Household Visits Research Articles

A constant contact community-based epidemiological investigation (C3EI) as part of malaria elimination demonstration project, Mandla district, Madhya Pradesh, India

BackgroundIn India, an increase in malaria cases by 21% (223,961 cases) has been reported between 2022 and 2023. Madhya Pradesh ranks 10th in malaria burden, with Mandla district selected for the Malaria Elimination Demonstration Project (MEDP) to demonstrate the feasibility of malaria elimination in a hard-to-reach, tribal-dominated, and hilly forested district. A Constant Contact Community-based Epidemiological Investigation (C3EI) was undertaken by continuous engagement with the community for real-time data collection, mapping of malaria cases, identification of risk factors, and monitoring of intervention outcomes designed to drive effective strategies for malaria elimination.MethodsThe study mapped 1,143,126 individuals from 248,825 households in the year 2017 in Mandla district for constant contact surveillance. Fortnightly household visits were conducted to inquire about febrile episodes, with on-spot diagnosis and treatment. Data collection was done using the SOCH mobile application, and analysis using R.ResultsThe constant contact household surveillance revealed that out of 956,795 individuals, 230,780 (24.12%) unique individuals reported one or more febrile episodes, with a total of 322,577 febrile episodes and 490 malaria episodes (RDT positive). Males had a higher risk of malaria infection than females (OR = 2.62; p < 0.0001). The cumulative incidence of malaria was highest among children aged 5–15 years and pregnant women. Multiple episodes of malaria infections were more common in adults over 30 years. The incidence of malaria per 100,000 persons gradually declined from 26.13 in 2018 to 11.18 in 2020, with the highest incidence during the monsoon season.ConclusionThe C3EI presents a new strategy suitable for disease elimination programmes. Implementing C3EI-type longitudinal studies in elimination projects holds promise for generating data to expedite malaria elimination efforts because the unit of observation is a ‘household’. Such a comprehensive approach allows identification in the gaps in case management for prompt interventions at the household-level.

Do they really boil their drinking water? a descriptive study in a rural district of the Lao people’s democratic republic

BackgroundFor safe drinking water, household water treatments (HWT) is important to reduce the risk of diarrhea in low-and-middle countries including Lao People’s Democratic Republic (Lao PDR). However, the measurement of HWT relies chiefly on self-report in most nationwide surveys. Thus, the validity of self-reported measurement is of concern. The objective of this study was to determine the proportion of households with the presence of boiled water among households that report boiling practices in a rural area of the Lao PDR.MethodsThis study was conducted with randomly selected 108 households in the four villages in the catchment area of the two health centers, in Xepon district of the Savannakhet province, between September and October 2023. The inclusion criterion of the households was the households that report boiling as HWT. Surveyors conducted interviews with an adult household member and observations on boiled water through household visits, using a questionnaire. Descriptive statistics were conducted to summarize the collected information using the frequency with proportion for categorical variables and the median with interquartile range for continuous variables. Bivariate analyses were conducted to assess an association between each of the factors and the presence of boiled water, using Fisher’s exact test.ResultsAmong the 108 households that reported boiling practice, 91 households were able to show the surveyor self-reported boiled water. Thus, the proportion of households with the presence of boiled water was 90.1% (95% confidence interval: 82.5–95.1%). Households with a fixed schedule of boiling were significantly more likely to present boiled water, compared to households without (94.5% vs. 50.0%). Not all household members do not necessarily drink boiled water: approximately a quarter (25.7%) of the participants reported that some household members drink unboiled water.ConclusionsThis study showed that among households that reported boiling drinking water, 90.1% were able to present a container with self-reported boiled water. It suggests that the self-reported measure of boiling practices can be valid in the study villages.

The burden of headache disorders in the adult population of Mongolia: estimates, and a health-care needs assessment, from a cross-sectional population-based study

BackgroundHaving previously shown headache disorders to be prevalent in Mongolia, here we elaborate on headache as a public-health concern in this country, reporting symptom burden and headache-attributed impaired participation at individual and societal levels, and conducting a health-care needs assessment.MethodsThe study followed the standardized methodology developed by the Global Campaign against Headache, generating a representative general-population sample through multi-level randomized cluster sampling. Participants aged 18–65 years were interviewed at unannounced household visits by interviewers administering the HARDSHIP questionnaire. Symptom burden was established through questions on frequency, duration and intensity of headache, with proportion of time in ictal state calculated from frequency and duration. Individual impaired participation was established through the HALT questionnaire, enquiring into lost time from paid and household work and from leisure activities. Symptom burden and impaired participation yesterday were also assessed in those reporting headache yesterday. Population-level estimates were derived by factoring in prevalence.ResultsThe total sample included 2,043 participants. Those reporting any headache in the last year (n = 1,351) spent, on average, 9.7% of all their time with headache, losing 1.3 workdays and 2.4 household days/3 months. These losses were considerably higher among those with probable medication-overuse headache (37.5%, 3.5 workdays, 6.7 household days) or other headache on ≥ 15 days/month (H15+) (21.9%, 2.4 workdays, 5.1 household days). At population-level (including those with and without headache), 6.2–7.4% of all time was spent with headache, 3.1% with H15+; 0.8 workdays and 1.4 household days/person/3 months were lost to headache, 0.3 workdays and 0.6 household days to migraine (the biggest contributor of all headache types). Our needs assessment estimated that one third (33.2%) of the adult population of Mongolia have headache (mostly migraine or H15+) likely to benefit from health care.ConclusionThis first population-based study on headache burden in Mongolia shows high levels of individual and societal burden, with H15 + the cause of greater burden at population level than migraine and TTH combined. Migraine, however, has the biggest impact on the nation’s productivity. From a purely economic perspective, Mongolia, with limited health resources, would probably be best served by focusing on mitigating migraine-attributed burden.

Are we really hesitant toward routine immunization: Findings from a cross-sectional study in urban area in the tribal dominant state of India.

Vaccine hesitancy has been inching up and its root cause lies in the factors that influence the vaccination. The present study was conducted to find out the proportion and factors contributing to vaccine hesitancy for routine childhood vaccinations in the slum population. A community-based cross-sectional study was carried out among 210 children between the age group of 0 and 59 months residing in the urban slums of Ranchi in 2021. Data were collected during the household visit by interviewing the parents using a predesigned pretested interview schedule which was developed based on the validated version of the vaccine hesitancy survey questionnaire originally developed by the World Health Organization Strategic Advisory Group of Experts' working group on vaccine hesitancy. Associations between variables were analyzed using logistic regression. A total of 210 children whose parents had given consent were included in our study. The majority of the families, 188 (89.5%), were not hesitant while only 22 (10.5%) were vaccine hesitant. Tribal children and unreserved category children had adjusted odds ratio of 4.41 (95% CI, 1.61-45.46) and 7.75 (95% CI, 1.07-56.08) for the delay as against their reference category. Most of the children were vaccinated in our study area and the families have shown confidence in vaccines. Although there were delays in vaccination and the reasons for the delays must be addressed to prevent these vaccine-hesitant populations from turning into vaccine-refusal population. Uniformity in vaccination days in different health facilities in slum areas, appropriate antenatal information, and counseling regarding childhood vaccinations, widespread awareness, and improving mother's education can help address the issue of vaccine hesitancy.

Mediating effects of inequitable gender norms on intimate partner violence and contraceptive use in a cluster randomized control trial in Niger.

Previous research has demonstrated that the Reaching Married Adolescents intervention (RMA) was associated with changes in inequitable gender norms, intimate partner violence (IPV), and modern contraceptive use. This study seeks to understand if changes in inequitable gender norms mediate the RMA intervention's effects on contraceptive use and intimate partner violence (IPV). A four-arm cluster randomized control trial was conducted to evaluate effects of the RMA intervention (household visits, small groups, combination, control) on married adolescent girls and their husbands in Dosso, Niger (baseline: 1042 dyads; 24m follow-up: 737 dyads; 2016-2019). Mediation was assessed using inverse odds ratio weighting. In the small group intervention, of the total effect on IPV prevalence (8% reduction), indirect effects via inequitable gender norms is associated with a 2% decrease (95% CI: -0.07, 0.12) and direct effects with a 6% decrease (95% CI: -0.20, -0.02). For household visits, of the total effect on contraceptive use (20% increase), the indirect effect accounts for an 11% decrease (95% CI: -0.18, -0.01) and direct effect, a 32% increase (95% CI: 0.13, 0.44); similar to findings for the combination arm. This experimental evidence informs the value of changing underlying social norms to reduce IPV and increase contraception use.

Advancing spatial repellents for malaria control: effectiveness and cost-effectiveness of a spatial repellent under operational use in Northern Uganda—study protocol for a cluster randomized controlled trial

BackgroundSpatial repellents (SRs) have been widely used for the prevention of mosquito bites, and preliminary findings suggest efficacy against both malaria (1) and Aedes-borne viruses (2) but their effectiveness in reducing mosquito-borne diseases under operational use has never been evaluated. SRs have the potential of being critical tools in the prevention of mosquito-borne diseases in contexts where typical vector control strategies, such as insecticide-treated nets (ITNs) and indoor residual spraying, are inaccessible or underutilized such as among displaced persons or in emergency relief settings.MethodsChildren will be enrolled in 3 separate cohorts to establish the effectiveness of SRs in reducing malaria infection in different distribution channels. One cohort will estimate the direct effect of the SR distributed through a reference channel (study personnel distribution). The two remaining cohorts will estimate the protection of the SR distributed through a voucher channel and the Village Health Team channel. Cohorts will be followed twice a month (approximately every 15 days): during the first scheduled household visit in the month, a blood sample will be taken for malaria rapid diagnostic test (Monthly Visit #1); and, during the second scheduled household visit, a blood sample will only be taken if the participant has a recent history of fever (Monthly Visit #2). The incidence of malaria in each cohort will be estimated and compared to the reference cohort to determine the benefit of using a SR in an area with high, year-round transmission of malaria.DiscussionThis study will address the knowledge gap of whether or not SRs are effective in reducing human malaria disease in humanitarian assistance and emergency response settings in sub-Saharan Africa where underlying transmission rates are historically high and ITNs may or may not be widely deployed. This research will inform policy makers on whether to recommend SRs as a means to further reduce malaria transmission for such operational programs.Trial registrationClinicalTrials.gov NCT06122142. Registered on November 8, 2023.

Epidemiological profile of malaria in a rural community in the Amazon, Mato Grosso State, Brazil, 2011

BackgroundMore than 95% of malaria transmission in Brazil occurs in the Legal Amazon Region, which in 2010 recorded around 333,429 cases reported in the Epidemiological Surveillance Information System-Malaria (Sivep_malaria), presenting an annual parasitic incidence (IPA) of 13.1 cases/1000 inhabitants.MethodsThis was a descriptive study that measured the community prevalence of Plasmodium infection and its relationship with land use in Três Fronteiras District, Colniza Municipality, Mato Grosso State. Data were collected during household visits in July 2011, with blood collection from finger pricks for the preparation of thick smear slides, and completion of a standardized case notification form. A georeferenced database was analysed, with land use evaluated as categorical variables. A kernel density map was built to show the density of cases and their location.ResultsOf the 621 respondents, 68(11%) had Plasmodium infection: 39 (57.4%) with Plasmodium vivax, 27(39.7%) with Plasmodium falciparum and two (2.9%) with mixed infections. Among infected individuals, 49 (72.1%) were men. Cases of malaria were distributed over the district, with greater occurrence of cases per household in open areas close to the mining company and artisanal mining sites. The was a greater density of cases located in the gold mining region.ConclusionTransmission of malaria in Três Fronteiras District has a heterogeneous distribution. Individuals residing in mining and timber extraction sites have increased occurrence of Plasmodium infection.

Population-based Study of Gastric Cancer Survival and Associations in Rural Western Honduras.

Two-thirds of global cancer occur in low/middle income countries (LMICs). Northern Central America is the largest LMIC region in the western hemisphere, and lack cancer registries to guide cancer control. We conducted a gastric cancer (GC) survival study in rural western Honduras, characterized as having among the highest GC incidence rates in Latin America. The cohort of incident GC diagnosed between 2002-2015 was studied with active follow-up, with household visits. The regional gastric cancer registry was primary for case identification, with completeness examination with hospital data and national death certificates. Cox regression models were used for survival calculations. Survival follow-up was achieved in 741/774 patients (95.7%). Household interviews were conducted in 74.1% (n=549). 65.7% were male, median age at diagnosis was 64 years, 24.5% were <55. 43.9% of tumors had pyloric obstruction. 45.2%, 43.2%, and 7.3% of histology was intestinal, diffuse, and mixed, respectively. 24.7% patients received treatment. 5-year survival rates were 9.9% for both males and females, 7.7% for age <45, and 7.9% for diffuse GC. Median survival time was 4.8 months (95%CI,4.2-5.6). In the final Cox regression model including age, sex, Lauren subtype, and poverty index, only treatment was significantly associated with survival (HR 2.43, 95%CI,1.8-3.2). Markedly low gastric cancer 5-year survival rates are observed in rural Central America. The majority of patients present with advanced disease, and a minority have access to therapy. The findings have implications for cancer control in the Central America LMICs and for U.S. Latino populations.

MERS-CoV exposure and risk factors for MERS-CoV ELISA seropositivity among members of livestock-owning households in southern Jordan: a population based cross-sectional study

Although dromedary camels (Camelus dromedarius) are known to be the host reservoir for MERS-CoV, the virus causing Middle East respiratory syndrome (MERS), zoonotic transmission pathways and camel subpopulations posing highest transmission risk are poorly understood. Extensively managed herds, ubiquitous across the Arabian Peninsula, present a major potential source of primary infection. In this study we aimed to address key knowledge gaps regarding MERS epidemiology among high-risk communities associated with such herds, which is essential information for effective control strategies. We did a cross-sectional study between Sept 27, 2017, and Oct 11, 2018, among members of livestock-owning households in southern Jordan (Aqaba East, Aqaba West, Ma'an East, and Ma'an West regions), with random selection of households (house and tent dwellings) from Ministry of Agriculture lists via computer-generated randomisation lists. Household visits were done, with questionnaires administered to household members regarding potential risk factors for MERS-CoV exposure in the past 6months and blood samples and nasal and oral swabs collected, alongside physical examination data including blood pressure and blood glucose. Children younger than 5years and individuals without capacity to provide informed consent were excluded. Serum was tested for IgG antibodies to MERS-CoV spike protein (S1 subunit) and nucleocapsid (N) protein with in-house indirect ELISAs, and viral RNA was detected in nasal and oral samples by RT-PCR. The primary outcome was evidence of MERS-CoV exposure (ascertained by seropositive status on S1 or NELISAs, or a positive swab sample on RT-PCR); secondary outcomes were potential associations between possible risk factors and seropositive status. RT-PCR data were to be presented descriptively. Seroprevalence estimates were obtained at the individual and household levels, and associations between hypothetical risk factors and seropositive status were assessed with use of mixed-effects logistic regression. We sampled 879household members (median age 27years [IQR 16-44]; 471 [54%] males and 408 [46%] females) from 204households. 72 (8%) household members were seropositive on S1 ELISA (n=25, 3%) or NELISA (n=52,6%). No positive nasal or oral swab samples were identified on RT-PCR. Within-household clustering was identified for seropositivity on S1 ELISA (intraclass correlation coefficient 0·88 [0·35-0·96]) but not NELISA (0·00 [0·00-0·27]). On multivariable analysis, S1 ELISA seropositivity was associated with frequently (≥weekly) interacting with young (age<1year) camels (adjusted odds ratio [ORadj] 3·85 [95% CI 1·41-11·61], p=0·011), with frequent kissing and petting (ORadj 4·56 [1·55-15·42], p=0·0074), and frequent feeding and watering (ORadj 4·97 [1·80-15·29], p=0·0027) of young camels identified as risk activities. Attending camel races (ORadj 3·73 [1·11-12·47], p=0·029), frequently feeding and watering camels of any age (ORadj 3·18 [1·12-10·84], p=0·040), and elevated blood glucose (>150mg/dL; ORadj 4·59[1·23-18·36], p=0·021) were also associated with S1 ELISA seropositivity. Among individuals without history of camel contact, S1 ELISA seropositivity was associated with sharing a household with an S1 ELISA-positive household member (ORadj 8·92 [1·06-92·99], p=0·044), and with sharing a household with an S1 ELISA-positive household member with history of camel contact (ORadj 24·74 [2·72-306·14], p=0·0050). NELISA seropositivity was associated with age (categorical, p=0·0069), a household owning a young camel (age <18months; ORadj 1·98 [1·02-4·09], p=0·043), and frequently feeding and watering camels of any age (ORadj 1·98 [1·09-3·69]; p=0·025). The study findings highlight the importance of effective MERS-CoV surveillance and control strategies among camel-owning communities in Jordan and the Arabian Peninsula. Juvenile dromedaries pose increased risk for zoonotic MERS-CoV transmission and should be prioritised for vaccination once such vaccines become available. Among high-risk communities, vaccination strategies should prioritise camel-owning households, particularly individuals engaged in camel husbandry or racing, and household members who are older or diabetic, with evidence to suggest secondary within-household transmission. UK Medical Research Council and US National Institute of Allergy and Infectious Diseases.

Enhancing the capacity of community health workers in prevention and control of epidemics and pandemics in Wakiso district, Uganda: evaluation of a pilot project

BackgroundCommunity Health Workers (CHWs) play a crucial role in outbreak response, including health education, contact tracing, and referral of cases if adequately trained. A pilot project recently trained 766 CHWs in Wakiso district Uganda on epidemic and pandemic preparedness and response including COVID-19. This evaluation was carried out to generate evidence on the outcomes of the project that can inform preparations for future outbreaks in the country.MethodsThis was a qualitative evaluation carried out one year after the project. It used three data collection methods: 30 in-depth interviews among trained CHWs; 15 focus group discussions among community members served by CHWs; and 11 key informant interviews among community health stakeholders. The data was analysed using a thematic approach in NVivo (version 12).ResultsFindings from the study are presented under four themes. (1) Improved knowledge and skills on managing epidemics and pandemics. CHWs distinguished between the two terminologies and correctly identified the signs and symptoms of associated diseases. CHWs reported improved communication, treatment of illnesses, and report writing skills which were of great importance including for managing COVID-19 patients. (2) Enhanced attitudes towards managing epidemics and pandemics as CHWs showed dedication to their work and more confidence when performing tasks specifically health education on prevention measures for COVID-19. (3) Improved health practices such as hand washing, vaccination uptake, and wearing of masks in the community and amongst CHWs. (4) Enhanced performance in managing epidemics and pandemics which resulted in increased work efficiency of CHWs. CHWs were able to carry out community mobilization through door-to-door household visits and talks on community radios as part of the COVID-19 response. CHWs were also able to prioritize health services for the elderly, and support the management of patients with chronic diseases such as HIV, TB and diabetes by delivering their drugs.ConclusionsThese findings demonstrate that CHWs can support epidemic and pandemic response when their capacity is enhanced. There is need to invest in routine training of CHWs to contribute to outbreak preparedness and response.

Headache prevalence and demographic associations in the Delhi and National Capital Region of India: estimates from a cross-sectional nationwide population-based study

BackgroundIndia is a large and populous country where reliable data on headache disorders are relatively scarce. This study in northern India (Delhi and National Capital Territory Region [NCR], including surrounding districts in the States of Haryana, Uttar Pradesh and Rajasthan) continues the series of population-based studies within the Global Campaign against Headache and follows an earlier study, using the same protocol and questionnaire, in the southern State of Karnataka.MethodsThis cross-sectional study used the Global Campaign’s established methodology. Biologically unrelated Indian nationals aged 18–65 years were included through multistage random sampling in both urban and rural areas of NCR. Interviews at unannounced household visits followed the structured Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire in its original English version or in the validated Hindi version. Demographic enquiry was followed by a neutral headache screening question and diagnostic questions based on the International Classification of Headache Disorders edition 3 (ICHD-3), which focused on each respondent’s most bothersome headache. Questions about headache yesterday (HY) enabled estimation of 1-day prevalence. A diagnostic algorithm first identified participants reporting headache on ≥ 15 days/month (H15+), diagnosing probable medication-overuse headache (pMOH) in those also reporting acute medication use on ≥ 15 days/month, and “other H15+” in those not. To all others, the algorithm applied ICHD-3 criteria in the order definite migraine, definite tension-type headache (TTH), probable migraine, probable TTH. Definite and probable diagnoses were combined.ResultsAdjusted for age, gender and habitation, 1-year prevalences were 26.3% for migraine, 34.1% for TTH, 3.0% for pMOH and 4.5% for other H15+. Female preponderance was seen in all headache types except TTH: migraine 35.7% vs. 15.1% (aOR = 3.3; p < 0.001); pMOH 4.3% vs. 0.7% (aOR = 5.1; p < 0.001); other H15 + 5.9% vs. 2.3% (aOR = 2.5; p = 0.08). One-day prevalence of (any) headache was 12.0%, based on reported HY. One-day prevalence predicted from 1-year prevalence and mean recalled headache frequency over 3 months was slightly lower (10.5%).ConclusionsThe prevalences of migraine and TTH in Delhi and NCR substantially exceed global means. They closely match those in the Karnataka study: migraine 25.2%, TTH 35.1%. We argue that these estimates can reasonably be extrapolated to all India.

The burden of headache and a health-care needs assessment in the adult population of Mali: a cross-sectional population-based study

BackgroundOur recent studies have shown headache disorders to be very common in the central and western sub-Saharan countries of Benin and Cameroon. Here we report headache in nearby Mali, a strife-torn country that differs topographically, culturally, politically and economically. The purposes were to estimate headache-attributed burden and need for headache care.MethodsWe used cluster-random sampling in seven of Mali’s eleven regions to obtain a nationally representative sample. During unannounced household visits by trained interviewers, one randomly selected adult member (18–65 years) from each household was interviewed using the structured HARDSHIP questionnaire, with enquiries into headache in the last year and, additionally, headache yesterday (HY). Headache on ≥ 15 days/month (H15+) was diagnosed as probable medication-overuse headache (pMOH) when associated with acute medication use on ≥ 15 days/month, and as “other H15+” when not. Episodic headache (on < 15 days/month) was recorded as such and not further diagnosed. Burden was assessed as impaired participation (days lost from paid and household work, and from leisure activity). Need for headache care was defined by criteria for expectation of benefit.ResultsData collection coincided with the SARS-CoV-2 pandemic. The participating proportion was nonetheless extremely high (99.4%). The observed 1-year prevalence of any headache was 90.9%. Age- and gender-adjusted estimates were 86.3% for episodic headache, 1.4% for pMOH and 3.1% for other H15+. HY was reported by 16.8% with a mean duration of 8.7 h. Overall mean headache frequency was 3.5 days/month. Participants with pMOH lost more days from paid (8.8 days/3 months) and household work (10.3 days/3 months) than those with other H15+ (3.1 and 2.8 days/3 months) or episodic headache (1.2 and 0.9 days/3 months). At population level, 3.6–5.8% of all time was spent with headache, which led to a 3.6% decrease in all activity (impaired participation). Almost a quarter (23.4%) of Mali’s adult population need headache care.ConclusionHeadache is very common in Mali, as in its near neighbours, Benin and Cameroon, and associated with substantial losses of health and productivity. Need for headache care is high – a challenge for a low-income country – but lost productivity probably translates into lost gross domestic product.

Dietary salt intake and kidney function in rural Senegalese populations: a cross-sectional study

IntroductionHigh salt intake is a major risk factor for hypertension and its complications such as chronic kidney disease (CKD) and cardiovascular diseases. The present study aimed to determine level of sodium consumption and its relation with kidney function in the rural populations of Ferlo (centre of Senegal).Subjects and methodsWe performed a cross-sectional study including 400 volunteers aged > 18 years. Clinical, biological and dietary data were collected during household visits. Daily sodium intake was measured in the 24 h-urine outpout and CKD was defined as eGFR < 60 ml/min. Linear regression analysis was used to assess association between sodium intake and covariates.ResultsMean age was 46.42 ± 15.60 and sex-ratio was 1.05. Prevalence of hypertension, CKD and overweight were 21.5, 11.7 and 20.5%, respectively. The median daily salt intake was 11.7 g with interquartile range of 14.8 g. Only 11.25% of participants consumed less than 5 g/day. After multivariate analysis, high salt intake was associated with age > 60 years, overweight and CKD. However, gender and hypertension were not significantly associated with salt intake. Industrial broths (91.5%) and bread (85%) represented the main sources of dietary salt.ConclusionThis study revealed high levels of daily salt intake contrasting with low potassium intakes in the majority of participants. Participants with CKD, overweight and age > 60 years presented higher salt consumption. Stategies to reduce salt consumption are urgently needed to reduce burden of CKD in rural Senegalese populations.

Layperson-Delivered Telephone-Based Behavioral Activation Among Low-Income Older Adults During the COVID-19 Pandemic

Older adults are particularly vulnerable to loneliness and its physical and psychosocial sequelae, but scalable interventions are lacking, especially during disasters such as pandemics. To compare the effects of layperson-delivered, telephone-based behavioral activation and mindfulness interventions vs telephone-based befriending on loneliness among at-risk older adults. This assessor-blinded, 3-arm randomized clinical trial screened Chinese older adults through household visits and community referrals from April 1, 2021, to April 30, 2023, in Hong Kong. Eligible participants (≥65 years of age) who were lonely, digitally excluded, living alone, and living below the poverty line and provided consent to participate were randomized into behavioral activation, mindfulness, and befriending groups. Assessments were conducted at baseline, 1 month, and 3 months. As part of the Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA) dual randomized clinical trial, 148 older laypersons were trained to deliver a twice-weekly 30-minute intervention via telephone for 4 weeks. The primary outcome was loneliness measured by the UCLA Loneliness Scale (range, 20-80) and the De Jong Gierveld Loneliness Scale (range, 0-6), with higher scores on both scales indicating greater loneliness. Secondary outcomes were depression, perceived stress, life satisfaction, psychological well-being, sleep quality, perceived social support, and social network. A total of 1151 participants (mean [SD] age, 76.6 [7.8] years; 843 [73.2%] female) were randomized to the behavioral activation (n = 335), mindfulness (n = 460) or befriending (n = 356) group. Most were widowed or divorced (932 [81.0%]), had primary education or below (782 [67.9%]), and had 3 or more chronic diseases (505 [43.9%]). Following intention-to-treat principles, linear mixed-effects regression model analyses showed that loneliness measured by the UCLA Loneliness Scale was significantly reduced in the behavioral activation group (mean difference [MD], -1.96 [95% CI, -3.16 to -0.77] points; P < .001]) and in the mindfulness group (MD, -1.49 [95% CI, -2.60 to -0.37] points; P = .004) at 3 months compared with befriending. Loneliness measured by the De Jong Gierveld Loneliness Scale was not significantly reduced at 3 months in the behavioral activation group (MD, -0.06 [95% CI, -0.26 to 0.13] points; P > .99]) but was in the mindfulness group (MD, 0.22 [95% CI, 0.03 to 0.40] points; P = .01) at 3 months compared with befriending. In the behavioral activation and mindfulness groups, sleep quality improved compared with befriending, but perceived stress increased. Psychological well-being and perceived social support improved in the behavioral activation group. No statistically significant between-group differences were observed in depression, life satisfaction, or social network. In this randomized clinical trial, scalable psychosocial interventions delivered remotely by older laypersons appeared promising in reducing later life loneliness and addressing the pressing mental health challenges faced by aging populations and professional geriatric mental health workforce shortages. Further research should explore ways to maximize the clinical relevance and cost-effectiveness of these interventions. Chinese Clinical Trial Registry Identifier: ChiCTR2300072909.

The role of community health workers in non-communicable diseases in Cape Town, South Africa: descriptive exploratory qualitative study

BackgroundCommunity health workers (CHW) are an integral part of primary health care re-engineering in South Africa. Cape Town is developing community-orientated primary care, with a central role for CHWs. Their role in human immunodeficiency virus, tuberculosis, maternal and child health has been articulated, but is less clear for non-communicable diseases (NCDs). Non-communicable diseases are now a major contributor to the burden of disease. The aim was to explore the current role of CHWs regarding NCDs in the Eastern sub-district of Cape Town, South Africa.MethodsAn exploratory descriptive qualitative study made use of non-participant observation and qualitative interviews with CHWs, their managers, and nurse coordinators. Data from nine semi-structured interviews and ten observations were analysed with the framework method and Atlas-ti.ResultsThe CHWs were embedded in their communities and provided services via support groups, household visits and delivery of medication. They linked people to care with assistance of nurse coordinators. They could also provide physical care in the home. They lacked the ability to counsel people on the risk factors for NCDs and their role in rehabilitation and palliative care was unclear. More nurse coordinators were needed to provide supportive supervision. Inter-sectoral collaboration was weak and hindered CHWs from addressing social issues. More standardised and comprehensive training should equip CHWs for health promotion and disease prevention during household visits. Data collected in the community needed to be analysed, reported on and integrated with data from the primary care facility. This should also contribute to a community diagnosis. Their relationship with facility-based members of the primary health care team needed to be improved. Attention needed to be given to the requirements for and conditions of employment, as well as working hours and remuneration. Some equipment was absent and hindered their services for NCDs.ConclusionsCHWs have the potential to provide a comprehensive approach to NCDs, but community-orientated primary care needs to be strengthened in many of the key areas to support their activities. In relation to NCDs, they need training in basic and brief behaviour change counselling and risk factors as well as in the areas of rehabilitation and palliative care.

Evaluating epilepsy management in an onchocerciasis-endemic area: Case of Maridi, South Sudan

PurposeThe epilepsy prevalence in Maridi County, South Sudan, in 2018 was 43.8 (95% CI: 40.9–47.0) per 1000 persons; 85.2% of the identified persons with epilepsy (PWE) met the criteria of onchocerciasis-associated epilepsy. To address this health problem, an epilepsy clinic was established at Maridi County Hospital in 2020. In August 2023, the impact of the clinic on the lives of PWE and their families was evaluated. MethodsAt the Maridi epilepsy clinic, data routinely collected by primary healthcare workers as part of patient care was reviewed. We also analyzed findings from two household surveys conducted in 2018 and 2022, which assessed the impact of the clinic on epilepsy care. Moreover, four households, each with four PWE, were visited in a high epilepsy prevalence area. PWE were examined by a neurologist, and in-depth interviews were conducted with family members. ResultsThe proportion of PWE on anti-seizure medication increased by 39.7% (95%CI: 35.3–44.2) between 2018 and 2022. The proportion of PWE reporting daily seizures decreased from 27.3% in 2018 to 5.3% in 2022. Of the 754 PWE seen in the clinic in July 2023, only 17 (2.3%) reported side effects. During household visits in July 2023, 13/173 (7.5%) of the visited PWE were found without remaining anti-seizure medication. A high level of epilepsy-related stigma was observed in all visited households. ConclusionThe Maridi epilepsy clinic positively impacted the lives of PWE in Maridi. Similar initiatives should be accessible for all PWE living in onchocerciasis-endemic areas. Evidence-based information about OAE is needed to decrease misconceptions and epilepsy-related stigma.

Tracing footprints for a greener tomorrow; A cross-sectional study to assess the carbon footprint of the urban households of Vijayapura city

Background: The concept of carbon footprint is rooted in measuring the volume of greenhouse gases, predominantly carbon dioxide (CO2), resulting from human activities. India has witnessed a significant surge in greenhouse gas emissions due to rapid economic growth and population expansion, making it the world's third-largest CO2 emitter. This upsurge intensifies the natural greenhouse effect, leading to global temperature rise, ocean acidification, and heightened risks to human health. Objectives: To assess the Carbon Footprint generated by urban households of Vijayapura. Material and methods: This study employs a cross-sectional approach targeting urban households residing within the operational area of the urban health center in BLDE(DU), Vijayapura City. The sample, comprising 150 households, was selected via systematic random sampling. Data was collected through household visits and interviews with the family heads using a semi-structured questionnaire. and analyzed utilizing SPSS Software Version 26. Results: The analysis of carbon emissions highlights that primary emissions surpass secondary emissions. Notably, households categorized under the upper socioeconomic class exhibit a statistically significant carbon emission rate of approximately 39.47 tonnes per month. Conclusion: This study's assessment of the carbon footprint emanating from urban households illuminates the pivotal connection between day-to-day choices and the broader ecological context.

Dengue Hemorrhagic Fever (DHF) Education for Residents of Labuh Baru Timur RT 02/08, Payung Sekaki District, Pekanbaru

This community service is conducted in the form of public health initiatives aimed at combating dengue hemorrhagic fever (DHF) in Indonesia. These initiatives are implemented in Labuh Baru Timur Village, RT 02/08, located in Payung Sekaki District, Pekanbaru City, Riau Province. The target beneficiaries of these activities include toddlers, children, adolescent girls, housewives, and the broader community. The primary objective of this community service endeavor is to enhance the knowledge of the targeted partner communities, particularly mothers who are members of POSYANDU (integrated health post), PUSKESMAS (community health centers), doctors, and village midwives, regarding the causes, consequences, and prevention strategies related to dengue hemorrhagic fever (DHF). The methods employed for executing this community service activity involved conducting household visits and organizing discussions on dengue hemorrhagic fever (DHF). Data about participants’ understanding of DHF were collected through pre-test and post-test questionnaires. The anticipated outcome of these efforts is to reduce the incidence of dengue hemorrhagic fever (DHF) and minimize its impact on affected individuals. In instances where residents are diagnosed with DHF and necessitate hospitalization, the objective is to facilitate their prompt and full recovery, thereby enabling them to resume their daily routines, including school attendance.

Spatial Mapping the Dengue and Chikungunya Burden in a Rural Area near Bangalore: a Descriptive Cross-Sectional Study.

The burden of dengue and chikungunya diseases across geographical regions of India is poorly quantified more so during Covid19 pandemic and from hospital-based studies. The objective was to assess the prevalence of dengue and chikungunya in the study mainly area and to visualize the spatial distribution of dengue and chikungunya cases using the Quantum Geographic Information System (QGIS). This descriptive cross-sectional study was conducted among the population in villages coming under a medical college's rural field practice area near Bangalore. A total of 31 villages were selected through a simple random sampling method and 3356 subjects were surveyed through household visits. QGIS was used for spatial mapping of cases. 3356 subjects were surveyed, and the prevalence of dengue and chikungunya was 1.13% and 0.02%, respectively. The overall prevalence of dengue and chikungunya cases together was 1.16%. All 39 (100%) cases had reported fever and 31 cases (79.5%) reported myalgia followed by arthralgia 22 (56.4%). QGIS supported spatial mapping of the cases and no clustering of cases was found in the study area. The burden of dengue and chikungunya is under reported, and the surveillance system needs to be strengthened in the rural area. QGIS was found to be useful in the spatial mapping of the cases and there was no clustering of cases observed.

The effectiveness of community health worker training, equipping, and deployment in reducing COVID-19 infections and deaths in rural Western Kenya: A comparison of two counties.

COVID-19 and other pandemics remain significant threats to population health, particularly in rural settings where health systems are disproportionately weak. There is a lack of evidence on whether trained, equipped, and deployed community health workers (CHWs) can lead to significant reductions in COVID-19 infections and deaths. Our objective was to measure the effectiveness of deploying trained and equipped CHWs in reducing COVID-19 infections and deaths by comparing outcomes in two counties in rural Western Kenya, a setting with limited critical care capacity and limited access to COVID-19 vaccines and oral COVID-19 antivirals. In Siaya, trained CHWs equipped with thermometers, pulse oximeters, and KN95 masks, visited households to convey health information about COVID-19 prevention. They screened, isolated, and referred COVID-19 cases to facilities with oxygen capacity. They measured and digitally recorded vital signs at the household level. In Kisii county, the standard Kenya national COVID-19 protocol was implemented. We performed a comparative analysis of differences in CHW skills, activity, and COVID-19 infections and deaths using district health information system (DHIS2) data. Trained Siaya CHWs were more skilled in using pulse oximeters and digitally reporting vital signs at the household level. The mean number of oxygen saturation measurements conducted in Siaya was 24.19 per COVID-19 infection; and the mean number of temperature measurements per COVID-19 infection was 17.08. Siaya CHWs conducted significantly more household visits than Kisii CHWs (the mean monthly CHW household visits in Siaya was 146,648.5, standard deviation 11,066.5 versus 42,644.5 in Kisii, standard deviation 899.5, p value = 0.01). Deploying trained and equipped CHWs in rural Western Kenya was associated with lower risk ratios for COVID-19 infections and deaths: 0.54, 95% CI [0.48-0.61] and 0.29, CI [0.13-0.65], respectively, consistent with a beneficial effect.