Village Health Volunteers Research Articles

Community Integration and Quality of Life: Stroke Survivors as Recipients of Rehabilitation by Village Health Volunteers (VHVs) in Thailand

This study investigated the effectiveness of rehabilitation services provided by trained Village Health Volunteers (VHVs) on community integration and quality of life (QOL) for stroke patients in Thailand. Community integration and QOL were measured before receiving rehabilitation and at three months post-intervention. Twenty-five stroke subjects from four rehabilitation centers were recruited by purposive sampling. The statistics used were descriptive and paired t-test. The community integration scores increased significantly (p < .05) from pre-test (mean = 9.80 ± 3.96) to post-test (mean = 11.44 ± 4.68). The QOL scores also significantly (p < .05) increased from pre-test (mean = 71.44 ± 8.38) to post-test (mean = 84.88 ± 12.07). Results demonstrate that rehabilitation services provided by trained VHVs can promote community integration and QOL for stroke survivors.

Effectiveness of Leader Village Health Volunteers Training Program on Preventing Cholangiocarcinoma in Thailand: Advantages for High-Risk Area with Limited Public Health Personnel.

Cholangiocarcinoma (CCA) still affects the health of rural people in northeast Thailand. Most people had a high level of overall risk according to CCA risk assessment in 2014. The question is how to make prevention of CCA as cost-effective as possible. The most appropriate answer is that someone should become a health leader to transfer knowledge to the public. This is the reason for developing the training program for village health volunteers (VHVs)-who play the role of change agents-to transfer knowledge to villagers. As for the evaluation of success, it is not evaluated if VHVs have increased knowledge or not, but it is assessed if people have better knowledge/attitudes, which lead to the correct behavior modification or not. After the program had been implemented for 2years, people were evaluated on knowledge, attitudes, perception, and satisfaction with the operation of VHVs in providing people with the knowledge and ability to prevent CCA. It was found that people had a higher level of knowledge and attitudes in preventing CCA than before implementing the program. Also, they perceived that VHVs transferred knowledge to villagers so that they had the ability to prevent CCA. Nowadays, VHVs in the digital era (VHVs 4.0) is very useful in solving CCA problems in Thailand because they are the main drivers of success. Potential development of VHVs together with use of digital technology is an advantage for high-risk area with limited public health personnel.

CONTAMINATED FLUORIDE IN BIOLOGICAL SAMPLES FROM MOUNTAINOUS AREAS IN THAILAND

The aims of the paper were to determine the contamination of fluoride in edible plants, meat and poultry products in contaminated areas. The urine samples from 373 village health volunteers living in 21 villages in Ma Khuea Chae sub-district, Lamphun province, Thailand, were collected and the fluoride concentration was measured by Ion Selective Electrode. Their village health volunteers were selected for further surveys regarding the consumption of edible plants, meat and poultry products which were produced in the areas. The results showed that the highest concentrations of fluoride in urine were found in Village 21: Ban Hong Ko Muang Song (7.07 + 3.57 g mL-1), Village 15: Ban Nong Hiang (6.26 + 2.01 g mL-1) and Village 9:Ban Pa Pao (4.73 + 2.79 g mL-1). The total average of fluoride from the 21 villages was 3.50 + 2.72 g L-1. There were 12 villages with a value of fluoride in urine higher than the standard recommendation, compared to the rest of the villages. The means of urinary fluoride residues in both male and female samples were slightly higher than the normal range (female > male). In addition, the average levels of contamination of fluoride on edible plants, meat and poultry products were significantly higher than the standard range in their villages. The residents of these areas were likely to risk the intake of fluoride to their bodies from the surrounding contaminated environment..

Improving the Village Health Volunteers’ Knowledge, Malaria Diagnostic Skill and Home Visits through the Observed Training

Municipality of Tidore Islands in North Maluku province, Indonesia, where this study conducted was a malaria endemic area. The malaria Annual Parasite Incidence in this area was 10.8 per 1000 inhabitants in 2010, 8.3 per 1000 inhabitants in 2011, 7.5 per 1000 inhabitants in 2012, 6.11 per 1000 inhabitants in 2013 and 2.10 per 1000 inhabitants in 2014, 2.10 per 1000 inhabitants in 2015. Geographically, this area is consisting of a number of separated islands. This reality reflects the complexity of delivering access, especially health care access to all those separated remote areas. The aim of this study was to increase village health volunteers’ knowledge of malaria and diagnostic skill and home visit through observed training and to analyze the correlation between the knowledge of the village health volunteers toward the diagnostic skill. This research was a Quasi-experimental research based in the community by observing the effects or developments of the results of training interventionscalled “The One Group Pretest-Posttest Design”. A linear regression analysis also conducted to analyze the correlation of observed health volunteer training toward the knowledge and the correlation between knowledge and the diagnostic skill. Result: There has been an increase in village health volunteers’ knowledge after the observed training conducted which included knowledge about malaria in general and the provision of skills to diagnose malaria with sensitivity of 73.4% and specificity of 54.2%Village health volunteers’ knowledge was significantly having correlation toward diagnostic skill (p=0.047) and 90.5% patients that visited completely by village health volunteers taking antimalarial drugs regularly.

Effect of pecuniary costs and time costs on choice of healthcare providers among caregivers of febrile children in rural Papua New Guinea

BackgroundUser fees, transportation costs, and time costs impair access to healthcare by rural communities in low and middle income countries. However, effects of time costs on demand for healthcare are less understood than effects of user fees for health providers. In addition, prospective patients might not know about all health services available. This study aims to investigate how the family caregivers of febrile children respond to the pecuniary costs and time costs in their choice of health providers in rural Papua New Guinea.MethodsUsing an original questionnaire, we surveyed households in the catchment area surrounding Dagua Health Center in East Sepik Province, Papua New Guinea, during February–March 2015. We estimated the probability of choosing one among four categories of providers (i.e., the health center, aid posts, village health volunteers [VHVs], or home-treatment) via a mixed logit model in which we restrict alternatives to those for which family caregivers knew cost information.ResultsOf 1173 family caregivers, 96% sought treatment for febrile children from four categories of providers. Almost all knew the location of the health center and a health volunteer, but only 50% knew the location of aid posts. Analysis by discrete choice model showed that pecuniary costs and time costs were inversely associated with the probability of choosing any type of provider. We then changed pecuniary costs and time costs counterfactually to calculate and compare the probability of choosing each provider. Time costs affected the choice more than pecuniary costs, and individual heterogeneity appeared among caregivers with respect to pecuniary costs. When pecuniary or time costs of VHVs are altered, substitution between VHVs and home-treatment appeared.ConclusionsOur findings suggest that policies to increase awareness of aid posts and reduce time costs in addition to treatment fees for each category of healthcare provider could help developing economies to improve access to essential healthcare services.

Barriers to Effective Diabetes Mellitus Self-Management (DMSM) Practice for Glycemic Uncontrolled Type 2 Diabetes Mellitus (T2DM): A Socio Cultural Context of Indonesian Communities in West Sulawesi.

Diabetes mellitus self-management (DMSM) is an essential strategy used to maintain blood glucose levels and to prevent severe complications. Several barriers have been documented while implementing DMSM practices. A qualitative study aimed to explore barriers to effective DMSM practice among uncontrolled glycemic type 2 diabetes mellitus (T2DM) patients in Indonesia. We conducted in-depth interviews and focus group discussions (FGDs) among 28 key informants, including patients, family members, healthcare providers (HCPs), and village health volunteers (VHVs). The interviews and FGDs were audiotaped and transcribed verbatim. The results revealed six core themes with sub-categories of themes used by all participants to describe the barriers to effective DMSM practice among uncontrolled T2DM patients. The critical barriers of DMSM practice included low perception of susceptibility to and severity of the illness; inadequate knowledge and skill of diabetes mellitus self-management; lack of motivation to perform diabetes mellitus self-management; insufficient human resources; lack of social engagement; and social exclusion and feelings of embarrassment. Our findings provide valuable information regarding the barriers while implementing the DMSM practice. Healthcare providers should negotiate with both T2DM patients and caretakers to participate in a DMSM program at a community health care level.

Impact of regular Breast Self-Examination on breast cancer size, stage, and mortality in Thailand.

Impact of regular Breast Self-Examination on breast cancer size, stage, and mortality in Thailand.

Factors influencing the choice of facility-based delivery in the ethnic minority villages of Lao PDR: a qualitative case study

BackgroundFacility-based delivery has been promoted to improve maternal and child health care in Lao PDR and a free delivery policy was introduced at designated health care facilities (HCF) in 2013. However, according to birth records of HCFs in the impoverished and remote district, only a few women utilized the HCFs despite good physical accessibility. The aim of this study was to analyze the factors influencing the choice of facility-based delivery in the impoverished and remote district after a free delivery policy was introduced.MethodsQualitative case study was employed. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted from August to October 2015. Five hamlets (or small village) located along the main road where only a few women delivered at HCFs were selected for the study based on birth records. The participants of the FGDs and IDIs were the village heads, village health volunteers, women who delivered at home or at a health facility within the past 2 years, their husbands, and mothers or mothers-in-law. Thematic analysis was used to analyze the data.ResultsA total of 12 FGDs and 27 IDIs were conducted, and the number of participants was 105. The factors influencing the choice of facility-based delivery were classified into nine categories and 19 subcategories. The categories were labeled, “perception of childbirth,” “traditional health concept: sabaai (a condition of health, ease, and comfort),” “perception of health care facilities and staff,” “previous pregnancy and childbirth experience,” “mode of available transportation,” “financial burden of childbirth at health care facility,” “family and community context,” “institutional context,” and “government policy on delivery.”ConclusionOur study demonstrated that five major factors negatively influenced the choice of facility-based delivery: (1) perception of childbirth, (2) preference for sabaai, (3) financial burden, (4) family decision-making, and (5) institutional context. To promote facility-based delivery in the impoverished and remote district, three strategies are recommended: (1) promoting community-based health education involving women and strengthening community-based mutual support, (2) clarifying items essential for delivery at HCFs, and (3) making HCFs more comfortable in terms of “sabaai.”

Thai Elder Abuse Problems and Prevention

The present qualitative research aimed to study: 1) the nature of abuse experienced by Thai elders, 2) the causes of elder abuse, and 3) the prevention of elder abuse. The key informants were the Thai elders and directors of 9 Social Welfare Development Centers for Older Persons and old age homes in Buriram, Chiang Mai, Nakhon Pathom, Pathum Thani, Chonburi, Lopburi, Bangkok, Kanchanaburi, and Phra Nakhon Si Ayutthaya. The in-depth interview technique was applied to collect data. The results suggested that the abuse of older people in Thailand could be categorized into 4 main groups, which were neglect, financial abuse, verbal abuse, and physical assault. The occurrence of elder abuse resulted from the individual factors of elders and abusers such as sons and daughters, sons-in-law, husband’s brothers, and grandchildren. The preventive measures to reduce elder abuse included driving Thai local administrative organizations to play a role in caring the elderly in each community, formulating a specific law on elder abuse, strictly complying with the elder abuse law, and encouraging community volunteers such as care-forthe- elderly-at-home volunteers and village health volunteers to pay attention to and look out for the elderly in communities.

Knowledge and perceived skills for health management after a flood among village health volunteers in southern Thailand

Knowledge and perceived skills for health management after a flood among village health volunteers in southern Thailand

The Determinants of Delayed Diagnosis and Treatment Among Malaria Patients in Myanmar: A Cross-Sectional Study

Background: This cross-sectional study was conducted to assess the determining factors for delayed diagnosis and treatment among malaria patients in Myanmar. Methods: The sample comprised 220 respondents diagnosed with malaria last year, living in the upper, middle, and lower part of Myanmar. In 2017, data were collected through interviews and analyzed using percentage, mean, standard deviation, and the chi-square test. Results: The results affirmed that most of the respondents were in the working age group and of low educational level. They also had poor knowledge and perception of malaria, and more than half of the respondents visited health centers or volunteered for their first treatment of choice. Most respondents received little social support for malaria. There were significant associations between age, sex, education, marital status, occupation, and delayed diagnosis and treatment (p &lt; 0.05). Knowledge and perceptions of malaria, health-seeking behavior, and low social support on malaria services were also significantly associated with delayed malaria diagnosis and treatment (p &lt; 0.05). Conclusion: According to the findings, appropriate strengthening of cooperation and collaborations among different sectors upon diagnosis, coverage of treatment services, interventions to increase community awareness, effective communication, behavioral changes, and improved capability of the village health volunteers are evidently needed.

Effects of a Self-Efficacy Promoting Program on Village Health Volunteers’ Knowledge and Perceived Self-Efficacy for Dementia Screening in Older Persons: A Case Study at Sakon Nakhon Province

OBJECTIVES: To study the effects of self-efficacy promoting program on village health volunteers’ (VHVs) knowledge and perceived self-efficacy for dementia screening in older adults. MATERIALS AND METHODS: In this quasi-experimental study, two group pre-test and post-test design were used to study sixty VHVs who fulfilled the inclusion criteria. These were randomly divided into two groups: an experimental group (n = 30) receiving the self-efficacy promoting program for a 4-week period and a control group (n = 30) receiving the routine program. Data were collected using a demographics questionnaire, a dementia knowledge questionnaire, and a perceived self-efficacy for dementia screening in older adults’ questionnaire. Data were analyzed using descriptive statistics, Chi-square test, paired t-test, independent t-test, Wilcoxon signed ranks test and Mann Whitney U test. RESULTS: After participating in the self-efficacy promoting program the experimental group had significantly higher mean scores of dementia knowledge and perceived self-efficacy for dementia screening in older adults than before receiving the program when compared to the control group (p < 0.001, p < 0.001, respectively). CONCLUSION: The self-efficacy promoting program is useful for developing the competency of VHVs in similar communities in order to assist nurses in monitoring and caring for dementia in older adults. Keywords: a self-efficacy promoting program, village health volunteers, dementia screening DOI: 10.31524/bkkmedj.2019.02.010

Factors associated with children\u2019s health facility visits for primaquine treatment in rural Papua New Guinea

BackgroundTo control and eventually eliminate vivax malaria, radical treatment with primaquine (PQ) is essential after completion of blood-stage treatment. Although in many malaria-endemic countries, village health volunteers (VHVs) are engaged in diagnostic treatment of malaria in remote communities, they principally provide blood-stage treatment. In such a situation, access to PQ following blood-stage treatment can be a barrier to complete treatment. However, studies on access to PQ treatment have been scarce and limited in health facility-based settings. This study aimed to identify factors associated with access to PQ treatment in rural Papua New Guinea (PNG) from the community case management perspective.MethodsA community-based, cross-sectional survey was conducted to collect sociodemographic information on children under 15 years of age, their households, and their caretakers in East Sepik Province, PNG. Data collection lasted from February to March, 2015. Information on the diagnoses of potential non-falciparum malaria and prescription of PQ in preceding year (January to December 2014) were obtained from child health-record books. Then, multilevel logistic regression model was used to determine the factors associated with formal health facility visits for PQ treatment among children with potential non-falciparum malaria.ResultsOf 420 episodes diagnosed as potential non-falciparum malaria, 46 (11%) were immediately given PQ. The rest were instructed to visit formal health facilities (HFs) for PQ, and the patients obtained PQ during the second visit to HFs was 44%. Consequently, the overall proportion of PQ prescription was 50%. Logistic regression analysis suggested that among the patients who were instructed to visit HFs for PQ treatment, the initial visit to VHV and higher transportation costs to HF were inversely associated with PQ prescription during the second visit to an HF.ConclusionsFew children received PQ treatment during the second visit to HFs following diagnosis of potential non-falciparum malaria. These findings suggest a need to establish a policy to reduce structural and economic barriers and improve rural inhabitant access to PQ treatment.

Effectiveness of repellent delivered through village health volunteers on malaria incidence in villages in South-East Myanmar: a stepped-wedge cluster-randomised controlled trial protocol

BackgroundTo combat emerging drug resistance in the Greater Mekong Sub-region (GMS) the World Health Organization and GMS countries have committed to eliminating malaria in the region by 2030. The overall approach includes providing universal access to diagnosis and treatment of malaria, and sustainable preventive measures, including vector control. Topical repellents are an intervention that can be used to target residual malaria transmission not covered by long lasting insecticide nets and indoor residual spraying. Although there is strong evidence that topical repellents protect against mosquito bites, evidence is not well established for the effectiveness of repellents distributed as part of malaria control activities in protecting against episodes of malaria. A common approach to deliver malaria services is to assign Village Health Volunteers (VHVs) to villages, particularly where limited or no services exist. The proposed trial aims to provide evidence for the effectiveness of repellent distributed through VHVs in reducing malaria.MethodsThe study is an open stepped-wedge cluster-randomised controlled trial randomised at the village level. Using this approach, repellent (N,N-diethyl-benzamide – 12% w/w, cream) is distributed by VHVs in villages sequentially throughout the malaria transmission season. Villages will be grouped into blocks, with blocks transitioned monthly from control (no repellent) to intervention states (to receive repellent) across 14 monthly intervals in random order). This follows a 4-week baseline period where all villages do not receive repellent. The primary endpoint is defined as the number of individuals positive for Plasmodium falciparum and Plasmodium vivax infections diagnosed by a rapid diagnostic test. Secondary endpoints include symptomatic malaria, Polymerase Chain Reaction (PCR)-detectable Plasmodium spp. infections, molecular markers of drug resistance and antibodies specific for Plasmodium spp. parasites.DiscussionThis study has been approved by relevant institutional ethics committees in Myanmar and Australia. Results will be disseminated through workshops, conferences and peer-reviewed publications. Findings will contribute to a better understanding of the optimal distribution mechanisms of repellent, context specific effectiveness and inform policy makers and implementers of malaria elimination programs in the GMS.Trial registrationAustralian and New Zealand Clinical Trials Registry (ACTRN12616001434482). Retrospectively registered 14th October 2016.

Developing the active larval indices surveillance system for dengue solution in low and high dengue risk primary care units, Southern Thailand

Purpose The purpose of this paper is to develop an active larval indices surveillance system and compare the outcomes of the implementation in primary care units (PCUs) at low and high risk of dengue. Design/methodology/approach The study design was conducted by implementing a community participation action research system in low and high dengue risk PCUs in Lansaka district, Nakhon Si Thammarat province, in the Southern Region of Thailand. There were five phases to the process including preparation of all stakeholders, situation assessment, development of the surveillance system, program implementation and evaluation. The system was developed in ten villages that were categorized as either low dengue risk PCUs (comprising six villages) or high dengue risk PCUs (four villages). A village was assigned as being at high or low dengue risk according to pre-determined criteria. The low dengue risk PCU assessments were conducted on a seven-step active larval indices surveillance system where PCU officials were additionally involved in coordinating, teaching, coaching and supporting the village health volunteers (VHVs) for dengue prevention activities. The high dengue risk PCUs, on the other hand, only followed a basic larval indices surveillance system with no follow-up support. Findings The outcomes of using intervention systems showed that the VHVs’ dengue knowledge and larval indices understanding in both PCUs increased significantly (p&lt;0.01). Furthermore, the low dengue risk PCUs had a higher larval indices level than the high dengue risk PCU (p&lt;0.01). Originality/value This study showed that the low dengue risk PCU followed an active larval indices surveillance system at the sub-district level which is appropriate for villages. This study also revealed that VHVs are needed to strengthen the capacity in terms of knowledge and skills of developing such a system to ensure reduced levels of dengue in the community.

Health Workers' and Villagers' Perceptions of Young Child Health, Growth Monitoring, and the Role of the Health System in Remote Thailand.

In Thailand, despite widespread improvements in child nutrition, stunting is still highly prevalent among northern hill tribe children. To understand how villagers and health workers (volunteers and officials) gauge health of children younger than 5 years, whether growth monitoring is salient, and the relationships of villagers with the health system in this remote location. Qualitative research was undertaken with 8 hill tribe villages. A workshop on infant and young child health and nutrition was held with 8 village health volunteers, 2 per village, selected by a public health officer. In-depth interviews were conducted with 20 villagers and 2 volunteers who had children 0 to 5 years. Eight other health workers were also interviewed. All dialogue was conducted in Thai through bilingual facilitators and recorded, transcribed, and translated into English. Transcripts were coded and analyzed thematically within and across participant groups. Overall, villagers considered strength and independence of children to be hallmarks of health; the size of children featured rarely. Volunteers did not perceive local benefits of growth monitoring, and the extent of child malnutrition was unclear to them. Nutrition counseling was seldom mentioned by villagers or health workers. Across all accounts, and considering silences, relationships of villagers with the health system seemed fragile. Villagers understand child health in terms of functional abilities rather than size. Volunteer health workers in this remote location have limited resources and support. Together this helps explain why, against a background of poverty and food insecurity, growth monitoring does not translate to improvements in child nutrition.

Low uptake of malaria testing within 24\xa0h of fever despite appropriate health-seeking among migrants in Myanmar: a mixed-methods study

BackgroundThere is limited information on uptake of malaria testing among migrants who are a ‘high-risk’ population for malaria. This was an explanatory mixed-methods study. The quantitative component (a cross sectional analytical study-nation-wide migrant malaria survey in 2016) assessed the knowledge; health-seeking; and testing within 24 h of fever and its associated factors. The qualitative component (descriptive design) explored the perspectives of migrants and health care providers [including village health volunteers (VHV)] into the barriers and suggested solutions to increase testing within 24 h. Quantitative data analysis was weighted for the three-stage sampling design of the survey. Qualitative data analysis involved manual descriptive thematic analysis.ResultsA total of 3230 households were included in the survey. The mean knowledge score (maximum score 11) for malaria was 5.2 (0.95 CI 5.1, 5.3). The source of information about malaria was 80% from public health facility staff and 21% from VHV. Among 11 193 household members, 964 (8.6%) had fever in last 3 months. Health-seeking was appropriate for fever in 76% (0.95 CI 73, 79); however, only 7% (0.95 CI 5, 9) first visited a VHV while 19% (0.95 CI 16, 22) had self-medication. Of 964, 220 (23%, 0.95 CI 20, 26) underwent malaria blood testing within 24 h. Stable migrants, high knowledge score and appropriate health-seeking were associated with testing within 24 h. Qualitative findings showed that low testing within 24 h despite appropriate health-seeking was due to lack of awareness among migrants regarding diagnosis services offered by VHV, delayed health-seeking at public health facilities and not all cases of fever being tested by VHV and health staff. Providing appropriate behaviour change communication for migrants related to malaria, provider’s acceptance for malaria testing for all fever cases and mobile peer volunteer under supervision were suggested to overcome above barriers.ConclusionsProviders were not testing all migrant patients with fever for malaria. Low uptake within 24 h was also due to poor utilization of services offered by VHV. The programme should seriously consider addressing these barriers and implementing the recommendations if Myanmar is to eliminate malaria by 2030.

Impact of the health education and preventive equipment package (HEPEP) on prevention of Strongyloides stercoralis infection among rural communities in Northeast Thailand: a cluster randomized controlled trial

BackgroundStrongyloidiasis is prevalent in northeast Thailand. This study aimed to evaluate the impact of the Health Education and Preventive Equipment Package (HEPEP), a package we developed to improve awareness and aid in the prevention of Strongyloides stercoralis infection among rural communities in northeast Thailand.MethodsThis was an intervention trial conducted in 12 villages (six interventions and six controls) in rural areas of northeast Thailand from March 2016 to September 2017. Single stool sample was collected from each participant and examined using agar plate culture (APC) technique. Each participant was interviewed using a pre-tested questionnaire, treated with single dose of ivermectin (200 μg/Kg), and allocated to either the intervention or control group. Members of the intervention group were given “Practices to Prevent Strongyloidiasis” poster and vinyl boards containing information aimed at raising awareness of S. stercoralis and strongyloidiasis. In addition, they were given a poster lecture regarding the lifecycle of S. stercoralis before being treated with ivermectin. Aside from that, they were also given a protective equipment package. Monthly refresher courses were provided by village health volunteers (VHVs) regarding the health information they had received and proper equipment usage. The control group, on the other hand, was only provided with a five-minute lecture regarding strongyloidiasis. Assessment of new infection was conducted 3 months later in 327 and 318 participants in the intervention group and control group, respectively.ResultsThe HEPEP had 41% greater efficacy in preventing S. stercoralis infection in the intervention group than the measures taken in the control group (adjusted Odds Ratio (aOR) = 0.59; 95%CI: 0.41 to 0.85, P-value = 0.005). The intervention group also scored significantly higher on all aspects of a test of S. stercoralis knowledge compared with the control group (mean difference (mean dif.) = 2.89, P-value = < 0.05).ConclusionsThe HEPEP was the first model that has been found to be effective in controlling of S. stercoralis in rural communities in the northeast Thailand. The results should encourage policy makers and public health personnel to improve control programs, as well as health promotion, with regard to parasites.Trial registrationThai Clinical Trials Registry (TCTR), Medical Research Foundation of Thailand, Medical Research Network of the Consortium of Thai Medical Schools: MedResNet (Thailand) (identification number: TCTR20180404002) Registered 4 April 2018 (retrospectively registered).

How are the village health volunteers deliver malaria testing and treatment services and what are the challenges they are facing? A mixed methods study in Myanmar

BackgroundVillage health volunteers (VHVs) play a key role in delivering community-based malaria care especially in the hard-to-reach areas in Myanmar. It is necessary to assess their performance and understand the challenges encountered by them for effective community management of malaria. This mixed methods study was conducted to (i) understand the cascade of malaria services (testing, diagnosis, referral, and treatment of malaria) provided by the VHVs under the National Malaria Control Programme (NMCP) in Myanmar in 2016 and compare with other health care providers and (ii) explore the challenges in the delivery of malaria services by VHVs.MethodsA sequential mixed methods study was designed with a quantitative followed by a descriptive qualitative component. The quantitative study was a cohort design involving analysis of secondary data available from NMCP database whereas the qualitative part involved 16 focus group discussions (eight each with community and VHVs) and 14 key informant interviews with program stakeholders in four selected townships.ResultsAmong 444,268 cases of undifferentiated fever identified by VHVs in 2016, 444,190 were tested using a rapid diagnostic test. Among those tested, 20,375 (4.6%) cases of malaria were diagnosed, of whom 16,910 (83.0%) received appropriate treatment, with 7323 (35.9%) receiving treatment within 24 h. Of all malaria cases, 296 (1.5%) were complicated, of whom 79 (26.7%) were referred to the higher facility. More than two thirds of all cases were falciparum malaria (13,970, 68.6%) followed by vivax (5619, 27.6%). Primaquine was given to 83.6% of all cases. VHVs managed 34.0% of all undifferentiated fever cases, 35.9% of all malaria cases, and identified 38.0% of all Plasmodium falciparum cases reported under NMCP. The key barriers identified are work-related (challenges in reporting, referral, management of malaria especially primaquine therapy, and lack of community support) and logistics related (challenges in transportation, financial constraints, time and shortage of drugs, and test kits). On the other hand, they also enjoy good community support and acceptance in most areas.ConclusionVHVs play an important role in malaria care in Myanmar, especially in the hard-to-reach areas. More programmatic support is needed in terms of logistics, transportation allowance, and supervision to improve their performance.

The use of the "Lansaka Model" as the larval indices surveillance system for a sustainable solution to the dengue problem in southern Thailand.

Background: Dengue has been spreading in Thailand for more than 50 years, and the community prevention of dengue transmission is an important strategy to help reduce outbreaks. The larval indices surveillance system is one of the most significant prevention methods at the household and district levels. Objective: This study sought to develop a larval indices surveillance system based on a specific community context. Method: Community participation action research (CPAR) studies represent a new approach to studying the high-risk dengue area of Lansaka district, Nakhon Si Thammarat province, Thailand. This study was conducted for 2 years (from 2013 to 2015) and applied the integrated concepts of 1) community capacity building, 2) epidemiology, 3) research design for health development, and 4) an online computer program. The method included five phases: 1) community preparation, 2) situation assessment, 3) the development of the surveillance system, 4) implementation, and 5) evaluation. Results: The model was designed in partnership with all the stakeholders from 44 villages across 5 sub-districts. The surveillance system consisted of seven steps at the household level based on primary care surveillance centers (PCSCs), as well as four components at the district level based on district surveillance centers (DSCs). The dengue morbidity rate decreased from 164, 151, and 135 cases/100,000 people in 2014, 2015, and 2016, respectively. Moreover, knowledge of both dengue and larval indices among village health volunteers (VHVs) increased significantly (p < .01). Conclusions: The results from the new system showed a decrease in both the larval indices level and morbidity rate; however, the levels remained higher than the standard. The active surveillance system requires continuous monitoring at both the household and district levels.