strong conflict management skills and high collective efficacy of committee members for programme implementation. This study found high cohesion among committee members, promoting a sense of belonging and agency, and facilitating social and behavior change activities for improved health outcomes. However, we found clear limits to the extent to which high social cohesion can contribute to community capacity to sustain health implementation and improvements. While cohesive community organizations present a good opportunity for health programmes, there is a need for more investment of resources to address funding, logistics, and service delivery limitations.

Sociodemographic correlates of discrimination against PLHIV in High HIV prevalence states of India, NFHS 2016–21

This study investigates the socio-demographic correlates of HIV discrimination among individuals aged 15–49 years. This study also aims to assess the change in discriminatory attitudes towards PLHIV in high HIV prevalence states from 2016 to 2021 using data from the national Demographic Health Survey (4th and 5th). To identify factors associated with discriminatory attitudes, a multivariable logistic regression analysis was performed. Further, predicted probabilities and average marginal effects were computed, and the difference in discriminatory attitudes across both rounds was examined using a non-linear Fairlie decomposition. Mass media exposure, improved wealth index, and comprehensive knowledge significantly reduced the discriminatory attitudes towards PLHIV. Fairlie decomposition indicated that comprehensive knowledge, knowledge of mother-to-child transmission, and mass media exposure was significant contributor to the differences observed in the discriminatory attitude towards PLHIV across survey rounds. This study emphasizes the importance of spreading accurate information about HIV transmission modes and reinforces existing programmes and policies aimed at reducing stigma and discrimination against PLHIV. These programmes' efficiency and effectiveness can be ensured by linking them with community-level programmes and activities organized by Self Help Groups (SHGs), which have resulted in a paradigm shift in empowering women in India.

The effect of nutrition and health behavior change communication through community-level actors on the nutritional status of pregnant women in the Ambo district, Ethiopia: A randomized controlled trial.

Pregnant women in Ethiopia often had trouble understanding the normal nutrition and health information given by health professionals and found it inconsistent. Undernutrition is still a significant public health problem as a result. Hence, this trial aimed to assess the effect of nutrition and health behavior change communication using the community-level actors on the nutritional status of pregnant women. Cluster-randomized controlled community trial with baseline and endline measurements were used. Endpoint data from 744 pregnant women (372 intervention and 372 control groups) were gathered, respectively. In the intervention group, the community-level actors delivered the behavior change communication main message based on intervention protocol. The control group got nutrition information during their ANC visits but did not receive the behavior change communication intervention. Binary generalized estimating equations regression analyses adjusted for baseline covariates were used to test effects of the intervention on nutritional status. Following the trial's implementation, the prevalence of undernutrition in the intervention arm fell by 10% from the baseline (23.7% vs. 13.7%) and was 13.7% lower than in the control arm (13.7% vs. 27.4%, p = <.001). Pregnant women in the intervention group showed significantly lower risk of undernutrition than the control group (ARR = 0.21; 95% CI 0.14-0.30). This study showed that engaging community actors to communicate about nutrition and health behavior change was successful in enhancing pregnant women's nutritional status. Therefore, nutrition and health behavior change communication through the community-level actors is recommended to improve the nutritional status of pregnant women.

“Because There’s Experts That Do That”: Lessons Learned by Health Care Organizations When Partnering with Community Organizations

BackgroundHealth care organizations’ partnerships with community-based organizations (CBOs) are increasingly viewed as key to improving patients’ social needs (e.g., food, housing, and economic insecurity). Despite this reliance on CBOs, little research explores the relationships that health care organizations develop with CBOs.ObjectiveUnderstand how health care organizations interact with CBOs to implement social care.DesignThirty-three semi-structured telephone interviews collected April–July 2019.ParticipantsAdministrators at 29 diverse health care organizations with active programming related to improving patients’ social needs. Organizations ranged from multi-state systems to single-site practices and differed in structure, size, ownership, and geography.MeasuresStructure and goals of health care organizations’ relationship with CBOs.ResultsMost health care organizations (26 out of 29) relied on CBOs to improve their patients’ social needs. Health care organization’s goals for social care activities drove their relationships with CBOs. First, one-way referrals to CBOs did not require formal relationships or frequent interactions with CBOs. Second, when health care organizations contracted with CBOs to deliver discrete services, leadership-level relationships were required to launch programs while staff-to-staff interactions were used to maintain programs. Third, some health care organizations engaged in community-level activities with multiple CBOs which required more expansive, ongoing leadership-level partnerships. Administrators highlighted 4 recommendations for collaborating with CBOs: (1) engage early; (2) establish shared purpose for the collaboration; (3) determine who is best suited to lead activities; and (4) avoid making assumptions about partner organizations.ConclusionsHealth care organizations tailored the intensity of their relationships with CBOs based on their goals. Administrators viewed informal relationships with limited interactions between organizations sufficient for many activities. Our study offers key insights into how and when health care organizations may want to develop partnerships with CBOs.

Mapping of Pro-Equity Interventions Proposed by Immunisation Programs in Gavi Health Systems Strengthening Grants.

Reaching zero-dose (ZD) children, operationally defined as children who have not received a first dose of the diphtheria, tetanus, and pertussis (DTP1) vaccine, is crucial to increase equitable immunisation coverage and access to primary health care. However, little is known about the approaches already taken by countries to improve immunisation equity. We reviewed all Health System Strengthening (HSS) proposals submitted by Gavi-supported countries from 2014 to 2021 inclusively and extracted information on interventions favouring equity. Pro-equity interventions were mapped to an analytical framework representing Gavi 5.0 programmatic guidance on reaching ZD children and missed communities. Data from keyword searches and manual screening were extracted into an Excel database. Open format responses were analysed using inductive and deductive thematic coding. Data analysis was conducted using Excel and R. Of the 56 proposals included, 51 (91%) included at least one pro-equity intervention. The most common interventions were conducting outreach sessions, tailoring the location of service delivery, and partnerships. Many proposals had "bundles" of interventions, most often involving outreach, microplanning and community-level education activities. Nearly half prioritised remote-rural areas and only 30% addressed gender-related barriers to immunisation. The findings can help identify specific interventions on which to focus future evidence syntheses, case studies and implementation research and inform discussions on what may or may not need to change to better reach ZD children and missed communities moving forward.

Exploring factors influencing acceptability of online capacity building platform for HIV and AIDS monitoring and evaluation in Ghana.

Introduction: Ghana's multi-sectoral approach towards the management of HIV and AIDS has resulted in many community-level activities and programs aimed at stopping HIV infections and reducing the impact of HIV and AIDS. This study seeks to investigate whether Monitoring & Evaluation (M&E) officers in Ghana will be willing to join in an electronic learning platform which is web-based as a means of building M&E capacity. Methods: 123 out of 130 participants were involved in the study. Continuous and categorical variables were analysed using means and proportions. Structural equation Modelling technique was used to determine the factors associated with acceptability/intention to use. Results: The results showed that Attitude toward usage had a positive significant influence on acceptability/intention to use (AITU). In addition, experience with online learning and Internet discussion also had a positive influence on perceived usefulness and perceived ease of use respectively. The overall model shows 71% of variation of M&E officers' attitude toward usage on acceptability/intention to use online M&E platform as observed by the covariates in the model. Conclusions: Attitude toward usage was observed to be the strongest determinant of the AITU online HIV/AIDS M&E platform for monitoring and evaluation activities.

Understanding the struggles of Bangladeshi women in coping with climate change through a gender analysis

Climate-induced disasters affect a wide range of communities in Bangladesh. Among them, women are the most affected groups. Climate change increases their socioeconomic vulnerabilities by directly impacting their families’ food security, water consumption, health, and overall livelihood. Unlike in many patriarchal societies, Bangladeshi women often face challenges of unequal social relations and hierarchies, which enforce gender differented vulnerabilities. In this context, this paper intends to reveal what barriers Bangladeshi women face and how they cope with many uncertainties relating to changing contexts, particularly at the household, community, and institutional levels. The paper draws from the author’s Ph.D. research which was carried out in four districts of Bangladesh, focused on four types of climate change impacts and adaptation practices. Qualitative data collection methods were used such as focus group discussions, in-depth Interviews with women, and observations of their household and community-level activities for the study. In addition to that, key informant interviews were conducted with local and national level experts, government officials, and development workers to reveal institutional barriers confronted by women. Findings explore women’s gendered struggles in preparing for and responding to climate change through their lived experiences. Moreover, the study sheds light on the limited gender-responsive environment drawing attention to the need for strategies and actions for gender-transformative approaches to develop climate-resilient households and communities with women at the center.

Awareness, Attitude, and Willingness Toward Bleeding Control by Bystanders in Riyadh

Background Hemorrhage after trauma is the second leading cause of death in patients in the prehospital environment, and intervention by bystanders before the arrival of professional rescuers has the potential to save lives in such circumstances. No studies have been conducted in Saudi Arabia till date to assess the knowledge and awareness of bleeding control by bystanders. Hence, this study was conducted with an aim to assess the level of awareness, attitude, and willingness toward bleeding control by bystanders in Riyadh city, the capital of Kingdom of Saudi Arabia (KSA). Methodology This is an observational cross-sectional survey design that was conducted from July 2022 to August 2022 using an electronic questionnaire targeting populations who live in Riyadh city. MS Excel 2022 was used for data entry and coding, while SPSS Version 26 (IBM Corp., Armonk, NY) was used for data analysis. Results In this study, 585 adults from Riyadh city were recruited. Among the participants, 62.9% of them were between 16 and 26 years of age; 55.4% were males and 90.3% were Saudi Arabian citizens. Of the participants, 76.1% reported that they did not have any experience in participation in bleeding control related activity. Fear of causing more harm to the patients by attempting bleeding control was expressed by 65.1%. In general, 40.2% of the participants have adequate knowledge considering controlling of bleeding in an emergency setting. Higher level of education and having a previous first aid training were associated with better knowledge significantly (p=0.001 and 0.012, respectively). Conclusion There is a great need to improve the level of awareness about the role of bystanders in bleeding control and to design community-level activities to popularize this important life-saving skill.

Process of developing models of maternal nutrition interventions integrated into antenatal care services in Bangladesh, Burkina Faso, Ethiopiaand India.

Integrating nutrition interventions into antenatal care (ANC) requires adapting global recommendations to fit existing health systems and local contexts, but the evidence is limited on the process of tailoring nutrition interventions for health programmes. We developed and integrated maternal nutrition interventions into ANC programmes in Bangladesh, Burkina Faso, Ethiopia and India by conducting studies and assessments, developing new tools and processes and field testing integrated programme models. This paper elucidates how we used information and data to contextualize a package of globally recommended maternal nutrition interventions (micronutrient supplementation, weight gain monitoring, dietary counselling and counselling on breastfeeding) and describes four country‐specific health service delivery models. We developed a Theory of Change to illustrate common barriers and strategies for strengthening nutrition interventions during ANC. We used multiple information sources including situational assessments, formative research, piloting and pretesting results, supply assessments, stakeholder meetings, household and service provider surveys and monitoring data to design models of maternal nutrition interventions. We developed detailed protocols for implementing maternal nutrition interventions; reinforced staff capacity, nutrition counselling, monitoring systems and community engagement processes; and addressed micronutrient supplement supply bottlenecks. Community‐level activities were essential for complementing facility‐based services. Routine monitoring data, rapid assessments and information from intensified supervision were important during the early stages of implementation to improve the feasibility and scalability of models. The lessons from addressing maternal nutrition in ANC may serve as a guide for tackling missed opportunities for nutrition within health services in other contexts.

Matching Intent With Intensity: Implementation Research on the Intensity of Health and Nutrition Programs With Women's Self-Help Groups in India.

In India, a large network of self-help groups (SHGs) implements interventions to improve women's and children's health and nutrition. There is growing evidence on the effectiveness of women's group interventions to improve health but limited information on implementation intensity, including how often groups meet, for how long, and with whom, despite this often being cited as a key factor for success. We aimed to assess the implementation intensity of large SHG-based health and nutrition interventions with rural, low-income women, to inform program design, delivery, and measurement. We synthesized process data from surveys, meeting observations, and process evaluations across 8 maternal and child health and nutrition interventions in India. We examined the implementation intensity of 3 common intervention delivery channels: group meetings, home visits, and community-level activities. SHG members spent approximately 30 minutes in monthly meetings discussing health or nutrition. SHG dissolution or limited participation in meetings was a common challenge. Beyond group meetings, home visits reached approximately 1 in 3 households with an SHG member. Pregnant and breastfeeding women's participation in community events varied across interventions. Interventions that aim to capitalize on existing networks of financial women's groups not specifically formed for health and nutrition objectives, such as SHGs, will need to have an implementation intensity that matches the ambition of their health objectives: substantial changes in behavioral or mortality outcomes are unlikely to be achieved with relatively light intensity. Interventions that require sustained interactions with members to achieve health outcomes need to ensure adequate community and individual outreach to supplement group meetings, as well as improved participation through more intensive community mobilization approaches. Evaluations of group-based interventions should report on implementation intensity to support the interpretation of evaluation evidence and to inform further scale-up.

The impact of a demand-side sanitation and hygiene promotion intervention on sustained behavior change and health in Amhara, Ethiopia: A cluster-randomized trial.

Behaviors related to water, sanitation, and hygiene (WASH) are key drivers of infectious disease transmission, and experiences of WASH are potential influencers of mental well-being. Important knowledge gaps exist related to the content and delivery of effective WASH programs and their associated health impacts, particularly within the contexts of government programs implemented at scale. We developed and tested a demand-side intervention called Andilaye, which aimed to change behaviors related to sanitation, personal hygiene, and household environmental sanitation. This theory-informed intervention was delivered through the existing Ethiopian Health Extension Programme (HEP). It was a multilevel intervention with a catalyzing event at the community level and behavior change activities at group and household levels. We randomly selected and assigned 50 kebeles (sub-districts) from three woredas (districts), half to receive the Andilaye intervention, and half the standard of care sanitation and hygiene programming (i.e., community-led total sanitation and hygiene [CLTSH]). We collected data on WASH access, behavioral outcomes, and mental well-being. A total of 1,589 households were enrolled into the study at baseline; 1,472 households (94%) participated in an endline assessment two years after baseline, and approximately 14 months after the initiation of a multi-level intervention. The intervention did not improve construction of latrines (prevalence ratio [PR]: 0.99; 95% CI: 0.82, 1.21) or handwashing stations with water (PR: 0.96; 95% CI: 0.72, 1.26), or the removal of animal feces from the compound (PR: 1.10; 95% CI: 0.95, 1.28). Nor did it impact anxiety (PR: 0.90; 95% CI: 0.72, 1.11), depression (PR: 0.83; 95% CI: 0.64, 1.07), emotional distress (PR: 0.86; 95% CI: 0.67, 1.09) or well-being (PR: 0.90; 95% CI: 0.74, 1.10) scores. We report limited impact of the intervention, as delivered, on changes in behavior and mental well-being. The effectiveness of the intervention was limited by poor intervention fidelity. While sanitation and hygiene improvements have been documented in Ethiopia, behavioral slippage, or regression to unimproved practices, in communities previously declared open defecation free is widespread. Evidence from this trial may help address knowledge gaps related to challenges associated with scalable alternatives to CLTSH and inform sanitation and hygiene programming and policy in Ethiopia and beyond. Trial registration: This trial was registered with clinicaltrials.gov (NCT03075436) on March 9, 2017.

A genderbased analysis of multidimensional poverty in rural Odisha

This study, the first of its kind, is undertaken with the basic objective of assessing the status and determinants of multidimensional poverty across gender in rural areas of Jagatsinghpur district of Odisha and thus justifies the novelty of the study.365 females and 459 malesacross 338 households in the age group of 18 years and older, selected randomly, from four blocks of Jagatsinghpur district constitute the unit of the study. The Alkire-Foster approach (2011) is used to construct theMPI.Gender-wise analysis reveals higher deprivation of females over males in completed years of schooling, nutrition, health insurance, ownership of the land asset and motor vehicle, autonomy in preventing domestic crime and violence, autonomy in job choice, and autonomy in participating in community-level activities, whereas higher deprivation of male over female is observed in few indicators such as housing, possession of bank account, and sanitation. The study also observed that about 75 per cent of femaleswere recognized as multidimensionally poor with a poverty threshold of 0.3333 against 48 per cent for males. The binomial logistic regression model reveals that age and educationare two important determinants of multidimensional poverty for females, whereas education, social category, and occupation are observed as important determinants of multidimensional poverty for males.Based on the findings, the studysuggests the reorientation of government policies to increase the educational standard along with the generation of more employment opportunities with an emphasis on self-employment activities, both for males and females in the rural areas of the district.

Correlation between community balance and mobility scale (CB&M) with a battery of outcome measures to assess balance in Parkinson\u2019s disease \u2013 a cross-sectional study

BackgroundEvaluating balance in a functional context that integrates challenging tasks frequently performed in the community is essential to identify community-dwelling individuals who are at risk of falls in early Parkinson Disease (PD) than a simple balance measure. Community Balance and Mobility (CB&M) scale is one such measure that evaluates severe deficits in gait, balance, and mobility. The risk of falling and fear of fall is common among PD individuals and this affects the day to day functioning as well as the quality of life. Early identification of individuals who may be at risk to fall will lead to intervention strategies that can help to with balance issues. The aim of this study was to correlate between Community Balance and Mobility with a battery of outcome measures commonly used to assess balance in Parkinson’s disease.MethodsA cross sectional study design; with individuals referred to Outpatient physiotherapy department, diagnosed with idiopathic Parkinson’s disease, independently mobile and on a stable drug regimen referred by the neurologist; were screened and recruited by convenience sampling. With written informed consent, demographic data gathered and scales such as Berg Balance scale, Community balance & mobility scale, Functional Reach test and Timed up and go test were administered with an ample amount of rest.ResultsThe results obtained were documented and analysed using Karl Pearson’s correlation coefficient. Significant correlation between CB&M and BBS (r = 0.795) was found, CB&M and TUG (r = − 0.755), CB&M and FRT (r = 0.772).ConclusionCB&M is a useful measure which integrates items that challenge balance in the community context. It has been used to assess high functioning community dwelling individuals and hence may be apt for individuals with early Parkinson’s, since the tasks to be performed in CB&M are challenging and these simulate community level activities where the risk of falls is higher. It may well be a good tool to assess early Parkinson’s; their level of balance, community level activity and without need for sophisticated & expensive equipment.

Animal Source Food Social and Behavior Change Communication Intervention Among Girinka Livestock Transfer Beneficiaries in Rwanda: A Cluster Randomized Evaluation.

Animal source foods (ASFs), including cow's milk, contain essential nutrients and contribute to a healthy diet, but frequency of intake is low among children in low- and middle-income countries. We hypothesized that an ASF social and behavior change communication (SBCC) intervention implemented by community health workers (CHWs) would increase child milk consumption and dietary diversity in households that received a cow from the Government of Rwanda's Girinka livestock transfer program. We tested the 9-month SBCC intervention among children aged 12-29 months at baseline in administrative cells randomly assigned to the intervention or control. Most mothers in the intervention group were exposed to CHWs' home visits (90.7%) or community-level activities (82.8%). At endline, more mothers in the intervention group compared with the control group knew that cow's milk was an ASF (90.1% vs. 81.7%, P=.03) and could be introduced to children at 12 months (41.7% vs. 18.7%, P<.001). More mothers in the intervention group compared with the control group knew they should feed their children ASFs (76.2% vs. 62.1%, P=.01) and give them 1 cup of cow's milk per day (20.6% vs. 7.8%, P<.001). Children's consumption of fresh cow's milk 2 or more times per week increased in the intervention group, although not significantly (8.0 percentage points, P=.17); minimum dietary diversity was unchanged. Children in the intervention group had increased odds of consuming cow's milk 2 or more times per week if their mothers recalled hearing that children should drink 1 cup of cow's milk per day during a CHW's home visit [odds ratio (OR) 2.1, 95% confidence interval (CI) (1.1, 3.9)] or a community activity [OR 2.0, 95% CI (1.2, 3.5)]. Approximately half of the children had no milk during the past week because their households produced too little or sold what was produced. In poor households receiving a livestock transfer, strategies to further tailor SBCC and increase cow's milk production may be needed to achieve larger increases in children's frequency of milk consumption.

Forest plantations reduce soil functioning in terrestrial ecosystems from South Africa

The role of forest plantations in regulating soil ecosystem functions remains poorly understood in terrestrial ecosystems from Africa. Here, we evaluated the importance of forest plantations in regulating soil microbial functional profiles, community-level physiological profiles (CLPPs) and activities of soil microbial communities compared with native forests in two contrasting seasons. We found that forest plantations consistently reduced the rates of multiple soil functions associated with soil nutrient and carbon (C) cycling and shifted the activity and functional profile of microbial communities in two contrasting seasons and two independent regions from South Africa. Our results suggest land use changes from natural forests to plantations to maintain a continuously growing human population will have important negative consequences for soil functions in forest ecosystems from Africa with implications for ecosystem functioning under changing environments.

Participant-governed networks as catalysts for sustainable transport and tourism infrastructure: the Northern Rivers Rail Trail, Australia

ABSTRACT Converting disused railway corridors into multi-purpose spaces to achieve strategic sustainable mobility, leisure, and/or tourism objectives is an increasingly prevalent public policy issue. Previous literature suggests it is often bottom-up processes driven by networks of community-level actors that generate community support and political will to operationalise rail trail visions, though a lack of understanding of such ‘bottom-up’ advocacy processes exists. This study adopted the concept of participant-governed networks to explore the structure and function of a grassroots, community-based network which secured political support and financial commitment for a regional transport and tourism project encompassing construction of a rail trail in northern New South Wales, Australia. Our analysis shows this network comprised an intuitive core–periphery structure of community-minded actors who contributed an eclectic range of resources to consolidate broader political and community networks to advance the rail trail vision.