Community Mobilization Research Articles

Process evaluation of the ‘Lafiyan Yara’ project on enhancing access to HIV testing services using existing community structures in Nigeria

BackgroundThe Lafiyan Yara Project aimed to increase demand for HIV counselling, testing, treatment, and prevention services among pregnant women and children in Taraba State, Nigeria. Implemented from 2019 to 2021, the project utilized existing community structures, including traditional birth attendants, village health workers, and patent and proprietary medicine vendors, for mobilization. This study assessed the project’s activities, contributors, relevance, effectiveness, and efficiency.MethodsThe process evaluation was conducted using focus group discussions and key informant interviews with beneficiaries, community leaders, project staff, health facility personnel, and government officials. Data analysis employed framework analysis.ResultsThe Lafiyan Yara project was reported to have achieved notable successes, including increased HIV testing rates among children and pregnant women, improved linkage to care services, reduced mother-to-child transmission of HIV, increased HIV/AIDS awareness and knowledge, and enhanced community engagement and support. Challenges identified included insufficient funding for community mobilizers, training needs for health workers, and inadequate availability of test kits at health facilities. Confidentiality and stigma issues arose during community mobilizations. A key lesson learned was the importance of a comprehensive HIV care approach, emphasizing testing and ensuring support for individuals testing positive.ConclusionsThe project’s approach of leveraging community structures to create demand for HIV services among women and children proved effective, provided proper linkage to care for those testing positive. Addressing stigma and involving husbands/fathers in the community approach are crucial for improving outcomes.Trial registrationIPHOAU/12/1384.

Community mobilisation approaches to preventing adolescent multiple risk behaviour: a realist review

BackgroundAdolescent multiple risk behaviour (MRB) is a global health issue. Most interventions have focused on the proximal causes of adolescent MRB such as peer or family influence, with systematic reviews reporting mixed evidence of effectiveness. There is increasing recognition that community mobilisation approaches could be beneficial for adolescent health. There are gaps in the current literature, theory and implementation that would benefit from a realist approach. We use a theory-driven evidence synthesis to assess how and why community mobilisation interventions work/do not work to prevent adolescent MRB and in what contexts.MethodsThis realist review used a six-stage iterative process, guided by the RAMESES framework. We systematically searched PubMed, MEDLINE, PsycINFO, Web of Science, CINAHL and Sociological s, from their inception to 2021. Studies were screened for relevance to the programme theory, assessed for rigour and included based on a priori criteria. Two independent reviewers selected, screened and extracted data from included studies. A realist logic of analysis was used to develop context-mechanism-outcome configurations that contributed to our programme theory.FindingsWe reviewed 35 documents describing 22 separate community mobilisation intervention studies. Most studies (n = 17) had a quality assessment score of three or four (out of four). We analysed the studies in relation to three middle range theories. To uphold our theory that these interventions work by creating a social environment where adolescents are less likely to engage in MRB, interventions should: (1) embed a framework of guiding principles throughout the community, (2) establish community readiness with population data and (3) ensure a diverse coalition with the support of intervention champions. Mechanisms such as empowerment through coalition ownership over the delivery of the intervention, cohesion across the community and motivation to work collaboratively to improve adolescent health are triggered to achieve social environment shifts. However, certain contexts (e.g. limited funding) restrict intervention success as these mechanisms are not fired.ConclusionsFor community mobilisation interventions to reduce adolescent MRB, the coalitions within them must seek to alter the social environment in which these behaviours occur. Mechanisms including empowerment, cohesion and motivation lead to this shift, but only under certain contexts.Systematic review registrationPROSPERO CRD42020205342

A Low-Cost, Integrated Immunization, Health, and Nutrition Intervention in Conflict Settings in Pakistan-The Impact on Zero-Dose Children and Polio Coverage.

Pakistan is one of two countries globally still endemic for poliovirus. While increasing immunization coverage is a concern, providing equitable access to care is also a priority, especially for conflict-affected populations. Recognizing these challenges, Naunehal, an integrated model of maternal, newborn, and child health (MNCH), immunization, and nutrition services delivered through community mobilization, mobile outreach, and private-sector engagement was implemented in conflict-affected union councils (UCs) with high poliovirus transmission, including Kharotabad 1(Quetta, Balochistan) and Bakhmal Ahmedzai (Lakki Marwat, Khyber Pakhtunkhwa). A quasi-experimental pre-post-design was used to assess the impact of the interventions implemented between April 2021 and April 2022, with a baseline and an endline survey. For each of the intervention UCs, a separate, matched-control UC was identified. At endline, the proportion of fully immunized children increased significantly from 27.5% to 51.0% in intervention UCs with a difference-in-difference (DiD) estimate of 13.6%. The proportion of zero-dose children and non-recipients of routine immunization (NR-RI) children decreased from 31.6% to 0.9% and from 31.9% to 3.4%, respectively, with a significant decrease in the latter group. Scaling up and assessing the adoption and feasibility of integrated interventions to improve immunization coverage can inform policymakers of the viability of such services in such contexts.

Effect of Maternal and Newborn Care Service Package on Perinatal and Newborn Mortality

In resource-constrained settings where the neonatal mortality rate (NMR) is high due to preventable causes and health systems are underused, community-based interventions can increase newborn survival by improving health care practices. To develop and evaluate the effectiveness of a community-based maternal and newborn care services package to reduce perinatal and neonatal mortality in rural Pakistan. This cluster randomized clinical trial was conducted between November 1, 2012, and December 31, 2013, in district Rahim Yar Khan in the province of Punjab. A cluster was defined as an administrative union council. Any consenting pregnant resident of the study area, regardless of gestational age, was enrolled. An ongoing pregnancy surveillance system identified 12 529 and 12 333 pregnancies in the intervention and control clusters, respectively; 9410 pregnancies were excluded from analysis due to continuation of pregnancy at the end of the study, loss to follow-up, or miscarriage. Participants were followed up until the 40th postpartum day. Statistical analysis was performed from January to May 2014. A maternal and newborn health pack, training for community- and facility-based health care professionals, and community mobilization through counseling and education sessions. The primary outcome was perinatal mortality, defined as stillbirths per 1000 births and neonatal death within 7 days per 1000 live births. The secondary outcome was neonatal mortality, defined as death within 28 days of life per 1000 live births. Systematic random sampling was used to allocate 10 clusters each to intervention and control groups. Analysis was conducted on a modified intention-to-treat basis. For the control group vs the intervention group, the total number of households was 33 188 vs 34 315, the median number of households per cluster was 3092 (IQR, 3018-3467) vs 3469 (IQR, 3019-4075), the total population was 229 155 vs 234 674, the mean (SD) number of residents per household was 6.9 (9.5) vs 6.8 (9.6), the number of males per 100 females (ie, the sex ratio) was 104.2 vs 103.7, and the mean (SD) number of children younger than 5 years per household was 1.0 (4.2) vs 1.0 (4.3). Altogether, 7598 births from conrol clusters and 8017 births from intervention clusters were analyzed. There was no significant difference in perinatal mortality between the intervention and control clusters (rate ratio, 0.86; 95% CI, 0.69-1.08; P = .19). The NMR was lower among the intervention than the control clusters (39.2/1000 live births vs 52.2/1000 live births; rate ratio, 0.75; 95% CI, 0.58-0.95; P = .02). The frequencies of antenatal visits and facility births were similar between the 2 groups. However, clean delivery practices were higher among intervention clusters than control clusters (63.2% [2284 of 3616] vs 13.2% [455 of 3458]; P < .001). Chlorhexidine use was also more common among intervention clusters than control clusters (55.9% [4271 of 7642] vs 0.3% [19 of 7203]; P < .001). This pragmatic cluster randomized clinical trial demonstrated a reduction in NMR that occurred in the background of improved household intrapartum and newborn care practices. However, the effect of the intervention on antenatal visits, facility births, and perinatal mortality rates was inconclusive, highlighting areas requiring further research. Nevertheless, the improvement in NMR underscores the effectiveness of community-based programs in low-resource settings. ClinicalTrials.gov Identifier: NCT01751945.

PEMBERDAYAAN KADER TENTANG PERAWATAN BAYI BARU LAHIR DENGAN MENGOPTIMALKAN PELAYANAN KOMPLEMENTER

Newborn babies, especially those less than one month old, are the age group at highest risk of health problems, so they need appropriate supervision and treatment. Cadres play a role as community mobilizers, counseling and monitoring, who directly deal with social problems, including health problems faced by the community, so they play a big role in supporting the success of treatment of the newborns. This community service activity aimed to train the skills of posyandu cadres through empowering the role of posyandu cadres regarding care of newborn babies by optimizing complementary services in Kampung Delima Village, Rejang Lebong Regency. This activity was carried out from July to November 2023 targeting health cadres in Kampung Delima Village, East Curup District. Rejang Lebong Regency. Activities were carried out through training and mentoring of cadres. The results of this activities after training showed an increase in cadres' knowledge and skills regarding newborn care by optimizing complementary services, which include bathing babies and umbilical cord care using topical breast milk, correct breastfeeding techniques and baby massage in Kampung Delima Village.

A preliminary appraisal of the mobility of tribal communities in the Sundarban Biosphere Reserve, India

A preliminary appraisal of the mobility of tribal communities in the Sundarban Biosphere Reserve, India

A case study of using community-based consensus methods to facilitate shared decision-making among a spinal cord injury network.

Spinal cord injury (SCI) research and policy decisions are rarely made in partnership with people with SCI, making them less relevant, applicable, and used by those whom the decisions are intended to support. Across disciplines, consensus methods have been promoted as a viable solution for supporting shared research and policy-based decision-making. In this paper, we describe a partnered approach between academic researchers and the Ontario SCI Alliance, a non-profit, SCI community mobilization network to co-develop and co-disseminate a community-based consensus exercise. The community-based consensus exercise included two modified Delphi surveys and one in-person retreat. The partnership's goal with this exercise was to facilitate shared decision-making for the development of their upcoming strategic plan. We then interviewed partners and participants from the Delphi and in-person retreat to discuss successes, challenges, and lessons learned from the exercise. Survey 1 was disseminated to over 2,500 members of the Ontario SCI community and received 374 responses (276 coming from people with SCI). Survey 2 had 118 responses, with 87 coming from people with SCI. The retreat had 73 attendees, including people with SCI, family/friends of people with SCI, clinicians, researchers, and SCI community and research organization staff/volunteers. The retreat included a presentation of the survey results, a clinician/researcher panel, and externally-facilitated working groups. All survey responses and retreat materials were synthesized. Using the synthesized feedback, the Ontario SCI Alliance was able to implement several changes for the Ontario SCI community, including higher-quality primary care experiences (reduced wait times, more accessible examining rooms), the development of a wound care strategy with the Ontario government, and an advocacy campaign for public coverage for catheters and urinary care supplies. From the five interviews conducted, five themes were co-constructed regarding the successes, challenges, and lessons learned from the exercise: (1) Inclusion, Diversity, Equity, and Accessibility; (2) Partnership; (3) Design Considerations; (4) Transparency and Clarity in Communication; and (5) Sustainability. Findings from this community case study demonstrate the feasibility of conducting a community-level consensus exercise among an equity-deserving group while providing detailed guidance for how to ensure future research and policy-based decision-making is shared across diverse knowledge users.

The Acceptance of The Orang Asli Community's Movement Preachers Towards the Construct of Self-Preparation in Dakwah

The community mobilizers for the Orang Asli community are preachers who carry out the missionary work of the Department of Islamic Development Malaysia (JAKIM) in Orang Asli villages. However, do they have sufficient preparation in carrying out the missionary task towards the Indigenous People in the hinterland? This article attempts to analyse the acceptance of Indigenous Community Mobilizers towards items within the construct of self-preparation in preaching. This study is a quantitative research using a survey research design. A total of 140 respondents were selected as the study sample involving all Indigenous Community Mobilizers in Malaysia who have served for more than 5 years. A total of 10 items within the construct of self-preparation were asked to the Indigenous Community Mobilizers. The research data were analysed using SPSS software based on frequency, percentage, and mean. The study results indicate that all 10 items within the construct of self-preparation received approval from the Indigenous Community Mobilizers with a minimum average score of 4.51, indicating a very good level. The implication of the study is that preachers require sufficient self-preparation to carry out preaching duties in the field.

Vulnerability to Sexually Transmitted Infections (STI) / Human Immunodeficiency Virus (HIV) among adolescent girls and young women in India: A rapid review.

Limited evidence is available on the vulnerability of Adolescent Girls and Young Women (AGYW) to sexual risk behaviour and STI/HIV. Though there are almost no statistics available on vulnerability, related literature suggests that AGYW have low awareness about sexual risk behaviour/ transmission and the prevalence of STI/HIV, making them vulnerable. We conducted a rapid review of peer-reviewed studies addressing transmission network, prevalence, incidence awareness, common determinants of sexual risk behaviour/STI/HIV, health-seeking behaviour and existing interventions addressing the situation among AGYW (age 15-24) to inform the evidence gap in this crucial area of research. We registered the study in PROSPERO (CRD42023403713). We developed detailed inclusion/exclusion criteria, searched JSTOR, PubMed, Google Scholar, Science Direct and Population Council Knowledge Commons databases and followed the guidance from Cochrane Rapid Review to develop the rapid review. We also searched the bibliography of the included studies. We included the English language peer-reviewed quantitative, qualitative, mixed method studies published from Jan 1 2000 to Mar 31 2023. Six reviewers extracted data, and the seventh reviewer independently assessed the quality. Ninety-six studies met the inclusion criteria. We used descriptive statistics and narrative synthesis methods for data analysis. We also conducted a Risk of Bias Assessment (RoB) to check the quality of the included studies. Inadequate literature was found on the transmission network. Prevalence and awareness of STI/HIV are low among AGYW. However, Female Sex Workers, sex-trafficked women or drug users in this age group suffer more. Age, education, income, relationship dynamics with spouses/partners, multiple partners, and substance use are crucial in determining STI/HIV. Traditional sources of health seeking are more popular than formal sources because of social stigma. Mass media campaigns, community mobilization programs, and life skills training programs increase awareness about HIV, condom use and self-efficacy. The inclusion of only English language studies and not conducting meta-analysis because of high heterogeneity are some of the limitations of the study.

Endline assessment of knowledge about sickle cell disease among the tribal community of Chhotaudepur district of Gujarat.

Sickle cell disease (SCD) is a significant public health concern in India, with one of the highest disability burdens worldwide. For the success of the disease prevention and control program that aims to reduce prevalence through health promotion and screening, the public's prior knowledge of the disease is important. Hence, this study was conducted to assess baseline knowledge of the disease and effects of health education and community mobilization program in the SCD endemic tribal community of Gujarat. This quasi-experimental study was conducted in three phases at Chhotaudepur district of Gujarat, India. Knowledge of the community was assessed through the administration of pretested quantitative questionnaire in 1646 and 1631 individuals respectively during formative and evaluation phases. Differences between the proportions of two phases were statistically assessed by chi-square tests. Despite 75.3% of respondents having heard of SCD before, only 20% could perceive the correct cause. It was improved by 42% post-intervention. During the evaluation, 83% respondents recognized the most common symptom of extreme pain, whereas 86.8% identified the correct diagnostic method. Seventy-seven percent respondents reported modern medicine as a treatment for SCD at endline. Knowledge and awareness about SCD were found inadequate in the community. However, health education intervention strategies effectively improved knowledge related to the disease and its causes, diagnosis, and treatment. Hence, urgent action is required to incorporate community mobilization and awareness generation strategies to mitigate the disease burden.

Rethinking community-led total sanitation for eradicating open defecation in rural Ebonyi state communities, Nigeria: practice considerations for social work practitioners and educators

Abstract Nigeria is ranked number two in the world with the highest prevalence of open defecation (OD) despite the adoption of community-led total sanitation (CLTS) since 2007. Using some CLTS-triggered communities in Ebonyi State, this study investigated the awareness of CLTS, OD status, and its drivers as well as social workers' involvement in environmental sustainability. Study data generated from primary surveys included the socio-demographic characteristics of the study population and measurable behavioral elements of the SaniFOAM framework. Results of the statistical analyses show that more than 79% of the respondents were aware of CLTS, yet OD prevalence was 84.8%. While being married (odds ratio (OR): 0.036), being a civil servant (OR: 0.109), and having at least secondary education (OR: 0.119) were associated with lower odds of OD, whereas dislike for trekking (OR: 4.322), absence of laws (OR: 5.380), sanctions (OR: 4.715), and other SaniFOAM variables were associated with increased odds of OD. The results suggest that behavioral change toward OD under CLTS, with its focus on community mobilization for self-awareness and self-assessment for eliminating OD, may be a mirage without stricter approaches, laws, and sanctions for behavioral change. The domiciliation of these within grassroot governments and social workers' involvement in sanitation promotion are suggested.

ANALISIS KERUSAKAN PERKERASAN JALAN DENGAN MENGGUNAKAN METODE BINA MARGA DAN PAVEMENT CONDITION INDEX (PCI)

Road is a land transportation infrastructure that is very important to support community mobilization in various activities. But as a result of the large volume of traffic and various factors that occur make the road longer will decrease in function and comfort when used in other words, the road is damaged. The purpose of this study was to determine the condition of the pavement of National Road III, Cisaga District, Ciamis Sta. 0+000 – 2+000. The method used in this study is a quantitative method, which is the process of finding knowledge that uses data in the form of numbers as a tool to analyze what you want to know. The type of method used is the observation method by making direct observations to the field to obtain data to be analyzed using the Highways and Pavement Condition Index (PCI) method. The results of the study based on the analysis of the Highways method obtained a priority order value of 5 which means including the Periodic Maintenance program including moderate damage levels from 3 levels of Priority Order, namely with activities to prevent wider damage to each damage in order to return to the condition according to plan. Meanwhile, based on the Pavement Condition Index (PCI) method, an average pavement condition value of 65.75 is included in Good road conditions. Although in good condition, this road condition is included in the road condition identified as damaged because it is at level 5 of 7 pavement condition levels of the Pavement Condition Index (PCI) method, so in line with the testing of the Highways method the road condition is included in the periodic maintenance program.

Mobilising Communities Prior to Healthcare Interventions: Reflections on the Role of Public Health Midwives Working With Vulnerable Communities of Sri Lanka.

Background: Public health midwives (PHMs) play a frontline role in the Sri Lankan public healthcare system, ensuring the health of children and women at the community level. However, cultural differences in diverse social contexts necessitate PHMs for customised interventions to ensure optimum child and maternal health, particularly in most vulnerable communities.Purpose: The objective of the present study is to explore how PHMs have adapted their roles as community change agents to facilitate community mobilisation before implementing healthcare interventions for children and mothers in the estate sector (a marginalised and vulnerable community) of Sri Lanka.Research Design and methods: Using an exploratory qualitative research design, data were collected through in-depth interviews with 16 participants. The thematic analysis revealed two main themes that describe how PHMs engage in community mobilisation in addition to their designated role as healthcare officials in the estate sector of Sri Lanka.Results: The first theme highlights PHMs'involvement in community mobilisation through context-relevant advocacy for effective service implementation. The second theme illustrates how PHMs'role has been reshaped as advocates to intervene in making the family a supportive institution for child and maternal health. PHMs who work in the estate sector in the country are morally committed to engaging in community mobilisation and advocacy. However, this obligation can be neglected due to the lack of formal arrangements and training in sociocultural determinants of health and working with vulnerable communities.Conclusions: The role of a PHM in the estate sector differs significantly from that in the urban and rural sectors, given the significance of their interventions in family health. Also, community mobilisation is a prerequisite for implementing health policies for child and maternal health in vulnerable communities. Both community-level and family-level advocacy interventions and mobilisation efforts are equally important to establishing a supportive environment, without which any child and maternal healthcare interventions are difficult to implement.

Stakeholder perspectives of a co-produced intervention to integrate mental health for children and youth within the community sub-system in South Africa

PurposeThis study evaluated the process of integrating child and youth mental health to existing psychosocial support in disadvantaged South African communities. MethodsFour child practitioners of the host organization attended a Train-of-Trainer programme. They subsequently co-produced an intervention informed by a service transformation framework along five service domains. Implementation involved 368 community participants. A sub-sample of 43 participants were engaged in focus groups on their experiences. Data were analysed through thematic analysis. ResultsEstablished themes were inter-linked and transcended the five intervention domains. Engagement and conceptualization of mental health through awareness were viewed as pre-requisites to application of new knowledge. This should be supported by systemic changes, predominantly community mobilization and integrated care. Knowledge transfer involving collaboration between services and communities would enable sustainability of impact. The findings led to the formulation of a Theory of Change. ConclusionsIntegration of child and youth mental health through a cascade approach that actively involves communities in co-production and delivery can enhance service provision in resource-constrained Majority World contexts.

Participatory development of a target policy profile to support soil-transmitted helminth elimination.

Soil-transmitted helminths (STH) are parasitic worms that infect nearly a quarter of the world's population, particularly those living in communities without access to adequate water, sanitation, and housing. Emerging evidence suggests that it may be possible to interrupt transmission of STH by deworming individuals of all ages via community-wide MDA (cMDA), as opposed to only treating children and other focal populations. Transitioning from a policy of STH control to STH elimination in targeted areas would require a fundamental shift in STH policy and programming. This policy change would require updated guidance to support countries as they adapt their current approaches for STH surveillance, supply chain management, community mobilization, and core programmatic activities in pursuit of STH elimination. There is an opportunity to engage with key stakeholders, such as program implementers and implementation partners, to understand what evidence they need to confidently adopt a new policy guideline and to deliver guideline adherent management at scale. We aimed to engage with STH stakeholders to develop a Target Policy Profile (TPoP), a single document that describes optimal characteristics and evidence requirements that STH stakeholders prioritized in future potential STH transmission interruption efforts. Steps in TPoP development included a scoping review and key informant interviews (KIIs), which were used to design a two-stage Delphi technique to identify and verify TPoP components. The scoping review resulted in 25 articles, and 8 experts participated in KII's. Twenty respondents completed the first Delphi survey and 10 respondents completed the second. This systematic effort resulted in a net of 3 key information domains (background/context, clinical considerations, and implementation considerations) encompassing 24 evidence categories (examples include evidence regarding safety and adverse events, implementation feasibility, or evidence dissemination). For each evidence category, STH stakeholders reviewed, endorsed, or revised a range of options for how the evidence could be presented. This information can be used by guideline committees or global policy makers prior to convening guideline advisory groups. The TPoP tool may also speed the process of stakeholder consensus building around guidelines, accelerating progress towards implementing evidence-based policy at scale.

ABORDAGEM DE COMUNIDADES NAS PRÁTICAS DE SAÚDE

This research details an approach to health practice in communities, emphasizing the importance of understanding social, institutional, and environmental relationships within a specific territory. The proposal suggests the inclusion of new actors in health, beyond traditional professionals, involving the organized population to address both clinical-epidemiological and social determinants. The approach process includes various stages, such as direct observation, information gathering, communication, and engagement with the community, identification of key informants, institutional analysis, community mobilization and participation, as well as mapping and strategic planning. The study emphasizes the need to respect local beliefs and traditions, promote knowledge exchange, and encourage active community participation in health decisions. The proposed approach aims to align health practices with the collective interests of society, promoting a more integrated and effective community health.

ABORDAGEM DE COMUNIDADES NAS PRÁTICAS DE SAÚDE

This research details an approach to health practice in communities, emphasizing the importance of understanding social, institutional, and environmental relationships within a specific territory. The proposal suggests the inclusion of new actors in health, beyond traditional professionals, involving the organized population to address both clinical-epidemiological and social determinants. The approach process includes various stages, such as direct observation, information gathering, communication, and engagement with the community, identification of key informants, institutional analysis, community mobilization and participation, as well as mapping and strategic planning. The study emphasizes the need to respect local beliefs and traditions, promote knowledge exchange, and encourage active community participation in health decisions. The proposed approach aims to align health practices with the collective interests of society, promoting a more integrated and effective community health.

Integrating health intervention into existing program structure of the neglected tropical diseases: lessons learned from Yobe and Ebonyi states.

Nigeria has a national policy on neglected tropical diseases (NTD) which is coordinated by the Federal Ministry of Health and integrated into the health system at all government levels. A network of grassroots mobilizers, named community drug distributors (CDDs), deliver NTD drugs and commodities to rural and hard-to-reach communities throughout Nigeria. Interviews with state and local government coordinators of Nigerian NTD programs and focus group discussions with CDDs in Yobe and Ebonyi states were conducted to understand the working modalities of NTD programs in Nigeria to identify the potential of leveraging the NTD structure for additional health interventions such as COVID-19 vaccine rollouts. Collected data was coded and managed on NVivo version 12 using content analysis. The study found that the NTD committee had the following: a structured planning and coordination process, a community mobilization approach for the effective delivery of routine Mass Administration of Medication (MAM) activities. Challenges encountered included little or no incentives for the CDDs, insecurity, transportation and logistics, and lack of equipment and drug commodities. Nigerian NTD health structures have a wide reach, with a presence in all states and local government areas (LGAs), and this has previously been leveraged to deliver commodities and interventions to rural and hard-to-reach communities for non-NTD health programs and could thus be used similarly for COVID-19 vaccination programs. The enablers of integrating health interventions into the NTD structure are increased availability of finances and manpower, while lack of financial incentives and partners' buy-in were identified as possible. challenges. The study suggests that integrating COVID-19 interventions into the NTD program in Nigeria would be a significant accomplishment, as the existing structure can support future interventions. The study also highlights the efficiency of the NTD program's modalities and processes, indicating that an organized structural system for public health interventions can. increase the services of existing interventions while allowing for the integration of future interventions.

A Holistic Strategy of Mother and Child Health Care to Improve the Coverage of Routine and Polio Immunization in Pakistan: Results from a Demonstration Project.

The eradication of poliovirus and improving routine immunization (RI) coverage rates present significant challenges in Pakistan. There is a need for interventions that focus on strengthening community engagement to improve routine immunization coverage. Our primary objective is to assess the impact of an integrated strategy designed to enhance community engagement and maternal and child health immunization campaigns on immunization coverage in Pakistan's high-risk union councils of polio-endemic districts. We implemented an integrated approach for routine immunization and maternal and child health in the polio-endemic district of Pakistan. This approach involved setting up health camps and actively engaging and mobilizing the local community. An independent team conducted surveys at three key points: baseline, midline, and endline, to evaluate immunization coverage among children under the age of five. The primary outcome measures for the study were coverage of OPV, IPV, and changes in the proportion of unvaccinated and fully vaccinated children. To select clusters and eligible households in each cluster, we utilized a 30 × 15 cluster sampling technique. Multivariable associations between socio-demographic factors and changes in the proportion of fully vaccinated children at the UC level were assessed using hierarchical linear regression models. A total of 256,946 children under the age of five (122,950 at baseline and 133,996 at endline) were enrolled in the study. By the endline, full immunization coverage had increased to 60% or more in all three study areas compared to the baseline. Additionally, there was a significant increase in the coverage of both OPV and IPV across all three provinces at the endline. The full immunization rates were assessed on three levels of the framework: the distal, intermediate (access and environment), and proximal level (camp attendance and effectiveness). At the distal level, on multivariate analysis, family size was found to be a significant predictor of change in immunity within the families (β = 0.68; p ≤ 0.0001). At the intermediate level, the likelihood of full immunization decreased with the decrease in knowledge about vaccination (β = -0.38; p = 0.002), knowledge about polio vaccine (β = -0.25; p = 0.011), and knowledge about IPV (β = -0.06; p = 0.546). Perceived obstacles to vaccination were fear of adverse events (β = -0.4; p ≤ 0.0001) and lack of education (β = 0.23; p = 0.031), which were found to be significant in bivariate and multivariate analyses. At the proximal level, community mobilization (β = 0.26; p = 0.008) and attendance at health camp (β = 0.21; p ≤ 0.0001) were found to enhance full immunization coverage. On the other hand, the most prominent reason for not attending health camp included no need to attend the health camp as the child was not ill (β = -0.13; p = 0.008). This study found that community mobilization and attendance at health camps significantly enhanced full immunization coverage. The findings highlight the importance of community engagement and targeted interventions in improving immunization coverage and addressing barriers to healthcare seeking.

Eeyou/Eenou community voices on ‘doing’ Miyupimaatisiiun (wellness) planning: An occupational transactional perspective

ABSTRACT This article is the second of ‘twin’ papers centering community participation in Miyupimaatisiuun (wellness) planning within the Eeyou Istchee (Northern Québec James Bay Cree) context. We present and discuss the results of a community-based study that took place over the course of 4 years (2016-2020). Data were collected through 13 visits to four communities, 22 individual conversation-based interviews with local members of Miyupimaatisiiun (wellness) Committees (MC), 50 hours of community-based activity observations, informal brief interviews, and documents related to MC planning activities. Data analysis was grounded in an occupational transactional perspective encompassing local and regional contexts with which MC members coordinate their intentions and actions to plan for community miyupimaatisiiun. Our first manuscript (Lévesque et al., 2022) presented study results on the meaning of community participation in wellness planning. This second paper predominantly addresses the processes of ‘doing’ Miyupimaatisiiun Committee participation. Three themes are presented and discussed: Connecting local entities, Positioning the local Miyupimatisiiun Committee, and Wearing multiple hats. These results help describe and understand community participation as occupational transaction with the effects of colonization and with coloniality, that is, settler forms of knowledge and ways of doing, as participants bridge community sectors and collectivize local entity resources and efforts toward community miyupimaatisiiun. Ways forward for local Cree governance and regional entities hoping to better support community engagement and mobilization for wellness planning, are proposed. Though research results will be of interest to a broad audience, particular relevance to occupational science is emphasized, in terms of occupational transactionalism and coloniality.