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Ackerman A, Afzal N, Lautarescu A, Wilson CA, Nadkarni A. Non-specialist delivered psycho-social interventions for women with perinatal depression living in rural communities: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003031. [PMID: 38976687 PMCID: PMC11230560 DOI: 10.1371/journal.pgph.0003031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/03/2024] [Indexed: 07/10/2024]
Abstract
Evidence from low- and middle-income countries suggests that non-specialist-delivered interventions effectively improve access to perinatal mental health care. However, there have been no systematic attempts to synthesize the evidence on effectiveness, relevance, and application of this strategy to resource-limited settings such as rural areas. The aim of this review is to synthesize the evidence about the effectiveness of non-specialist delivered interventions in improving depression and related outcomes in women with perinatal depression living in rural communities. Seven electronic databases were searched using the following search concepts: perinatal depression (e.g., puerperal depression, antenatal depression), rural areas (e.g., remote, nonmetropolitan, underserved), and non-specialist workers (e.g., lay worker, volunteer aide, informal caretaker. The risk of bias was assessed using RoB-2 and ROBINS-I tools. A narrative synthesis was performed as the high degree of study heterogeneity precluded a meta-analysis. Nine unique studies were eligible for inclusion. Psychoeducation and problem-solving techniques were the most used intervention elements. Two interventions significantly reduced the prevalence of perinatal depression compared to usual care, and three interventions reported effectiveness in reducing depression symptom severity. There was little to no consistent evidence for other outcomes, including but not limited to maternal health care utilization, breastfeeding behaviors, and child health. This review provides limited evidence to suggest that non-specialist delivered interventions effectively improved outcomes among women with perinatal depression living in rural communities. The paucity of high-quality studies included in this review demonstrates that this rural demographic is frequently neglected in the context of maternal mental health research.
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Affiliation(s)
- Anouk Ackerman
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- UCLA David Geffen School of Medicine, Los Angeles, California, United States of America
| | - Nimrah Afzal
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Alexandra Lautarescu
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Claire A Wilson
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Abhijit Nadkarni
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Rogers HE, Hershey JA, Morone J, Lipman TH, Wilson-Hall L, Anderson K, Hawkes CP. Perspectives of Pediatric Community Health Workers: Roles, Successes, and Challenges. Health Promot Pract 2023; 24:1206-1214. [PMID: 35876335 DOI: 10.1177/15248399221112866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This multicenter qualitative study described the roles of 10 pediatric community health workers (CHWs) in their own words through exploration of the role features, successes, and challenges in pediatric health care settings across three urban U.S. cities (Philadelphia, New York City, and Cincinnati). Individual, semi-structured telephone interviews were conducted. Interviews described prominent features of the pediatric CHW role, which included taking a family-centered approach to goal setting and determining support needed, ensuring family goals stayed at the center of the work, and acting as a trusted figure for families to talk openly with. CHWs described their role as rewarding, believing in the work, and feeling a sense of fulfillment, and felt successful when families had positive outcomes, including when barriers were eliminated, resources were obtained, or independence was demonstrated by families. Challenges CHWs faced in their roles included establishing trust with families, managing the ever-changing family circumstances many families experience due to socioeconomic barriers, and managing limitations of protocol and restrictions within their roles. This study demonstrated numerous considerations for CHW practice in pediatric health care settings, in addition to considerations for pediatric-specific CHW program development and management. The primary policy implication of this study included a basis for increased funding for CHW programs in pediatric health care settings. This study also demonstrated a need for further research on the change CHWs effect within child and family systems outside of health care, such as schools and child welfare agencies.
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Affiliation(s)
- Hanna E Rogers
- Evaluation Strategies, Ypsilanti, MI, USA
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jennifer Morone
- Yale University School of Medicine, New Haven, CT, USA
- Veterans Administration Health Services Research & Development, Washington, DC, USA
| | - Terri H Lipman
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | - Colin P Hawkes
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University College Cork, Cork, Ireland
- University of Pennsylvania, Philadelphia, PA, USA
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Watson ED, Moosa S, Janse Van Rensburg DC, Schwellnus M, Lambert EV, Stoutenberg M. Task-Shifting: Can Community Health Workers Be Part of the Solution to an Inactive Nation? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6675. [PMID: 37681815 PMCID: PMC10487434 DOI: 10.3390/ijerph20176675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/03/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
Background: In low-to-middle income countries (LMICs), there is a growing burden of non-communicable diseases (NCDs) placing strain on the facilities and human resources of healthcare systems. Prevention strategies that include lifestyle behavior counseling have become increasingly important. We propose a potential solution to the growing burden of NCDs through an expansion of the role for community health workers (CHWs) in prescribing and promoting physical activity in public health settings. This discussion paper provides a theoretical model for task-shifting of assessment, screening, counseling, and prescription of physical activity to CHWs. Five proposed tasks are presented within a larger model of service delivery and provide a platform for a structured, standardized, physical activity prevention strategy aimed at NCDs using CHWs as an integral part of reducing the burden of NCDs in LMICs. However, for effective implementation as part of national NCD plans, it is essential that CHWs received standardized, ongoing training and supervision on physical activity and other lifestyle behaviors to optimally impact community health in low resource settings.
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Affiliation(s)
- Estelle D. Watson
- Department of Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
- Department of Exercise Science, Faculty of Science, University of Auckland, Auckland 1023, New Zealand
| | - Shabir Moosa
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
| | - Dina C. Janse Van Rensburg
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Martin Schwellnus
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Estelle V. Lambert
- UCT Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Department of Human Biology, Division of Research Unit for Exercise Science and Sports Medicine, Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, 7700, South Africa
| | - Mark Stoutenberg
- Department of Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
- College of Public Health, Temple University, Philadelphia, PA 19122, USA
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Ferla JP, Gill MM, Komba T, Abubakar A, Remes P, Jahanpour O, Mariki M, Mang'enya MA, Van de Ven R, Antelman G. Improvement of community health worker counseling skills through early childhood development (ECD) videos, supervision and mentorship: A mixed methods pre-post evaluation from Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001152. [PMID: 37276228 DOI: 10.1371/journal.pgph.0001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/04/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Community health workers (CHWs) play significant roles in improving health practices in under- resourced communities. This study evaluated an early childhood development (ECD) project in Tanzania assessing the effect of mobile video use, supervision and mentorship to improve quality of CHW counseling skills. METHODS CHWs participating in the Malezi Project in Tabora Region were enrolled in a mixed methods pre-post evaluation. CHWs previously trained in UNICEF's Care for Child Development package were further trained in counselling caregivers on nurturing care and father engagement using videos. Health providers were trained to provide ECD-focused supervision/mentorship of CHWs in facilities and during home visits. At baseline and endline, CHWs completed interviews and trained study staff observed and scored CHW counseling sessions using a structured checklist which were reduced into six dimensions through principal component analysis: introduce, educate, ask, plan/problem solve, interact/encourage, and responsive care. Twenty-five in-depth interviews were completed with caregivers and four focus group discussions with CHWs were conducted. RESULTS Almost all (n = 107; 95%) 119 enrolled CHWs completed the expected eight observations (n = 471 baseline; n = 453 endline). At endline, more CHWs reported having one-on-one meetings with their supervisors (51% increasing to 75%; p < .0002) and that supervisors accompanied them to households for mentoring (60% increasing to 89%; p < .0001). We observed a shift in CHW counselling skills in clinic and home sessions. Scores in the categories of introduce, plan/problem solve, and interact/encourage significantly improved between baseline and endline; scores for ask and educate remained unchanged or decreased at both timepoints. Two-thirds of caregivers interviewed reported that father's involvement with their child increased due to CHW visits. Male participation increased in home observation sessions from 5.6% at baseline to 17.6% at endline (p < .0001). CONCLUSION Use of videos, supervision, and mentorship were associated with CHW performance improvements in providing nurturing care counselling and in father engagement, especially in home settings.
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Affiliation(s)
| | - Michelle M Gill
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | - Teopista Komba
- Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Pieter Remes
- Development Media International, Mwanza, Tanzania
| | - Ola Jahanpour
- Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
| | - Martha Mariki
- President's Office Regional and Local Government, Dodoma, Tanzania
| | - Mary A Mang'enya
- Community Development, Gender, Elderly and Children, Tanzania Ministry of Health, Dodoma, Tanzania
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Delamou A, Grovogui FM, Miller L, Nye A, Kourouma M, Kolié D, Goumou T, Bossert TJ. Implementation research protocol on the national community health policy in Guinea: A sequential mixed-methods study using a decision space approach. PLoS One 2023; 18:e0280651. [PMID: 36662762 PMCID: PMC9858093 DOI: 10.1371/journal.pone.0280651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023] Open
Abstract
The overall goal of this study is to explore the rollout of the community health policy in Guinea in the context of decentralization, and the role of decision space (the decision authority, capacities, and accountability of local officials) in explaining gaps between the policy's conceptualization and actual implementation. The implementation research study will employ a sequential explanatory mixed-methods design. The study will be conducted in 27 communes purposefully selected across the country and include communes where the national community health policy is fully, partially, and not yet being implemented. The quantitative component, based on a survey questionnaire and secondary data, will use ordinary least squares (OLS) multiple regression to compare maternal and child health (MCH) coverage indicators according to the level of policy implementation in the commune. An interrupted time series analysis will be conducted to assess changes in routine MCH service delivery indicators associated with implementation of the community health policy, comparing indicators from one year prior to implementation. OLS regression will be conducted to assess the association between decision space and MCH indicators; all analyses will be carried out in Stata. Findings from the quantitative study will be used to inform the key qualitative questions and areas to explore in greater depth, to develop the interview and focus group guides, and to generate an initial codebook. Qualitative data will be double coded in NVivo by two qualitative analysts, and results generated using thematic analysis. Findings from the quantitative and qualitative components will be integrated and triangulated for interpretation and reporting. Findings and recommendations of this study will inform revisions to the National Community Health Policy to improve its rollout and effectiveness.
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Affiliation(s)
- Alexandre Delamou
- African Centre for Excellence (CEA-PCMT), University Gamal Abdel Nasser of Conakry, Conakry, Guinea
- Maferinyah Training and Research Center in Rural Health, Forécariah, Guinea
| | - Fassou Mathias Grovogui
- African Centre for Excellence (CEA-PCMT), University Gamal Abdel Nasser of Conakry, Conakry, Guinea
- Maferinyah Training and Research Center in Rural Health, Forécariah, Guinea
| | - Lior Miller
- Results for Development Institute, Washington, D.C., United States of America
| | - Amy Nye
- Results for Development Institute, Washington, D.C., United States of America
| | - Mamadi Kourouma
- National Directorate of Community Health and Traditional Medicine, Ministry of Health and Public Hygiene, Conakry, Guinea
| | - Delphin Kolié
- African Centre for Excellence (CEA-PCMT), University Gamal Abdel Nasser of Conakry, Conakry, Guinea
- Maferinyah Training and Research Center in Rural Health, Forécariah, Guinea
| | - Tohanizé Goumou
- National Directorate of Community Health and Traditional Medicine, Ministry of Health and Public Hygiene, Conakry, Guinea
| | - Thomas J. Bossert
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Menezes R, Lelijveld N, Wrottesley SV, Brennan E, Mates E, James PT. Integrating Women and Girls' Nutrition Services into Health Systems in Low- and Middle-Income Countries: A Systematic Review. Nutrients 2022; 14:4488. [PMID: 36364750 PMCID: PMC9657561 DOI: 10.3390/nu14214488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 08/16/2023] Open
Abstract
Women's nutrition has been highlighted as a global priority to ensure the health and well-being of both them and future generations. This systematic review summarises the available literature on the integration of nutrition services for girls and women of reproductive age (GWRA) into existing public health systems across low- and middle-income countries, as well as any barriers to integration. We searched PubMed and Cochrane Database of Systematic Reviews for articles published since 2011 according to eligibility criteria. A total of 69 articles were included. Evidence suggested that several services for GWRA are well integrated into public health systems, including antenatal care services, nutrition education and counselling, and micronutrient supplementation programmes. However, there was limited evidence on the integration of family planning, adolescent health, and reproductive health services. Barriers to integration fell into five main themes: lack of training and capacity building, poor multisectoral linkages and coordination, weak advocacy, lack of M&E systems, and inequity. We identified a lack of evidence and services for non-pregnant GWRA and for women postpartum. Addressing barriers to integration and gaps in nutrition services for GWRA would increase service coverage and contribute to improving health outcomes for GWRA and future generations.
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Kavle JA. Strengthening maternal nutrition counselling during routine health services: a gap analysis to guide country programmes. Public Health Nutr 2022; 26:1-18. [PMID: 36210775 DOI: 10.1017/s1368980022002129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The WHO recommends counselling on healthy eating, weight gain, and physical activity during antenatal care (ANC) and postnatal care (PNC), yet advice and information are often not tailored to women's nutritional needs and contexts. The purpose of the gap analysis was to identify key elements related to the provision of maternal nutrition counselling during routine health contacts and provide programme considerations to strengthen quality service delivery. DESIGN A search of PubMed, Cochrane Library, CINAHL Plus and Scopus databases was conducted to retrieve studies from January 2010 to December 2021. Using inclusion criteria, quantitative, qualitative and mixed methods studies were included in the final gap analysis. SETTING Low-, middle- and high-income country contexts. PARTICIPANTS Following application of gap analysis criteria, thirty-seven articles from sixteen countries were included in the analysis. RESULTS Gaps in delivery of maternal nutrition counselling include provider capacity building, frequency, content and delivery platforms. Globally, counselling on appropriate weight gain during pregnancy is often not delivered with the desired content nor quality, while targeted counselling to overweight and obese women was provided in several high-income country contexts. Delivery of maternal nutrition counselling through multiple delivery platforms demonstrated improvements in maternal diet and/or weight gain during pregnancy. CONCLUSIONS Strengthening the integration of maternal nutrition counselling into pre- and in-service curricula, routine health provider training, supportive supervision and provider mentoring is needed. Future efforts may consider generating global and regional weight gain guidelines and incorporating maternal nutrition counselling indicators as part of quality-of-care ANC/PNC standards and routine health systems.
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Affiliation(s)
- Justine A Kavle
- Kavle Consulting, LLC, 200 Massachusetts Ave NW, Washington, DC20001, USA
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Shahid M, Ameer W, Malik NI, Alam MB, Ahmed F, Qureshi MG, Zhao H, Yang J, Zia S. Distance to Healthcare Facility and Lady Health Workers’ Visits Reduce Malnutrition in under Five Children: A Case Study of a Disadvantaged Rural District in Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138200. [PMID: 35805858 PMCID: PMC9266103 DOI: 10.3390/ijerph19138200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023]
Abstract
This study accesses the impact of lady health worker (LHWs) visits in the community and distance to a healthcare facility on the nutritional status of under-five children. Additionally, it explores the perceptions and attitudes of the community about the performance of LHWs. A self-administered instrument was applied to gather data on different parameters, such as children’s height, age, weight, and socioeconomic status from 384 rural households in a marginalized district of Punjab province with the help of a purposive random sampling technique. The binary logistic regression model was employed for the computation of the probability of malnutrition. The prevalences of stunting, underweight children, and wasting in the district were 34.8%, 46.1%, and 15.5%, respectively. The logistic results illustrate that those households in which LHW visits occur regularly within 15 days (OR = 0.28 with 95% CI: 0.09–0.82) have a lower probability of malnutrition prevalence among their children. The distance to the health facility shows that the odds of malnutrition were higher from 3–4 Kilometers (Km) (OR = 2.61, 95% CI: 0.85–8.14), and odds were also higher for the ≥5 km category (OR = 2.88, 95% CI: 0.94–8.82). Children from richer families had lower chances of being malnourished (OR = 0.28, 95% CI: 0.07–1.14). Furthermore, the respondents show a positive attitude towards LHWs. They have given the first rank to their performance being beneficial to mothers and childcare, especially on checkups and safe deliveries, while they have shown negative responses and given lower ranks to their performance due to irregular visits (6th rank) and poor community awareness (7th rank). We conclude that LHWs’ regular visits to targeted households and less distance to healthcare facilities reduce the malnutrition risk in under-five children.
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Affiliation(s)
- Muhammad Shahid
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing 100029, China; (M.S.); (H.Z.)
- Vanke School of Public Health, Tsinghua University, Beijing 100029, China;
| | - Waqar Ameer
- Department of Economics, Shandong Business and Technology University, Jinan 250100, China;
| | - Najma Iqbal Malik
- Department of Psychology, University of Sargodha, Sargodha 40100, Pakistan;
| | | | - Farooq Ahmed
- Vanke School of Public Health, Tsinghua University, Beijing 100029, China;
- Department of Anthropology, Quaid-i-Azam University, Islamabad 44000, Pakistan
- Department of Anthropology, University of Washington, Seattle, WA 98195, USA
| | - Madeeha Gohar Qureshi
- Department of Economics, Pakistan Institute of Development Economics, Islamabad 44000, Pakistan;
| | - Huiping Zhao
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing 100029, China; (M.S.); (H.Z.)
| | - Juan Yang
- Chinese Academy of Science and Technology for Development, Beijing 100029, China
- Correspondence: (J.Y.); (S.Z.)
| | - Sidra Zia
- Vanke School of Public Health, Tsinghua University, Beijing 100029, China;
- Correspondence: (J.Y.); (S.Z.)
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Chen Y, You Y, Wang Y, Wang Y, Dai T. Global Insights Into Rural Health Workers' Job Satisfaction: A Scientometric Perspective. Front Public Health 2022; 10:895659. [PMID: 35784240 PMCID: PMC9249262 DOI: 10.3389/fpubh.2022.895659] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/10/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction Rural health workers (RHWs) play an irreplaceable role in ensuring and improving the health level of rural residents as the most basic and extensive medical service providers in rural areas. However, rural health institutions are facing significant worker shortages worldwide, not only in low- and middle-income countries but also in developed countries. As an important variable to explain RHWs' work status and predict turnover behavior, job satisfaction has received more and more attention currently. Methods Publications from 1 January 1995 to 31 December 2021 were identified from the Science Citation Index Expanded (SCI-Expanded), the Social Sciences Citation Index (SSCI), and the Emerging Sources Citation Index (ESCI) of the Web of Science Core Collection (WoSCC); CiteSpace, VOSviewer, and R software were applied to conduct this study. Results A total of 251 publications were obtained from the WoSCC database. The number of publications had a statistically significant increase in the study period. Ranking in the top three of the most productive countries or regions in this field was the United States, the United Kingdom, and China. "Health Care Sciences & Services," "Nursing," and "Public, Environmental & Occupational Health" seemed to be the major subjects. According to the reference co-citation analysis, "motivation," "rural and remote areas," and "work environment" were three noteworthy topics during the development of the research field. Moreover, through the keyword analysis, the underlying relationship among "job satisfaction," "job burnout," and "turnover intention" was explored. Conclusion Publications about job satisfaction associated with RHWs had remarkably indicated that this research field had great development potential and broad prospects. As an emerging topic related to RHWs' job status, job satisfaction and its related affected factors were systematically summarized by cluster and keywords analysis. We also highlighted that job satisfaction had a negative predictive effect on RHWs' job burnout and turnover intention, and job burnout played a positive role in predicting turnover intention. In addition, the job satisfaction and working environment of RHWs under the COVID-19 pandemic should receive more attention in the future.
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Affiliation(s)
- Yuquan Chen
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences, Beijing, China
- Peking Union Medical College, Beijing, China
| | - Yanwei You
- School of Social Sciences, Tsinghua University, Beijing, China
| | - Yiche Wang
- Department of Economics and Management, Shanghai University of Sport, Shanghai, China
| | - Yutong Wang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tao Dai
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences, Beijing, China
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Stansert Katzen L, Skeen S, Dippenaar E, Laurenzi C, Notholi V, le Roux K, Rotheram-Borus MJ, le Roux I, Mbewu N, Tomlinson M. Are we listening to community health workers? Experiences of the community health worker journey in rural South Africa. Res Nurs Health 2022; 45:380-389. [PMID: 35184308 PMCID: PMC9271365 DOI: 10.1002/nur.22220] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/13/2021] [Accepted: 02/01/2022] [Indexed: 08/20/2023]
Abstract
Access to healthcare in developing countries remains a challenge. As a result, task-shifting to community health workers (CHWs) is increasingly used to mitigate healthcare worker shortages. Although there is solid evidence of CHW program effectiveness, less is known about CHWs' experiences of becoming and then working daily as CHWs-information that should play an important role in the design of CHW programs. We examined the experiences of a group of CHWs working in a government-run CHW program in South Africa's rural Eastern Cape Province. Semistructured qualitative interviews (N = 9) and focus groups (N = 2) focusing on motivations for becoming a CHW and experiences of working as CHWs were conducted and thematically analyzed. Three themes were identified: (1) becoming a CHW, (2) facing challenges in the field, and (3) gaining community acceptance through respect and legitimacy. In this study, CHWs were motivated by altruism and a desire to help their community. They faced a range of challenges such as limited training, lack of supervision, equipment shortages, logistical issues, and clinics with limited services. Respect and legitimacy through community acceptance and trust is crucial for effective CHW work. CHWs in this study described how confidentiality and their own persistence facilitated the process of gaining respect and legitimacy. CHWs have a unique knowledge of contexts and requirements for successful programs and greater efforts are needed to include their perspectives to improve and develop programs. Recognition is needed to acknowledge the significant personal input required by CHWs for programs to be successful.
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Affiliation(s)
- Linnea Stansert Katzen
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Sarah Skeen
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Elaine Dippenaar
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Christina Laurenzi
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Vuyolwethu Notholi
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Karl le Roux
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
- Department of Family Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, California, USA
| | - Ingrid le Roux
- Philani Maternal, Child Health and Nutrition Trust, Cape Town, South Africa
| | - Nokwanele Mbewu
- Philani Maternal, Child Health and Nutrition Trust, Cape Town, South Africa
| | - Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
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Tadesse A, Walelign Fentaye F, Mekonen AM, Yasine T. The impact of Ethiopian community-based health extension program on diarrheal diseases among under-five children and factors associated with diarrheal diseases in the rural community of Kalu district, Northeast Ethiopia: a cross-sectional study. BMC Health Serv Res 2022; 22:168. [PMID: 35139841 PMCID: PMC8830013 DOI: 10.1186/s12913-022-07565-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background The health extension program is a community-based health care delivery program with eighteen defined packages. The main aim of the health extension program is to help to reduce child mortality. So, the aim of this study is to assess the impact of a health extension program on diarrheal disease under-five children in the rural community of Kalu district, Northeast Ethiopia, 2021. Methods A community-based cross-sectional study design was conducted from March to April/2021. A Multi-stage sampling technique was used to get a total sample size of 556 (182 model households and 374 non-model households) with a response rate of 92.22%. Binary logistic regression analysis was done, and P-value < 0.05 was considered statistically significant. Propensity score matching analysis was used to determine the contribution of health extension program “model households” on diarrhea diseases among under-five children. The average treatment effect on the treated was calculated to compare the means of outcomes across model and non-model households. Results Health extension program (HEP) model household contributed a 17.7% (t = -5.02) decrease in children’s diarrheal diseases among under-five children compared with HEP non-model households. Mothers from non-model households were 2.19 times more likely to develop under-five children diarrheal diseases AOR (Adjusted Odds Ratio): 2.19, 95% CI: 1.34–3.57 than mothers from model households. Households who got no frequent home visits were 3.28 times more likely to develop under-five diarrheal diseases AOR (Adjusted Odds Ratio): 3.28, 95% CI: 1.40–7.68. Conclusion When the health extension program is implemented fully (model household), the prevalence of under-five diarrheal disease in the rural community could decrease. The need to develop supportive strategies for the sustainability of model households and encouraging households to be model households is very important. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07565-7.
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Affiliation(s)
- Ahmed Tadesse
- Department of Health Systems Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara, Ethiopia
| | - Fasil Walelign Fentaye
- Department of Health Systems Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara, Ethiopia
| | - Asnakew Molla Mekonen
- Department of Health Systems Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara, Ethiopia.
| | - Toyeb Yasine
- Department of Health Systems Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara, Ethiopia
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Gordon S, Rotheram-Fuller E, Rezvan P, Stewart J, Christodoulou J, Tomlinson M. Maternal depressed mood and child development over the first five years of life in South Africa. J Affect Disord 2021; 294:346-356. [PMID: 34315096 DOI: 10.1016/j.jad.2021.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND While the negative impact of peri-natal depression is well-documented in high-income countries, the long-term effects across the life course in low and middle-income countries is less clear. Children's adjustment over the first five years is examined as a function of patterns of maternal depressed mood. METHODS Pregnant women in 24 peri-urban townships (N = 1,238) were randomized to a home-visiting intervention or standard care and reassessed five times, with high retention. There were no intervention effects on children past 18 months. Multilevel regression models examined the impact of depressed mood on child outcomes. Using the Edinburgh Postnatal Depression Scale, four patterns of maternal depressed mood were identified: never (40.6%); antenatal (13.0%); early childhood (26.1%); and recurrent episodes of depressed mood (20.3 %). FINDINGS Mothers' patterns of depressive symptoms and child outcomes were similar, regardless of intervention. Never depressed mothers were significantly younger, had higher income, less food insecurity, were more likely to have electricity, be living with HIV or have an HIV positive partner, and had fewer problems with alcohol than depressed mothers. Children of mothers who experienced depressed mood weighed less, were more aggressive, and were hospitalized more often than children of never depressed mothers, but were similar in cognitive and social development. INTERPRETATIONS Depressed mood, has significant negative impacts on South African children's growth and aggressive behavior. The timing of maternal depressed mood was less important than never having a depressed mood or a recurrent depressed mood. FUNDING There were no funding conflicts in executing this trial.
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Affiliation(s)
- Sarah Gordon
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | | | - Jackie Stewart
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa; School of Nursing and Midwifery, Queens University, Belfast, United Kingdom.
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Horwood C, Hinton R, Haskins L, Luthuli S, Mapumulo S, Rollins N. 'I can no longer do my work like how I used to': a mixed methods longitudinal cohort study exploring how informal working mothers balance the requirements of livelihood and safe childcare in South Africa. BMC WOMENS HEALTH 2021; 21:288. [PMID: 34362363 PMCID: PMC8349013 DOI: 10.1186/s12905-021-01425-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/15/2021] [Indexed: 11/10/2022]
Abstract
Background Returning to work after childbirth is challenging for working mothers. Childcare quality may have lifelong effects on children’s health, development and cognitive function. Over 60% of working women globally are informal workers without employment or maternity protection, but little is known about how these women care for their children. Methods We conducted a mixed-methods longitudinal cohort study among informal women workers in Kwazulu-Natal, South Africa between July 2018 and August 2019. Participants were followed up from late pregnancy until they had returned to work. We conducted structured quantitative interviews and in-depth qualitative interviews at different time points: before and after the baby was born, and after returning to work. Subsequently, a photovoice activity was conducted with groups of participants to explore the childcare environment. We employed narrative thematic analysis for qualitative data and descriptive analysis for quantitative data. Results 24 women were recruited to participate. Women returned to work soon after the baby was born, often earlier than planned, because of financial responsibilities to provide for the household and new baby. Women had limited childcare choices and most preferred to leave their babies with family members at home, as the most convenient, low cost option. Otherwise, mothers chose paid carers or formal childcare. However, formal childcare was reported to be poor quality, unaffordable and not suited to needs of informal workers. Mothers expressed concern about carers’ reliability and the safety of the childcare environment. Flexibility of informal work allowed some mothers to adapt their work to care for their child themselves, but others were unable to arrange consistent childcare, sometimes leaving the child with unsuitable carers to avoid losing paid work. Mothers were frequently anxious about leaving the child but felt they had no choice as they needed to work. Conclusion Mothers in informal work had limited childcare options and children were exposed to unsafe, poor-quality care. Maternity protection for informal workers would support these mothers to stay home longer to care for themselves, their family and their baby. Provision of good quality, affordable childcare would provide stability for mothers and give these vulnerable children the opportunity to thrive. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01425-y.
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Affiliation(s)
- Christiane Horwood
- Centre for Rural Health, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa.
| | | | - Lyn Haskins
- Centre for Rural Health, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Silondile Luthuli
- Centre for Rural Health, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Sphindile Mapumulo
- Centre for Rural Health, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Rotheram-Borus MJ. Designing Evidence-Based Preventive Interventions That Reach More People, Faster, and with More Impact in Global Contexts. Annu Rev Clin Psychol 2021; 17:551-575. [PMID: 33962538 PMCID: PMC10015738 DOI: 10.1146/annurev-clinpsy-081219-120453] [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] [Indexed: 11/09/2022]
Abstract
This article demonstrates the substantial similarities globally among preventive, evidence-based interventions (EBIs) designed to address HIV by providing four examples: an HIV family-focused intervention, the Community Popular Opinion Leader intervention, a South African maternal/child health program, and an EBI for sex workers in India. Each identified the key problems in the target population, utilized well-established social cognitive theories, created processes for engaging the target population, set standards for staff accountability, and included routine data collection to facilitate iterative program improvements over time. Building EBIs based on these common, robust features is an alternative design strategy to replication with fidelity. These components provide a road map for researchers, especially those using new technologies, and for local providers seeking to deliver EBIs that match their clients' and communities' needs. Technology platforms and community organizations may serve as resources for designers of the next generation of EBIs, offering an alternative to repeatedly validating the same interventions and replicating them with fidelity.
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Rahman M, Jahir T, Yeasmin F, Begum F, Mobashara M, Hossain K, Khan R, Hossain R, Nizame FA, Jain A, Leontsini E, Unicomb L, Luby SP, Winch PJ. The Lived Experiences of Community Health Workers Serving in a Large-Scale Water, Sanitation, and Hygiene Intervention Trial in Rural Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3389. [PMID: 33805884 PMCID: PMC8037636 DOI: 10.3390/ijerph18073389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
Community health workers (CHWs) are key to implementing community-based health interventions and quality can be enhanced by better understanding their lived experiences. The WASH Benefits, Bangladesh trial engaged 540 female CHWs to promote varying health intervention packages. We report on factors influencing their lived experiences during the trial, to aid future recruitment, training and retention of CHWs. Nine focus groups and 18 in-depth interviews were conducted with CHWs. Focus groups and interviews were transcribed and thematic content analysis performed to summarize the results. All CHWs described experiencing positive working conditions and many benefits both socially and financially; these contributed to their retention and job satisfaction. Their honorarium was commonly applied towards their children's education and invested for income generation. CHWs gained self-confidence as women, to move unaccompanied in the community and speak in public. They earned respect from the community and their family members who helped them manage their family obligations during work and were viewed as a resource for advice on health and social issues. Many participated in family decision-making from which they were previously excluded. Health programs should foster a positive experience among their CHWs to aid the recruitment, retention and development of this important human resource.
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Affiliation(s)
- Mahbubur Rahman
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Tania Jahir
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Farzana Yeasmin
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Farzana Begum
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Mosammot Mobashara
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Khobair Hossain
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Rizwana Khan
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Rezwana Hossain
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Fosiul Alam Nizame
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Anika Jain
- Department of International Health, John Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (A.J.); (E.L.); (P.J.W.)
| | - Elli Leontsini
- Department of International Health, John Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (A.J.); (E.L.); (P.J.W.)
| | - Leanne Unicomb
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (T.J.); (F.Y.); (F.B.); (M.M.); (K.H.); (R.K.); (R.H.); (F.A.N.); (L.U.)
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Peter J. Winch
- Department of International Health, John Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (A.J.); (E.L.); (P.J.W.)
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Ransing R, Kukreti P, Raghuveer P, Mahadevaiah M, Puri M, Pemde H, Karkal R, Patil S, Nirgude A, Kataria D, Sagvekar S, Deshpande SN. Development of a brief psychological intervention for perinatal depression (BIND-P). Asia Pac Psychiatry 2021; 13:e12436. [PMID: 33098740 DOI: 10.1111/appy.12436] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lack of recognition in national programs, poor referral system, and non-availability of trained human resources are the important barriers for the delivery of perinatal depression (PND) services in low- and middle-income countries (LAMICs). To address this there is an urgent need to develop an integrative and non-specialist-based stepped care model. As part of its research thrust on target areas of India's National Mental Health Programme (NMHP), the Indian Council of Medical Research funded a research project on the outcome of PND at four sites. In this article, we describe the development of the primary health care worker-based stepped care model and brief psychological intervention for PND. METHODS A literature review focused on various aspects of PND was conducted to develop a model of care and intervention under NMHP. A panel of national and international experts and stakeholders reviewed the literature, opinions, perspectives, and proposal for different models and interventions, using a consensus method and WHO implementation toolkit. RESULTS A consensus was reached to develop an ANM (Auxillary nurse midwife)-based stepped-care model consisting of the components of care, training, and referral services for PND. Furthermore, a brief psychological intervention (BIND-P) was developed, which includes the components of the low-intensity intervention (eg, exercise, sleep hygiene). CONCLUSION The BIND-P model and intervention provide a practical approach that may facilitate effective identification, treatment, and support women with PND. We are currently evaluating this model across four study sites in India, which may help in the early detection and provision of appropriate and integrative care for PND.
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Affiliation(s)
- Ramdas Ransing
- Department of Psychiatry, BKL Walwalkar Rural Medical College, Sawarde, Ratnagiri, Maharashtra, India
| | - Prerna Kukreti
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Pracheth Raghuveer
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Mahesh Mahadevaiah
- Department of Psychiatry, Dharwad Institute of Mental Health and Neurosciences (DIMHANS), Dharwad, Karnataka, India
| | - Manju Puri
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Harish Pemde
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Ravichandra Karkal
- Department of Psychiatry, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Suvarna Patil
- Department of Psychiatry, BKL Walwalkar Rural Medical College, Sawarde, Ratnagiri, Maharashtra, India
| | - Abhay Nirgude
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Dinesh Kataria
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Shraddha Sagvekar
- Department of Mental Health Nursing, SVJCT's Samarth Nursing College, Sawarde, Ratnagiri, Maharashtra, India
| | - Smita N Deshpande
- Department of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental health, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
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