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Owusu L, Tuwor RD, Ackam N, Loglo A, Agbavor B, Agbanyo A, Dornu O, Antwi PB, Oppong MN, Adjei JK, Frimpong V, Abass MK, Novignon J, Asiedu K, Laryea DO, Amoako YA, Phillips RO. Role and capacity needs of community based surveillance volunteers in the integrated management of skin neglected tropical diseases (skin NTDs): a qualitative study from central Ghana. BMC Public Health 2023; 23:1086. [PMID: 37280609 PMCID: PMC10243008 DOI: 10.1186/s12889-023-16015-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/30/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Community Based Surveillance Volunteers (CBSVs) have been instrumental in the management of Neglected Tropical Diseases (NTDs) but a concern that their services in scale up programmes may be affected due to high attrition rates has been widely acknowledged. We explored the roles and capacity needs of existing CBSVs to inform for a successful integrated NTD management programme in Ghana and similar contexts. METHODS We conducted qualitative interviews with 50 CBSVs, 21 Community Nurses, 4 Disease control officers, 7 skin NTD researchers, 2 skin NTD patients and a Director of District Health Services in Central Ghana. Interviews were digitally recorded, transcribed and coded prior to translation and thematic analysis. RESULTS The roles of CBSVs in NTD management were shown to have an impact on disease identification, surveillance, health seeking behaviours and status of CBSVs. Lack of motivation, inadequate structures for engagement of CBSVs within the health system and delayed management of reported cases were identified as gaps that hinder effective delivery of CBSV roles. Provision of incentives as recognition for the unpaid services rendered by CBSVs was seen as a major factor to reduce the rate of CBSV attrition in this scale up programme. Other factors included the formulation of policies by government to guide CBSV engagement, regular training of CBSV in NTD management as well as provision of resources and logistics. CONCLUSION Measures including continuous training, institution of rewards and incentivization are important for ensuring the sustainability of CBSVs in the provision of skin NTD services in Ghana.
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Affiliation(s)
- Lucy Owusu
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ruth Dede Tuwor
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nancy Ackam
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Aloysius Loglo
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bernadette Agbavor
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abigail Agbanyo
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Olivia Dornu
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Philemon Boasiako Antwi
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Ntiamoah Oppong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jonathan Kofi Adjei
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Venus Frimpong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Jacob Novignon
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Hushie M. Developing governance models and funding mechanisms of state-civil society partnerships for HIV/AIDS treatment and prevention based on lessons from Ghana. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:138-147. [PMID: 31282299 DOI: 10.2989/16085906.2019.1625937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The contribution of civil society organisations (CSOs) to national HIV/AIDS responses in sub-Saharan African countries, with Global Health Initiatives' (GHIs) funding channelled through National AIDS Commissions (NACs), is well researched. Less well understood are the governance models and funding mechanisms being used to successfully engage CSOs in the HIV/AIDS response. Using data from government, donor, CSO and documentary sources, this article characterises the organisational principles and practices and unique funding models adopted by the Ghana AIDS Commission (GAC) to effectively and efficiently engage CSOs in the HIV/AIDS response. It found four major governance principles and practices that target: 1) strategic planning for service delivery; 2) focussed expressions of interest; 3) competitive tendering and contracting for service delivery; and 4) adoption of results-based management. It also identified three predominant funding models that illustrate the application of these guiding principles to harness the inherent strengths of CSOs to more effectively respond to HIV/AIDS, namely: 1) direct funding of locally-based CSOs; 2) funding international and national NGOs to engage local CSOs in partnership; and 3) funding umbrella organisations. These findings are significant for Ghana but they may also have relevance for other low- or middle-income countries (LMICs) that have limited experience delivering HIV/AIDS services through state-civil society partnerships, as well as broader debates on the role of donors, governments and CSOs working in partnership to fight HIV/AIDS.
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Affiliation(s)
- Martin Hushie
- a Department of Behavioural Sciences, School of Allied Health Sciences , University for Development Studies , Tamale , Ghana
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Lachenal G, Owona Ntsama J, Ze Bekolo D, Kombang Ekodogo T, Manton J. Neglected Actors in Neglected Tropical Diseases Research: Historical Perspectives on Health Workers and Contemporary Buruli Ulcer Research in Ayos, Cameroon. PLoS Negl Trop Dis 2016; 10:e0004488. [PMID: 27101371 PMCID: PMC4839562 DOI: 10.1371/journal.pntd.0004488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Guillaume Lachenal
- SPHERE UMR 7219, Université Paris Diderot and Institut Universitaire de France, Paris, France
- * E-mail: (GL); (JM)
| | - Joseph Owona Ntsama
- Fondation Paul Ango Ela pour la Géopolitique en Afrique Centrale, Yaoundé, Cameroon
| | | | | | - John Manton
- Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail: (GL); (JM)
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Barogui YT, Sopoh GE, Johnson RC, de Zeeuw J, Dossou AD, Houezo JG, Chauty A, Aguiar J, Agossadou D, Edorh PA, Asiedu K, van der Werf TS, Stienstra Y. Contribution of the community health volunteers in the control of Buruli ulcer in Bénin. PLoS Negl Trop Dis 2014; 8:e3200. [PMID: 25275562 PMCID: PMC4183479 DOI: 10.1371/journal.pntd.0003200] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/19/2014] [Indexed: 11/15/2022] Open
Abstract
Background Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans. Usually BU begins as a painless nodule, plaque or edema, ultimately developing into an ulcer. The high number of patients presenting with ulcers in an advanced stage is striking. Such late presentation will complicate treatment and have long-term disabilities as a consequence. The disease is mainly endemic in West Africa. The primary strategy for control of this disease is early detection using community village volunteers. Methodology/Principal Findings In this retrospective, observational study, information regarding Buruli ulcer patients that reported to one of the four BU centers in Bénin between January 2008 and December 2010 was collected using the WHO/BU01 forms. Information used from these forms included general characteristics of the patient, the results of diagnostic tests, the presence of functional limitations at start of treatment, lesion size, patient delay and the referral system. The role of the different referral systems on the stage of disease at presentation in the hospital was analyzed by a logistic regression analysis. About a quarter of the patients (26.5%) were referred to the hospital by the community health volunteers. In our data set, patients referred to the hospital by community health volunteers appeared to be in an earlier stage of disease than patients referred by other methods, but after adjustment by the regression analysis for the health center, this effect could no longer be seen. The Polymerase Chain Reaction (PCR) for IS2404 positivity rate among patients referred by the community health volunteers was not systematically lower than in patients referred by other systems. Conclusions/Significance This study clarifies the role played by community health volunteers in Bénin, and shows that they play an important role in the control of BU. Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans. Usually, the number of patients presenting with ulcers in an advanced stage is high. This complicates treatment and increases the risk of disabilities. The disease is endemic mainly in West Africa. The primary strategy for control is early detection using community village volunteers. In Bénin, data was collected to understand the role of the different referral systems on the stage of disease at presentation in the hospital and the diagnostic precision. About a quarter of the patients were referred to the hospital by the community health volunteers. Community health volunteers referred patients more frequently in an earlier stage of disease. The PCR confirmation rate among patients referred by the community health volunteers was not systematically lower than in patients referred by other systems. We found that community health volunteers played an important role in the referral system of BU patients in Bénin. This information is relevant for health care programs attempting to control BU but may also be relevant for health care programs working on other diseases in areas with restricted resources.
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Affiliation(s)
- Yves Thierry Barogui
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli de Lalo, Ministère de la Santé, Cotonou, Bénin
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Ghislain Emmanuel Sopoh
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Ministère de la Santé, Cotonou, Bénin
| | - Roch Christian Johnson
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d'Abomey-Calavi, Abomey-Calavi, Bénin
| | - Janine de Zeeuw
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ange Dodji Dossou
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Ministère de la Santé, Cotonou, Bénin
| | - Jean Gabin Houezo
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Ministère de la Santé, Cotonou, Bénin
| | - Annick Chauty
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli de Pobè, Ministère de la Santé, Cotonou, Bénin
| | - Julia Aguiar
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli de Zangnanado, Ministère de la Santé, Cotonou, Bénin
| | - Didier Agossadou
- Programme National de Lutte Contre la Lèpre et l'Ulcère de Buruli, Ministère de la Santé, Cotonou, Bénin
| | - Patrick A. Edorh
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d'Abomey-Calavi, Abomey-Calavi, Bénin
| | - Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Tjip S. van der Werf
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Öcek ZA, Çiçeklioğlu M, Yücel U, Özdemir R. Family medicine model in Turkey: a qualitative assessment from the perspectives of primary care workers. BMC FAMILY PRACTICE 2014; 15:38. [PMID: 24571275 PMCID: PMC3942270 DOI: 10.1186/1471-2296-15-38] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 02/21/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND A person-list-based family medicine model was introduced in Turkey during health care reforms. This study aimed to explore from primary care workers' perspectives whether this model could achieve the cardinal functions of primary care and have an integrative position in the health care system. METHODS Four groups of primary care workers were included in this exploratory-descriptive study. The first two groups were family physicians (FP) (n = 51) and their ancillary personnel (n = 22). The other two groups were physicians (n = 44) and midwives/nurses (n = 11) working in community health centres. Participants were selected for maximum variation and 102 in-depth interviews and six focus groups were conducted using a semi-structured form. RESULTS Data analysis yielded five themes: accessibility, first-contact care, longitudinality, comprehensiveness, and coordination. Most participants stated that many people are not registered with any FP and that the majority of these belong to the most disadvantaged groups in society. FPs reported that 40-60% of patients on their lists have never received a service from them and the majority of those who use their services do not use FPs as the first point of contact. According to most participants, the list-based system improved the longitudinality of the relationship between FPs and patients. However, based on other statements, this improvement only applies to one quarter of the population. Whereas there was an improvement limited to a quantitative increase in services (immunisation, monitoring of pregnant women and infants) included in the performance-based contracting system, participants stated that services not among the performance targets, such as family planning, postpartum follow-ups, and chronic disease management, could be neglected. FPs admitted not being able to keep informed of services their patients had received at other health institutions. Half of the participants stated that the list-based system removed the possibility of evaluating the community as a whole. CONCLUSIONS According to our findings, FPs have a limited role as the first point of contact and in giving longitudinal, comprehensive, and coordinated care. The family medicine model in Turkey is unable to provide a suitable structure to integrate health care services.
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Affiliation(s)
- Zeliha Asli Öcek
- Ege University Faculty of Medicine, Department of Public Health, 35100 Izmir, Turkey
| | - Meltem Çiçeklioğlu
- Ege University Faculty of Medicine, Department of Public Health, 35100 Izmir, Turkey
| | - Ummahan Yücel
- Ege University Izmir Atatürk School of Health, Department of Midwifery, Izmir, Turkey
| | - Raziye Özdemir
- Karabuk University School of Health, Department of Midwifery, Karabuk, Turkey
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Senkubuge F, Modisenyane M, Bishaw T. Strengthening health systems by health sector reforms. Glob Health Action 2014; 7:23568. [PMID: 24560261 PMCID: PMC4651248 DOI: 10.3402/gha.v7.23568] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 11/25/2013] [Accepted: 12/06/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses. METHODS A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, we explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health. FINDINGS Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging 'street level' policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms. CONCLUSIONS The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems.
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Affiliation(s)
- Flavia Senkubuge
- Health Policy and Management, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa;
| | - Moeketsi Modisenyane
- Health Policy and Management, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Tewabech Bishaw
- Alliance For Brain Gain and Innovative Development (ABIDE), Addis Ababa, Ethiopia; African Federation of Public Health Associations (AFPHAs), Addis Ababa, Ethiopia; Ethiopian Public Health Association, Addis Ababa, Ethiopia
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Warren AE, Wyss K, Shakarishvili G, Atun R, de Savigny D. Global health initiative investments and health systems strengthening: a content analysis of global fund investments. Global Health 2013; 9:30. [PMID: 23889824 PMCID: PMC3750586 DOI: 10.1186/1744-8603-9-30] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 07/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Millions of dollars are invested annually under the umbrella of national health systems strengthening. Global health initiatives provide funding for low- and middle-income countries through disease-oriented programmes while maintaining that the interventions simultaneously strengthen systems. However, it is as yet unclear which, and to what extent, system-level interventions are being funded by these initiatives, nor is it clear how much funding they allocate to disease-specific activities - through conventional 'vertical-programming' approach. Such funding can be channelled to one or more of the health system building blocks while targeting disease(s) or explicitly to system-wide activities. METHODS We operationalized the World Health Organization health system framework of the six building blocks to conduct a detailed assessment of Global Fund health system investments. Our application of this framework framework provides a comprehensive quantification of system-level interventions. We applied this systematically to a random subset of 52 of the 139 grants funded in Round 8 of the Global Fund to Fight AIDS, Tuberculosis and Malaria (totalling approximately US$1 billion). RESULTS According to the analysis, 37% (US$ 362 million) of the Global Fund Round 8 funding was allocated to health systems strengthening. Of that, 38% (US$ 139 million) was for generic system-level interventions, rather than disease-specific system support. Around 82% of health systems strengthening funding (US$ 296 million) was allocated to service delivery, human resources, and medicines & technology, and within each of these to two to three interventions. Governance, financing, and information building blocks received relatively low funding. CONCLUSIONS This study shows that a substantial portion of Global Fund's Round 8 funds was devoted to health systems strengthening. Dramatic skewing among the health system building blocks suggests opportunities for more balanced investments with regard to governance, financing, and information system related interventions. There is also a need for agreement, by researchers, recipients, and donors, on keystone interventions that have the greatest system-level impacts for the cost-effective use of funds. Effective health system strengthening depends on inter-agency collaboration and country commitment along with concerted partnership among all the stakeholders working in the health system.
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Affiliation(s)
- Ashley E Warren
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Kaspar Wyss
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland
| | | | - Rifat Atun
- Imperial College London, South Kensington Campus, London SW7 2AZ, UK
- Department of Global Health and Population, Harvard School of Public Health, Harvard University, Cambridge, USA
| | - Don de Savigny
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland
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Harimanana A, Clavel S, Chivorakul P, Perez F, Preux PM, Barennes H. Associated factors with adherence to antiepileptic drug in the capital city of Lao PDR. Epilepsy Res 2012. [PMID: 23182965 DOI: 10.1016/j.eplepsyres.2012.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Available medical care for epilepsy and antiepileptic drugs (AED) are provided in Vientiane Municipality by district hospitals supported by a non-governmental organization, which is referred to as a community-based intervention (CB), and reference hospital which is referred to as hospital-based interventions (HB). Identifying underlying factors of AED adherence is of public health interest. A community-based cross-sectional survey among randomly selected patients with epilepsy (PWE) who were being cared in Vientiane Municipality was undertaken in 2010. The Morisky scale was used to assess the level of adherence. Univariate and multivariate logistic regression analyses were performed to address predictive factors. Overall, 99 PWE were included in the study. Overall adherence was estimated at 57.6%, 57.1% and 58.0% for the HB and CB group, respectively. High level of adherence was related to illiteracy, being on monotherapy and experiencing fewer seizures. Implementing closer medical care at primary level to PWE improves the likelihood of reducing primary and secondary treatment gap which is related to PWEs' adherence. An active intervention through a downstream channel of training of medical health staff from reference level to community level enhances the prescription of adequate AED, the improvement of the quality of relation between PWE and medical staff.
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Affiliation(s)
- Aina Harimanana
- Institut de la Francophonie pour la Médecine Tropicale, BP 9519 Vientiane, Lao Democratic People's Republic
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Balaluka GB, Nabugobe PS, Mitangala PN, Cobohwa NB, Schirvel C, Dramaix MW, Donnen P. Community volunteers can improve breastfeeding among children under six months of age in the Democratic Republic of Congo crisis. Int Breastfeed J 2012; 7:2. [PMID: 22364405 PMCID: PMC3323360 DOI: 10.1186/1746-4358-7-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 02/24/2012] [Indexed: 11/15/2022] Open
Abstract
Background Malnutrition is a major public health problem in developing countries and exclusive breastfeeding is an efficient strategy that can be used to prevent malnutrition and reduce child mortality. The objective of this study is to evaluate the effectiveness of community volunteers in promoting exclusive breastfeeding from birth in an area of endemic malnutrition. Methods This evaluation analyzed the impact of the community-based nutrition project in Katana health district of the Democratic Republic of Congo from 2004 to 2006. Each of the villages in this sector had a nutritional village committee made up of five members responsible for continuously working to raise awareness of the importance of exclusive breastfeeding from birth among pregnant women and community leaders in their respective villages. The program worked with community volunteers with a mean age of 37 years, most of whom were married (86%). Eighty percent of the community volunteers had completed secondary school or a higher level of education. Data related to the period of exclusive breastfeeding and to the number of visits made to the health services for 208 children. The data were compared with data from 178 infants collected from another health sector, which had never developed a community-based nutrition program. Results The duration of exclusive breastfeeding from birth (median, range) was 6 months (2 to 7) in the intervention area compared with 4 months (1 to 6) in the comparison area (p < 0.001). The proportion of infants receiving exclusive breastfeeding at six months of age was higher in the intervention area than in the comparison area: 57.7% (95% Confidence Interval, CI, 50.9 to 64.5) versus 2.7% (95%CI, 1.1 to 6.6) (p < 0.001). The intervention group had a higher mean weight at 12 months (standard deviation): 8.42 kg (1.41) compared to 7.97 kg (1.02), although this difference was not statistically significant (p = 0.055). Conclusions The promotion of breastfeeding by community volunteers in an area of endemic malnutrition in rural Democratic Republic of Congo increased the duration of exclusive breastfeeding from birth.
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Affiliation(s)
- Ghislain B Balaluka
- Centre de Recherche en Sciences Naturelles de Lwiro (CRSN), Bukavu, Democratic Republic of Congo.
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Samb B, Evans T, Dybul M, Atun R, Moatti JP, Nishtar S, Wright A, Celletti F, Hsu J, Kim JY, Brugha R, Russell A, Etienne C. An assessment of interactions between global health initiatives and country health systems. Lancet 2009; 373:2137-69. [PMID: 19541040 DOI: 10.1016/s0140-6736(09)60919-3] [Citation(s) in RCA: 332] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Since 2000, the emergence of several large disease-specific global health initiatives (GHIs) has changed the way in which international donors provide assistance for public health. Some critics have claimed that these initiatives burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. So far, most of the evidence for this debate has been provided by speculation and anecdotes. We use a review and analysis of existing data, and 15 new studies that were submitted to WHO for the purpose of writing this Report to describe the complex nature of the interplay between country health systems and GHIs. We suggest that this Report provides the most detailed compilation of published and emerging evidence so far, and provides a basis for identification of the ways in which GHIs and health systems can interact to mutually reinforce their effects. On the basis of the findings, we make some general recommendations and identify a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. The target date for achievement of the health-related Millennium Development Goals is drawing close, and the economic downturn threatens to undermine the improvements in health outcomes that have been achieved in the past few years. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity, value for money, and outcomes in global public health, then these opportunities should not be missed.
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Berhanu S, Alemu S, Prevett M, Parry E. Primary care treatment of epilepsy in rural Ethiopia: Causes of default from follow-up. Seizure 2009; 18:100-3. [DOI: 10.1016/j.seizure.2008.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 06/26/2008] [Accepted: 07/04/2008] [Indexed: 10/21/2022] Open
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