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PubMed2006

[Low level educated community health workers training: a strategy to improve children access to acute respiratory treatment in Senegal].

BACKGROUND: Acute respiratory infections (ARI) are the leading cause of death in childhood. Most of children's deaths happen at home without health level first cares. However in Senegal only health workers are allowed to prescribe antibiotics. A competency-based training was developed to improve and assess the management of acute respiratory infections in young children aged 2 to 59 months by low level educated community health workers (CHWs) in 4 districts of Senegal. The first findings showed the CHWs capable of acquiring the skills needed to effectively manage ARI cases in accordance with the World Health Organization's ARI case management strategy. The aim of this study was to assess the quality of their management after a 1 year follow-up. METHODS: We provided to CHWs 3 days course in ARI management. After the 3-day course, a 4-month follow-up was performed. We organized a 1-day refresher course every month and in every district. In order to assess the quality of management of CHWs we analyzed the management process and compared the CHWs classification to the classification of the first level health facilities. RESULTS: Twenty-three percent (3727/15,965) of IRA cases of district were managed by CHWs. Ninety percent (2738/3042) among them were well classified, well managed and well followed-up. But 28% of severe pneumonia cases were misclassified as pneumonia. About treatment, 22.5% of 'cough or cold' got wrong treatment with cotrimoxazole and 10.3% of severe pneumonia got cotrimoxazole without referral. Less than half of severe pneumonia benefited of the first follow-up and only 18% of the second. CONCLUSIONS: The results highlight that a CHWs low-level educated in French, trained and followed-up could apply the WHO algorithm of IRA management. They could help to give proximal care related to children ARI, to the community. But it seems useful of emphasizing the recognition of danger signs and the follow-up of severe cases.

Acute Disease↗
PubMed2006

Neonatal jaundice and its management: knowledge, attitude and practice of community health workers in Nigeria.

BACKGROUND: Neonatal jaundice (NNJ) is still a leading cause of preventable brain damage, physical and mental handicap, and early death among infants in many communities. Greater awareness is needed among all health workers. The objective of the study was to assess the knowledge of primary health care workers about the description, causes, effective treatment, and sequelae of NNJ. METHODS: The setting was a local government area i.e. an administrative district within the south-western part of Nigeria. Community health workers in this area were interviewed by means of a self-administered questionnaire which focused on awareness and knowledge of neonatal jaundice and its causes, treatment and complications. RESULTS: Sixty-six community health workers participated in the survey and male-to-female ratio was 1:5. Their work experience averaged 13.5 (SD 12.7) years. Only 51.5% of the respondents gave a correct definition of NNJ. 75.8 % knew how to examine for this condition while 84.9 % knew at least two of its major causes in our environment. Also, only 54.5 % had adequate knowledge of effective treatment namely, phototherapy and exchange blood transfusion. Rather than referring affected babies to hospitals for proper management, 13.4 %, 10.4 % and 3 % of the participants would treat with ineffective drugs, natural phototherapy and herbal remedies respectively. None of the participants knew any effective means of prevention. CONCLUSION: Primary health care workers may have inadequate knowledge and misconceptions on NNJ which must be addressed concertedly before the impact of the condition on child health and well-being can be significantly reduced. We recommend regular training workshops and seminars for this purpose.

Adult↗
PubMed1998

Ethical holistic thinking and practice for community health workers and nurses.

If we take on board the assumption that social realities are perceived through filters of experience, social position, personality and emotion, then we accept that 'facts' can be differently construed or constructed Compassion cannot be taught as a competency, but we can be made aware through reflexive thinking that the closest we can ever get to a shared truth is through listening to and understanding the other. This paper is a modest attempt to provide some tools for community health workers and nurses who are concerned about the quality of their practice and wish to find creative solutions.

Community Health Nursing↗
PubMed1995

Case management by community health workers of children with acute respiratory infections: implications for national ARI control programme.

Health worker performance in the management of children with acute respiratory infections (ARI) was assessed in two local government areas (LGAs) in Nigeria. The data derived were utilized to identify training needs. Survey instruments included an inventory list for ARI-related equipment and supplies, observation checklists for children presenting to the health worker with ARI symptoms, a questionnaire for exist interviews with mothers, and a supervisor performance checklist. One hundred and twenty-three health workers in Ife Central LGA and 50 in Ojo were observed at selected public health facilities. Most health workers took a good general history, but specific ARI-related history and physical examination were frequently omitted. Symptomatic diagnosis and treatment were common. Drugs most commonly prescribed for treatment of ARI were chloroquine, paracetamol and antibiotics. Essential drugs and supplies for ARI management were not available in some facilities. Communication with mothers was generally unsatisfactory and instruction on home management incomplete. Many of the health workers had not attended a continuing education programme in the previous two years and supervision which could have provided on-the-spot training was irregular. Improvements in ARI case management will require attention to policy, logistics, training (including in-service education) and supervision. The possible role of an integrated approach to the management of the sick child in improving the quality of health worker performance is discussed.

Child Health Services↗
PubMed2003

Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans.

BACKGROUND: African Americans suffer disproportionately from diabetes complications, but little research has focused on how to improve diabetic control in this population. There are also few or no data on a combined primary care and community-based intervention approach. METHODS: We randomly assigned 186 urban African Americans with type 2 diabetes (76% female, mean A SD age 59 A 9 years) to 1 of 4 parallel arms: (1) usual care only; (2) usual care + nurse case manager (NCM); (3) usual care + community health worker (CHW); (4) usual care + nurse case manager/community health worker team. Using the framework of the Precede-Proceed behavioral model, interventions included patient counseling regarding self-care practices and physician reminders. RESULTS: The 2-year follow-up visit was completed by 149 individuals (84%). Compared to the Usual care group, the NCM group and the CHW group had modest declines in HbA(1c) over 2 years (0.3 and 0.3%, respectively), and the combined NCM/CHW group had a greater decline in HbA(1c) (0.8%. P = 0.137). After adjustment for baseline differences and/or follow-up time, the combined NCM/CHW group showed improvements in triglycerides (-35.5 mg/dl; P = 0.041) and diastolic blood pressure, compared to the usual care group (-5.6 mmHg; P = 0.042). CONCLUSIONS: Combined NCM/CHW interventions may improve diabetic control in urban African Americans with type 2 diabetes. Although results were clinically important, they did not reach statistical significance. This approach deserves further attention as a means to reduce the excess risk of diabetic complications in African Americans.

Baltimore↗
PubMed2005

Tuberculosis patient adherence to direct observation: results of a social study in Pakistan.

A randomized controlled trial was carried out in Pakistan in 1999 to establish the effectiveness of the direct observation component of DOTS programmes. It found no significant differences in cure rates for patients directly observed by health facility workers, community health workers or by family members, as compared with the control group who had self-administered treatment. This paper reports on the social studies which were carried out during and after this trial, to explain these results. They consisted of a survey of all patients (64% response rate); in-depth interviews with a smaller sample of different types of patients; and focus group discussions with patients and providers. One finding was that of the 32 in-depth interview patients, 13 (mainly from the health facility observation group) failed to comply with their allocated DOT approach during the trial, citing the inconvenience of the method of observation. Another finding was that while patients found the overall TB care approach efficient and economical in general, they faced numerous barriers to regular attendance for the direct observation of drug-taking (most especially, time, travel costs, ill health and need to pursue their occupation). This may be one of the reasons why there was no overall benefit from direct observation in the trial. Provider attitudes were also poor: health facility workers expressed cynical and uncaring views; community health workers were more positive, but still arranged direct observation to suit their, rather than patients', schedules. The article concludes that direct observation, if used, should be flexible and convenient, whether at a health facility close to the patient's home or in the community. The emphasis should shift in practice from tablet watching towards treatment support, together with education and other adherence measures.

Data Collection↗
PubMedDate not supplied

[Health program and use of community health workers: the example of scorpion envenomation in Tunisia].

Scorpion envenomation is a public health problem in Tunisia (40.000 cases/year), particularly in the zone of central Tunisia (region of Sidi Bouzid). The size of the province, its low rate of urbanization and the relatively limited health ressources required an anti-scorpion approach based on the implication of community health workers. During the year 1997, the 338 health workers who assure 76% of the emergency points treated 42% of scorpion envenomation cases. In spite of the success of the experience, authors discuss "the specialization" of these agents whose the contribution to others aspects of primary care could be improven. These health workers don't constitute a basic component of the organization of health care, but an exceptional measure for special geographical considerations.

Animals↗
PubMed1990

The relative influence of the community and the health system on work performance: a case study of community health workers in Colombia.

A central component of the primary health care approach in developing countries has been the development and utilization of community-based health workers (CHWs) within the national health system. While the use of these front line workers has the potential to positively influence health behavior and health status in rural communities, there continues to be challenges to effective implementation of CHW programs. Reports of high turnover rates, absenteeism, poor quality of work, and low morale among CHWs have often been associated with weak organizational and managerial capacity of government health systems. However, no systematic research has examined the contribution of work-related factors to CHW job performance. The research reported in this paper examines the relative influence of reward and feedback factors associated with the community compared to those associated with the health system on the performance of CHWs. The data are drawn from a broader study of health promoters (CHWs) conducted in two departments (provinces) in Colombia in 1986. The research was based on a theoretical model of worker performance that focuses on job related sources of rewards and feedback. A survey research design was employed to obtain information from a random sample of rural health promoters (N = 179) and their auxiliary nurse supervisors about CHW performance and contributing factors. The findings indicate that feedback and rewards from the community have a greater influence on work performance (defined as degree of perceived goal attainment on job tasks) than do those stemming from the health system.(ABSTRACT TRUNCATED AT 250 WORDS)

Colombia↗
PubMedDate not supplied

Training community health workers to reduce health disparities in Alabama's Black Belt: the Pine Apple Heart Disease and Stroke Project.

African American women have significantly higher mortality rates from heart disease and stroke than White women despite advances in treatment and the management of risk factors. Community health workers (CHWs) serve important roles in culturally relevant programs to prevent disease and promote health. This article describes the Pine Apple Heart and Stroke Project's activities to (1) revise the Women's Wellness Sourcebook Module III: Heart and Stroke to be consistent with national guidelines on heart disease and stroke and to meet the needs of African American women living in rural southern communities; (2) train CHWs using the revised curriculum; and (3) evaluate the training program. Revisions of the curriculum were based on recommendations by an expert advisory panel, the staff of a rural health clinic, and feedback from CHWs during training. Questionnaires after training revealed positive changes in CHWs' knowledge, attitudes, self-efficacy, and self-reported risk reduction behaviors related to heart disease, stroke, cancer, and patient-provider communication. This study provides a CHW training curriculum that may be useful to others in establishing heart disease and stroke programs in rural underserved communities.

Black or African American↗
PubMed2005

How do we determine whether community health workers are cost-effective? Some core methodological issues.

Since the Alma-Ata Conference in 1978 reiterated the goal of "Health for All by the Year 2000", health service delivery programs promoting the primary health care approach using community health workers (CHWs) have been established in many developing countries. These programs are expected to improve the cost-effectiveness of health care systems by reaching large numbers of previously underserved people with high-impact basic services at low cost. However, there is a dearth of data on the cost-effectiveness of CHW programs to confirm these views. This may be because conventional approaches to economic evaluation, particularly cost-effectiveness, tend not to capture the institutional features of CHW programs. Therefore, this paper aims to examine the means by which economic methods can be extended to provide evidence regarding the cost-effectiveness of CHWs in developing countries.

Community Health Services↗
PubMed1989

Assessment of MCH services offered by professional and community health workers in the district of Solenzo, Burkina Faso. I. Utilization of MCH services.

A representative household survey of a district of Burkina Faso was carried out in order to study the utilization of trained birth attendants (TBA) versus professional health workers as providers of under fives' (UFC), antenatal (ANC), and maternity care (MC). Overall utilization by the target groups varied between 13 per cent (UFC), 31 per cent (ANC), and 32 per cent (MC). The presence of a village health post did not increase utilization of MCH care. Furthermore, those who did utilize, preferred to choose another source of care: the professional midwife for ANC, the traditional 'old woman' for delivery. Sick infants were generally not taken to the village health worker (VHW), but rather treated by the family itself. The determinants of utilization were assessed by means of multivariate analysis. The level of care offered in the village (health post, dispensary, and medical centre), educational level of both the mother and the husband, and ethnic group were identified as major factors influencing health seeking behaviour in MCH. A strong case is made for improvement of quality of care before extension of geographical coverage. The importance of involving husbands in sensitization for the utilization of MCH-care is stressed and the implications are discussed for the role of the community health workers in caring for mothers and children.

Burkina Faso↗