Community Health Research Articles

The Association between Emotional Responses to Climate Change, Antenatal Anxiety and Maternal-Fetal Attachment in Primigravida Women.

To investigate the association between emotional responses to climate change, antenatal anxiety, and maternal-fetal attachment in primigravida women. A multi-site cross-sectional research design study. This study was conducted at four primary health care (PHC) facilities in Damanhur district, El-Behera, from February 2024 to April 2024. Two hundred eighty-five women completed a comprehensive questionnaire that included a Woman's Social and Reproductive Form, The inventory of climate emotions (ICE) scale, The Stirling Antenatal Anxiety Scale (SAAS) and the Maternal-Fetal Attachment Scale (MFAS-HU-20). The study revealed that emotional responses to climate change show strong positive correlations with each other, ranging from 0.689 to 0.840, all significant at p < 0.001 level. Additionally, antenatal anxiety demonstrates substantial positive correlations with emotional responses to climate change, albeit with associations ranging from 0.239 to 0.287, all significant at p < 0.001 level. Moreover, maternal-fetal attachment displays substantial negative correlations with emotional responses to climate change, indicating that as emotional responses to climate change increase, maternal-fetal attachment tends to decrease. The correlations range from -0.263 to -0.426, all significant at p < 0.001. The emotional impact of climate change can adversely affect the bonding process between mother and fetus. Healthcare professionals, including obstetricians, midwives, and mental health counsellors, should integrate climate-related emotional distress into their assessments and interventions. Providing targeted psychological support for expectant mothers. The study's findings highlight the need for nursing to integrate climate-related emotional distress screening into prenatal care and for research to explore long-term effects and intervention effectiveness. In practice, healthcare providers should adopt holistic approaches that combine environmental and psychological support, developing comprehensive guidelines and community-based programs to support pregnant women. The research adhered to that is STROBE. Public contributions by women in community health centers.

Socio-Cultural Relationship to Self-Efficacy of Breastfeeding in Pregnant Women in the 3rd Trimester in the Working Area of Imogiri Ist Health Center and Kretek Community Health Center, Bantul Regency

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background: &lt;/em&gt;&lt;/strong&gt;Socio-cultural factors, especially in Javanese society very influence the success and failure of exclusive breastfeeding. Social culture can be in customs, traditions, taboos, etc. Breastfeeding mothers who have low &lt;em&gt;breastfeeding self-efficacy &lt;/em&gt;when they later face problems while breastfeeding will tend to make it easier to decide to use alternative techniques for breastfeeding their babies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Objective: &lt;/em&gt;&lt;/strong&gt;To determine the socio-cultural relationship towards &lt;em&gt;breastfeeding self-efficacy &lt;/em&gt;in third-trimester pregnant women&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Method: &lt;/em&gt;&lt;/strong&gt;The type of research is a quantitative analytical descriptive. Data collection methods use surveys, observations, or interviews with a &lt;em&gt;cross-sectional approach method&lt;/em&gt;&lt;em&gt;. &lt;/em&gt;The sampling technique used &lt;em&gt;purposive sampling of &lt;/em&gt;as many as 126 respondents with a gestational age of &amp;gt;30 weeks and according to the inclusion criteria. There are 2 instruments used, namely Sociocultural and &lt;em&gt;Breastfeeding Self-efficacy Scale-Short Form &lt;/em&gt;&lt;em&gt;(BSES-SF)&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results: &lt;/em&gt;&lt;/strong&gt;Based on research conducted on 126 respondents, Social Culture Supports ( &lt;em&gt;0.000 &amp;lt; 0.05) &lt;/em&gt;and Social Culture Does Not Support &lt;em&gt;(0.009 &amp;lt; 0.05) &lt;/em&gt;from the &lt;em&gt;Chi-Square test &lt;/em&gt;with value 0,000 &lt;em&gt;(p &lt;/em&gt;&lt;em&gt;&amp;gt; &lt;/em&gt;&lt;em&gt;0.05) &lt;/em&gt;H a rejected means it shows that there is a significant relationship between social culture and &lt;em&gt;breastfeeding self-efficacy.&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;The Breastfeeding Self-Efficacy Score &lt;/em&gt;showed that most respondents had high self-confidence ( 82.5 % ).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusion: &lt;/em&gt;&lt;/strong&gt;There is a significant relationship between social culture and &lt;em&gt;breastfeeding self-efficacy.&lt;/em&gt;&lt;em&gt; &lt;/em&gt;In this study, it can be said that respondents in the research area do not have traditions, culture, and taboos that do not support breastfeeding. The majority of respondents with supportive social culture (95%) have high &lt;em&gt;breastfeeding self-efficacy &lt;/em&gt;(73%) with quite a large difference from moderate and very low &lt;em&gt;breastfeeding self-efficacy (27%)&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;

Family caregiver narratives of hospice death vigils

BackgroundOften, family members and friends gather around a dying hospice patient to say goodbye in what is known as a death vigil. The purpose of this study is to explore...

Learning medical sociology through an innovative 'Elective study module' integrating humanities with medicine for undergraduate students of a medical college in Bengaluru, India.

Background The newly introduced 'Elective programme', a voluntary special study module in the final phase of the undergraduate medical curriculum, offers scope for new immersive, self-directed learning opportunities. We describe a programme of study for learning 'medical sociology' through the innovative use of humanities in medicine. Methods Our elective module, called 'Community Health and Rock Music' (CHaRM), was a 2-week programme, merging the curricular subject of community health with 'rock music' as an exposure to the 'counter-culture' outside of the medical world. The half-day sessions consisted of: (i) watching/listening to a rock song-video without reading its lyrics; (ii) listening to the same song again but with lyrics; (iii) undertaking an emotionally stimulating activity (watching a movie, making a site-visit, etc.); and (iv) debriefing, to identify/discuss the underlying social determinants of health and their relevance in the grooming of a socially aware medical student. Formative assessment was intended to gauge levels of expression of the affective domain (attitude/emotions). Results Seven of 143 students volunteered for this programme. Key learnings were a clear appreciation of the societal determinants of health (such as deprivation/discrimination/social structures); multi-level causation of diseases; social issues not addressed in traditional medical curriculum; personal growth; teamwork; and the role of empathy in medical practice. Additional learning was the exposure to the 'counter-culture of arts'. All 7 student assessments 'met expectation', with 4 of them 'exceeding expectation'. Conclusion An 'elective programme' combining humanities with medicine is potentially an innovative, student-centric and replicable model of learning that impacts the affective domain critical for doctors-in-training.

Quantifying linguistic heritage: Philological insights for high-impact language preservation

This research paper digs into the complex intersection of philological viewpoints and quantitative analysis to disentangle the dynamics of language protection. Considering the developing threat to language endangerment, our examination utilizes a comprehensive quantitative way to deal with the health of a particular linguistic community. With the utilization of language proficiency measures, documentation indices and demographic information, our review gives a complex comprehension of language evolution inside a cultural structure. The theoretical framework gives understanding into the complexities of language preservation techniques by coordinating deep rooted philological standards. Besides the fact that the discoveries add to the empirical comprehension of language preservation, they also furnish practitioners and policymakers with significant experiences. This examination desires to propel the discussion on language revitalization methodologies by melding the thorough quantitative methodology with the rich tradition of philology, stressing the importance of keeping up with linguistic legacy in a continually shifting global context. The implications of the examination go past scholarly circles, giving proof to practical, proof based activities to preserve endangered languages.

The oral microbiome of children in health and disease-a literature review.

The oral microbiome is a complex community of microorganisms residing in the oral cavity interacting with each other and with the host in a state of equilibrium. Disruptions in this balance can result in both oral and systemic conditions. Historically, studying the oral microbiome faced limitations due to culture-dependent techniques that could not capture the complexity and diversity of the microbial community. The emergence of advanced genomic technologies and the ease of sample collection from the oral cavity has revolutionized the understanding of the oral microbiome, providing valuable insights into the bacterial community in both health and disease. This review explores the oral microbiome in children, discussing its formation and dynamics in both states of health and disease, its role in various conditions such as dental caries, periodontal disease, oral cancer, cleft lip and palate, and explores its connection to several systemic consequences.

The Role of the Public Health Nurse in Collaborative Efforts to Manage COVID-19 in a Rural Hispanic Population: A Qualitative Inquiry.

While local health departments (LHDs) recognize the need to provide culturally congruent care to rural Hispanic populations, the COVID-19 pandemic tested their capacity to leverage available knowledge, skills, and resources to integrate effective transcultural collaborations to improve health outcomes. Twelve semi-structured interviews of community leaders were conducted and interpreted using qualitative thematic analysis. The role of the LHD's Public Health Nurse (PHN) in the pandemic response was examined using the Public Health Intervention Wheel (2019), specifically collaboration, coalition-building, and community organizing components. The PHN directed the community response to the pandemic. Four pivotal themes emerged from the data: identifying gaps, forming alliances, putting boots on the ground, and moving forward. The need to provide culturally congruent care to the Hispanic population required the development of transcultural knowledge through multi-faceted strategies. Sustaining relationships borne out of the pandemic is important to enhance community response to future disasters.

Peer navigation intervention for individuals with serious mental illness reentering the community after jail incarceration: a qualitative case study

BackgroundCriminal legal system-involved individuals with serious mental illness (SMI) experience more challenges accessing mental health and other community services than those without a history of criminal legal system involvement. A formative qualitative study was conducted to explore feasibility and acceptability and inform the adaptation of a mental health peer navigation intervention for individuals with SMI reentering the community after jail incarceration.MethodsIn-depth qualitative interviews and focus-group discussions were conducted with mental health peer navigators (i.e., certified mental health peer support specialists, peer recovery coaches) and individuals with lived experience of SMI and criminal legal system involvement (N = 20 total). Data were analyzed using applied thematic analysis.ResultsFour major themes emerged: (1) Feasibility and acceptability of peer-provided services: all participants reported that peer navigation services would be feasible and acceptable for individuals with SMI reentering the community after jail incarceration; (2) roles of peer navigators in addressing barriers to care: peers can address barriers to care experienced during community reentry and contribute towards service linkage/engagement; (3) shared identity and combating stigma: having a shared identity with peer navigators may minimize the impact of stigma and make it easier for clients with multiple marginalized identities to seek support; and (4) peer navigator skills and recommendations for the planned program: essential peer navigation skills include authenticity, reliability, active listening, advocacy, trauma-informed care, motivational interviewing, and empathy. Recommendations for the planned program include initiating services while clients are in custody, emphasizing the voluntary nature of peer support, knowing the limits of a peer navigation intervention, and offering support for peer navigators while on the job.ConclusionParticipants saw peer navigation services for individuals with SMI with criminal legal system involvement as potentially feasible and acceptable. Such programs may enhance their impact by offering supportive supervision, emphasizing the voluntary nature of the service, and acknowledging recovery as a self-directed endeavor.

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.

Improving Clinical Preparedness: Community Health Nurses and Early Hypoglycemia Prediction in Type 2 Diabetes Using Hybrid Machine Learning Techniques.

The aim of the study was to analyze the data of diabetic patients regarding warning signs of hypoglycemia to predict it at an early stage using various novel machine learning (ML) algorithms. Individual interviews with diabetic patients were conducted over 6 months to acquire information regarding their experience with hypoglycemic episodes. This information included warning signs of hypoglycemia, such as incoherent speech, exhaustion, weakness, and other clinically relevant cases of low blood sugar. Researchers used supervised, unsupervised, and hybrid techniques. In supervised techniques, researchers applied regression, while in hybrid classification ML techniques were used. In a 5-fold cross-validation approach, the prediction performance of seven models was examined using the area under the receiver operating characteristic curve (AUROC). We analyzed the data of 290 diabetic patients with low blood sugar episodes. Our investigation discovered that gradient boosting and neural networks performed better in regression, with accuracies of 0.416 and 0.417, respectively. In classification models, gradient boosting, AdaBoost, and random forest performed better overall, with AUC scores of 0.821, 0.814, and 0.821, individually. Precision values were 0.779, 0.775, and 0.776 for gradient boosting, AdaBoost, and random forest, respectively. AdaBoost and Gradient Boosting models, in particular, outperformed all others in predicting the probability of clinically severe hypoglycemia. These techniques enable community health nurses to predict hypoglycemia at an early stage and provide the necessary therapies to patients to prevent complications resulting from hypoglycemia.

M-SAKHI - Mobile health solutions to help community providers promote maternal and infant nutrition and health: a description of development of the Program Impact Pathway using Theory of Change.

Behaviour Change Communication (BCC) intervention programmes often lack documentation of successful processes. This manuscript aims to describe the development of Program Impact Pathway (PIP) using Theory of Change (ToC) approach for a mHealth BCC intervention titled 'Mobile Solutions Aiding Knowledge for Health Improvement (M-SAKHI)' aimed at reducing stunting in infants at 18 months of age. The PIP was developed using ToC to design the intervention and plan its implementation. Literature review and data from previous pilots helped to identify health service gaps that needed to be addressed by the PIP of this intervention. M-SAKHI was implemented in 244 villages under governance of forty primary health centres of Nagpur and Bhandara districts of eastern Maharashtra in central India. The study investigators and the public health stakeholders participated in developing the PIP. M-SAKHI evaluation study recruited 2501 pregnant women who were followed up through delivery until their infants were 18 months old. The PIP was developed, and it identified the following pathways for the final impact: (1) improving maternal and infant nutrition, (2) early recognition of maternal and infant danger signs, (3) improving access and utilisation to healthcare services, (4) improving hygiene, sanitation and immunisation practices, and (5) improving implementation and service delivery of community health workers through their training, monitoring and supervision in real time. This paper will illustrate the significance of development of PIP for M-SAKHI. It can aid other community-based programmes to design their PIP for nutrition-based BCC interventions.

Effect of community – facility linked interventions on maternal health service utilization and newborn care in rural low-resource settings in Eastern Uganda

BackgroundImproving maternal and newborn care (MNC) in hard-to-reach areas is essential for accelerating progress towards sustainable development goals (SDGs). We implemented the “Communities in which Mothers and Newborns Thrive (COMONETH) project” in rural settings of eastern Uganda between 2017 and 2020 to reduce barriers to accessing MNC services. We evaluated the effect of the COMONETH intervention on enhancing the utilization of MNC services and the adoption of appropriate care practices in Luuka district, Uganda.MethodsWe used a pre- and post-comparison design to measure the effect of a demand-supply linked COMONETH intervention on MNC indicators. We trained Community Health Workers (CHW) to educate and refer expectant mothers to health facilities when needed. We also showed videos to pregnant women on identification of pregnancy danger signs, mentored and simulated health workers with PRONTO, and improved obstetric surgery at the referral facilities. We assessed antenatal care (ANC), facility delivery, postnatal care (PNC), and newborn care practices. We used optimal full propensity score matching, and weighted logistic regression and then estimated average treatment effect on the treated (ATT) of the intervention on MNC outcomes on the odds ratio scale.ResultsA total of 583 women at baseline and 619 at endline participated in the study. The intervention was associated with increased odds of attending 4 ANC visits (OR = 1.26, 95% CI = 1.07–1.49), 8 ANC visits (OR = 2.27, 95% CI = 1.06–4.82) and utilization of PNC services (OR = 1.40, 95% CI = 1.20–1.63). We did not observe a significant association between intervention and early ANC attendance (OR = 0.88, 95% CI 0.80–1.00) and facility deliveries (OR = 0.99, 95% CI = 0.93–1.06). The intervention strategy was associated with improvements in practices: delayed bathing (OR = 1.22, 95% CI = 1.06–1.40), putting nothing on the cord (OR = 1.42, 95% CI = 1.27–1.59) and wrapping of babies immediately (OR = 1.08, 95% CI = 1.03–1.14).ConclusionsThe findings demonstrated the potential of a demand-supply linked intervention to improve MNC outcomes in low-resource settings and should be promoted in similar settings. Interventions that strengthen the quality of care at health facilities and bridge demand-side gaps can improve MNC practices and reduce morbidity and mortality in rural settings.

Environmental Justice and Sustainable Development: Cumulative Environmental Exposures and All-Cause Mortality in Colorado Counties

(1) Background: Colorado’s (CO) Environmental Justice mapping tool, CO EnviroScreen, quantifies environmental injustices through “EnviroScreen Scores”, highlighting areas likely affected by environmental health disparities. Identifying the specific scores most strongly associated with mortality could help prioritize interventions and allocate resources to address these issues. This study contributes to sustainable development goals by examining the relationship between environmental justice indicators and population health outcomes. By utilizing the CO EnviroScreen tool, we assess how cumulative environmental exposures and vulnerabilities impact mortality rates, providing insights for sustainable planning and public health policies. (2) Methods: We assessed the cross-sectional association between county-level all-cause mortality rates in CO, using 2019 data from the Colorado Department of Public Health and Environment, and three county-level component scores obtained from CO EnviroScreen: sensitive populations (i.e., health-related outcomes), environmental exposures (e.g., from air, water, noise), and climate vulnerability (i.e., risk of drought, flood, extreme heat, wildfire). A quasi-Poisson generalized linear model was utilized, incorporating covariates (county-level metrics for insufficient sleep, alcohol overconsumption, physical inactivity, and smoking) to explore associations adjusted for behavioral risk factors (n = 64 counties). (3) Results: The analysis revealed that a 10% increase in the “Environmental Exposures” component score was associated with a 3% higher all-cause mortality rate (95% CI: 1.00, 1.05), highlighting the importance of addressing environmental determinants for sustainable community health. No significant associations were observed for the “Sensitive Populations” or “Climate Vulnerability” component scores. (4) Conclusions: This study provides novel evidence of an association between the CO EnviroScreen score, particularly the environmental exposure component, and all-cause mortality rates at the county level in Colorado in 2019. The findings suggest that cumulative environmental exposures may contribute to geographic disparities in mortality risk, even after adjusting for key behavioral risk factors. These results underscore the importance of integrating environmental justice considerations into sustainable development strategies to promote equitable health outcomes and resilient communities. While our study demonstrates the utility of CO EnviroScreen in identifying areas at risk due to environmental factors, it does not establish a direct link to broader environmental justice outcomes. Further research is needed to explore specific environmental exposures and their direct impacts on health disparities to provide a more complete picture of environmental justice in Colorado.

South Asian Muslim individuals’ lived experiences of Type 2 Diabetes healthcare – ‘I just want someone to actually break it down for me’

Objective Type 2 Diabetes is highly prevalent across Aotearoa New Zealand, and South Asian people have a disproportionately high burden of disease. This research aimed to improve understanding of South Asian Muslim people’s experiences navigating New Zealand’s diabetes healthcare to promote cultural responsiveness and equitable outcomes. Method We conducted semi-structured interviews with 10 South Asian Muslim individuals with Type 2 Diabetes. Interviews explored how participants made sense of their diabetes in relational and cultural contexts, and the healthcare barriers and facilitators they experienced. Reflexive thematic analysis was used to develop themes from the interview transcripts. Results Three key themes were developed: the feeling, managing, and reflecting on diabetes worry in relational contexts; the cultural and relational challenges of enacting self-control and discipline; and how diabetes is a family experience, for better or for worse. Conclusion These themes illustrated the multifaceted relational dynamics of navigating diabetes healthcare. Several avenues to consider for developing culturally sensitive diabetes care were suggested. This included: practitioners exploring dynamics of worry, shame and self-blame, building upon family supports, supporting reducing family-facilitated health barriers, addressing power dynamics which facilitate institutional distrust, and funding culturally appropriate, accessible community health interventions.

Positive Deviance in Nutritional Practices for Two-Year-Olds in Poor Fisherman Families in the Belawan Health Center Area, 2022

The problem of malnutrition is still the main problem faced in human resource development. The problem of growth and development of Baduta is a serious problem because at this age the process of physical and intellectual growth and development is critical. Malnutrition problems mostly occur in poor families but are not caused by poor families who have well-nourished children. The Belawan Community Health Center working area is one of the community health centers with the highest number of cases of malnutrition in Medan City. To overcome this, a program is needed that is believed to be effective and sustainable. One of the existing programs to overcome the problem of malnutrition and malnutrition is positive deviation. This research aims to identify positive behavior in feeding (type of food, processing of food ingredients, mealtimes and method of feeding) of toddlers who are well-nourished in poor fishing families in the Belawan Community Health Center Working Area in 2022. This research method is qualitative research with a narrative approach. Researchers studied individual lives by asking one or several individuals to tell stories about their lives related to positive behavior in feeding well-nourished animals. This information is then retold by the researcher in a narrative chronology. The findings of this research indicate that addressing nutritional challenges in children can be effectively achieved by leveraging the potential and resources within the community. This is done through the identification of positive deviant behaviors, particularly those related to beneficial feeding practices. These practices encompass aspects such as the types of food provided, the methods of food preparation, the timing of meals, and the approach to food administration. Keep up the great work! The way you’re thinking about integrating community strengths is spot-on for creating sustainable solutions.

Commercial Tobacco Cessation Interventions for American Indian and Alaska Native Persons Living in the United States: A Narrative Systematic Review of Effectiveness Using a Health Equity Lens.

Identify commercial tobacco cessation interventions for American Indian and Alaska Native (AI/AN) communities, focusing on strategies used to advance health equity, including strategies to address social determinants of health (SDOH), community engagement, and cultural tailoring. We searched Medline, Embase, PsycINFO, Cochrane Library, CINAHL, Scopus, ProQuest Central, Academic Search Complete, JSTOR, and Indigenous/Tribal health-related journals and databases. We included peer-reviewed studies on commercial tobacco cessation for AI/AN persons published January 1998-April 2023 that reported quit rates/attempts. We excluded studies that only used pharmaceutical interventions. Two reviewers independently assessed each study against our inclusion/exclusion criteria. A reviewer extracted data, and another checked for completeness. Synthesis focused on reported intervention effectiveness and strategies used for addressing SDOH, community engagement, and cultural tailoring. We used a synthesis matrix which allowed for comparison across studies. We screened 1116 articles and included 12 for synthesis. Of the 12, five engaged community health workers; four included SDOH elements; and six were reported effective. Of these six, five included early-stage community engagement and four were culturally tailored. There are few commercial tobacco cessation interventions for AI/AN populations. Building capacity, including tribal capacity, to develop and test multi-level, culturally grounded cessation interventions that address relevant SDOH may advance commercial tobacco cessation efforts in these populations.

Opportunities and challenges in utilizing community assets to extend chronic care management in podoconiosis endemic areas: Evidence from Northwestern Ethiopia.

Community-based chronic care intervention is important in the control and prevention of lifelong conditions such as podoconiosis and similar 'intensive disease management' neglected tropical diseases (NTDs). Despite a call for such interventions, few efforts have been made to identify opportunities and challenges related to their implementation. Employing a qualitative approach, this study explored the possibility of engaging community actors, physical places and networks to promote chronic care management in rural Ethiopia. We gathered data from affected individuals, community members, local leaders, health professionals and community health workers between April and May 2022. The study revealed that affected individuals, family members, religious leaders, traditional leaders, and health professionals have the potential to extend chronic care management in rural areas. Houses, churches, schools, and healthcare facilities are suitable venues at which to perform interventions. Strong community solidarity and political will are vital to chronic care interventions, while lack of understanding about chronic conditions, financial constraints, and limited resources at healthcare facilities could pose challenges. Using community assets has great promise for expanding chronic care management with minimal costs and efforts in under resourced areas. Achieving this will require a successful plan to coordinate the collaboration among the agents and settings.

COMMUNITY INTERVENTIONS TO REDUCE MATERNAL MORTALITY IN LOW-RESOURCE AREAS

Maternal mortality, defined as the death of women during pregnancy, childbirth or in the postpartum period, continues to be a serious public health problem, especially in low-resource areas. Factors such as limited access to quality healthcare, lack of infrastructure, shortage of qualified professionals and socio-economic inequalities contribute to high mortality rates. In many of these regions, community interventions have been key to reducing maternal mortality by providing direct assistance to pregnant women, promoting health care education and strengthening the link between communities and medical services. This study seeks to analyze community interventions implemented in low-resource areas to reduce maternal mortality, evaluating their strategies, challenges and the results obtained in improving maternal survival rates. This study is a systematic review that investigates the effectiveness of maternal health interventions in low- and middle-income countries, focusing on skilled birth attendant programs, community transport, and technological innovations. The analyses were carried out in databases such as PubMed, BMC Pregnancy and Childbirth and African Journal of Reproductive Health, using data from articles published between 2015 and 2021. Community interventions to reduce maternal mortality range from health education programs, training traditional birth attendants and strengthening maternal and child support networks. One of the main approaches involves training community health agents, who work directly in communities, providing basic prenatal care, referral to medical services in cases of risk and promoting knowledge about signs of pregnancy complications. These actions are especially important in remote areas, where access to health facilities is limited. Another key aspect of these interventions is the promotion of safe practices during childbirth and the strengthening of emergency transport systems, ensuring that pregnant women at risk can be transferred to health centers equipped to deal with complications. The introduction of simple technologies, such as clean delivery kits and essential medicines, has shown promising results in reducing infections and hemorrhages, which are primary causes of maternal mortality. Awareness campaigns also play a crucial role, educating the population about the importance of prenatal care, proper nutrition and birth assistance in controlled environments. These initiatives aim not only to improve knowledge about maternal health, but also to combat cultural and social barriers that can prevent pregnant women from seeking medical care in a timely manner. It is concluded that community interventions have proven to be an effective approach to reducing maternal mortality in low-resource areas. Training health workers, implementing safe delivery practices and raising awareness about antenatal care are strategies that have contributed significantly to improving maternal health outcomes. However, for these interventions to be sustainable and scaled up, continued public policy support, adequate funding and the integration of these actions with formal health systems are essential.

Epidemiology and population-based incidence of influenza in two communities, Bandung district, West Java, Indonesia, 2008–2011

Influenza surveillance is important for monitoring influenza virus circulation and disease burden to inform influenza prevention and control measures. The aim of this study was to describe the epidemiology and to estimate the incidence of influenza in two communities in West Java, Indonesia, before and after the 2009 H1N1 pandemic. A population-based surveillance study in the community health care setting was conducted to estimate the annual incidence of influenza. A real-time reverse transcription polymerase chain reaction (RT-PCR) assay was used for influenza case ascertainment. A population census was implemented to calculate the population at risk and estimate community health care utilization rate. The mean annual incidence of influenza A and B, adjusted for healthcare utilization, was 1.6 (95%CI: 1.3–2.0) and 0.7 (95%CI: 0.5–1.0) per 1000 persons, respectively, with the most affected group being young and school-age children. The annual cumulative incidence of influenza A for children under five in 2009, 2010, and 2011 was 7.0 (95%CI: 4.4–11.2), 10.6 (95%CI: 7.3–15.4), and 6.3 (95%CI: 3.8–10.2). For influenza B was 4.3 (95%CI: 2.4–7.8), 2.0 (95%CI: 0.8–4.7), and 0.4 (95%CI: 0.1–2.8), respectively. This study highlights that the incidence of influenza among young and school-age children is consistently higher compared to adults and the elderly throughout these periods. These populations are potential targets for influenza vaccination in Indonesia.

The potential role of perceived neighborhood social cohesion on COVID-19 vaccination uptake among individuals aged 50 and older: Results from the Korean Community Health Survey.

The COVID-19 pandemic highlighted the critical importance of vaccination in controlling infectious diseases. While previous research has identified social cohesion as a potential facilitator of health behaviors, empirical studies exploring its direct impact on COVID-19 vaccination rates, especially across different age groups, remain limited. This cross-sectional study utilized data from the 2021 Korean Community Health Survey, a nationally representative survey conducted in South Korea. The analysis focused on adults aged 50 and older, categorizing them into two age groups (50-64 and ≥65). We investigated the association between perceived neighborhood social cohesion and COVID-19 vaccination status, controlling for socio-economic status, health behaviors, and concerns related to COVID-19. Statistical analysis was conducted using complex sample multiple logistic regression to adjust for potential confounders. The study included 135,352 participants, with an analysis showing that in the age group ≥65, higher levels of perceived neighborhood social cohesion were significantly associated with increased vaccination uptake (aOR for trust between neighbors: 1.200, 95% CI: 1.058-1.362; aOR for mutual assistance among neighbors: 1.491, 95% CI: 1.312-1.695). Interestingly, these associations were not significant in the 50-64 age group. Additionally, satisfaction with healthcare services was associated with higher vaccination uptake in both age groups (aOR: 1.106, 95% CI: 1.004-1.219 for 50-64; aOR: 1.306, 95% CI: 1.160-1.471 for ≥65). Our findings suggest that perceived neighborhood social cohesion plays a crucial role in influencing COVID-19 vaccination uptake among older adults, particularly those aged 65 and above. These results indicate that health policies aimed at enhancing social cohesion may effectively improve vaccination rates, especially among the elderly. Future research should explore the impact of social cohesion on other age groups and assess the causal relationships in longitudinal studies.