Effectiveness of a community intervention on malaria in rural Tanzania - a randomised controlled trial

Background

Malaria infections are a major public health problem in Africa and prompt treatment is one way of controlling the disease and saving lives.

Methods

This cluster-randomised controlled community intervention conducted in 2003–2005 aimed at improving early malaria case management in under five children. Health workers were trained to train community-based women groups in recognizing malaria symptoms, providing first-line treatment for uncomplicated malaria and referring severe cases. Evaluation was through a pre- (2004) and a post-intervention survey (2005). Anaemia prevalence was the primary outcome.

Results

1715 children aged 6–59 months were included in the pre-intervention survey and 2169 in the post-intervention survey. The prevalence of anaemia decreased significantly from 37% [95% CI 34.7–39.3] to 0.5% [95% CI 0.2–0.7] after the intervention (p<0.001); slightly more in the intervention (from 43.9% to 0.8%) than in the control (30.8% to 0.17%) group (p=0.038). Fever and reported fever decreased significantly and the mean body weight of the children increased significantly over the study period in both control and intervention groups.

Conclusion

The decrease in anaemia was significantly associated with the intervention, whereas the fever and body weight trends might be explained by other malaria control activities or seasonal/climate effects in the area. The community intervention was shown to be feasible in the study context.     

Health seeking behaviour and challenges in utilising health facilities in Wakiso district,Uganda

Background

The health seeking behaviour of a community determines how they use health services. Utilisation of health facilities can be influenced by the cost of services, distance to health facilities, cultural beliefs, level of education and health facility inadequacies such as stock-out of drugs.

Objectives

To assess the health seeking practices and challenges in utilising health facilities in a rural community in Wakiso district, Uganda.

Methods

The study was a cross sectional survey that used a structured questionnaire to collect quantitative data among 234 participants. The sample size was obtained using the formula by Leslie Kish.

Results

While 89% of the participants were aware that mobile clinics existed in their community, only 28% had received such services in the past month. The majority of participants (84%) did not know whether community health workers existed in their community. The participants'' health seeking behaviour the last time they were sick was associated with age (p = 0.028) and occupation (p = 0.009). The most significant challenges in utilising health services were regular stock-out of drugs, high cost of services and long distance to health facilities.

Conclusions

There is potential to increase access to health care in rural areas by increasing the frequency of mobile clinic services and strengthening the community health worker strategy.     

Knowledge and practices on malaria prevention in two rural communities in Wakiso District,Uganda

Background

Malaria is the leading cause of morbidity and mortality in Uganda particularly among children under 5 years of age.

Objectives

The study assessed the knowledge and practices on malaria prevention in 2 rural communities in Wakiso District, Uganda with emphasis on the various prevention methods.

Methods

The study was a cross-sectional survey carried out among 376 households using both quantitative and qualitative methods. Log-binomial regression, chi square and Spearman''s rank order correlation were used to test for associations.

Results

The majority of participants (64.6%) had low knowledge on malaria prevention methods, with untreated mosquito nets (81.7%), mosquito coils (36.9%) and insecticide treated nets (29.6%) being the most known methods. Knowledge on malaria prevention methods was associated with age (χ2 = 32.1; p < 0.01), employment status (χ2 = 18.1; p < 0.01), education (χ2 = 20.3; p = 0.01), income (χ2 = 14.5; p = 0.01) and having heard a malaria message in the previous 12 months (χ2 = 92.3; p < 0.01). Households that had at least one mosquito net were 45.5% and net ownership increased with household income. Only 0.5% of the houses had undergone indoor residual spraying in the previous 12 months, while 2.1% had complete mosquito proofing in windows and ventilators to prevent mosquito entry.

Conclusion

There is potential to improve practices on malaria prevention by targeting other methods beyond mosquito nets such as installing proofing in windows and ventilators. The integrated approach to malaria prevention which advocates the use of several malaria prevention methods in a holistic manner should be explored for this purpose.     

Community understanding of pneumonia in Kenya

Background

Effective management of pneumonia demands active participation by the caretaker to facilitate early seeking of appropriate health care and adequate compliance to home care messages. This would only be possible if the caretakers'' perception of pneumonia is appropriate. This study aims to determine community''s perception of childhood pneumonia in a suburb of Nairobi.

Objectives

To determine community perception of childhood pneumonia.

Design

Cross sectional study utilizing qualitative ethnographic methodology.

Participants

Six key informants for in-depth interview and eight groups for focus group discussions from the study community.

Results

Pneumonia was perceived to be the most serious childhood illness. There was a great deal of diversity of Kikuyu phrases for chest-in drawing. There was no term for rapid breathing. Chest in-drawing, fever, difficult in breathing, startling at night and convulsions were perceived as features of pneumonia. Chest in-drawing, fever and convulsions were indicative of severe disease.

Conclusion

The caretakers perceived severe pneumonia as outlined in the IMCI guidelines. Non-severe pneumonia was not perceived for what it should be. Inappropriate knowledge on causes of pneumonia and signs of non severe pneumonia are likely to interfere with compliance with home care messages.     

Factors influencing the usage of different types of malaria prevention methods during pregnancy in Kenya

Background

In sub-Saharan Africa, malaria is a leading cause of morbidity and mortality, which, during pregnancy, is associated with adverse health outcomes for both mother and foetus. Utilization of Insecticide Treated Nets (ITNs) and Intermittent Preventive Therapy (IPTp) is advocated to prevent malaria during pregnancy.

Objective

To examine factors which influence the use of different types of malaria prevention methods among pregnant women in Kenya.

Methods

This study used 2008–09 Kenya Demographic and Health survey. Pregnant women aged 15–49 years were included (622 women). Distribution of the study population was assessed in frequency tables. Bivariate and multivariate logistic regression analysis was employed.

Results

Fifty-two percent of women used ITNs and 38.5% reported uptake of IPTp. In multivariate analysis age, malaria risk areas, religion, education and income influenced ITN usage, whereas only age, malaria risk areas and marital status were found to influence IPTP uptake.

Conclusions

ITN use and IPTp uptake were well below the 80% Kenya Malaria Strategy 2006 target. In an effort to increase uptake it is vital for future research to understand reasons for low usage and uptake of malaria prevention programmes so as to enable policy-makers to make informed decisions.     

Knowledge and utilization of malaria control measures by pregnant and newly delivered mothers in Ibadan, Nigeria

Background

The World Health Organisation (WHO) guidelines for the control of malaria during pregnancy include prompt and effective case management of malaria combined with prevention of infection by insecticide-treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp). Despite this the uptake is poor.

Objective

To describe the malaria prevention measures utilized by these women in this environment.

Methods

Information was obtained from consented pregnant and newly delivered women on their socio-demographic characteristics, knowledge and use of malaria chemoprophylaxis

Results

One Thousand three hundred thirty (1330) pregnant and newly delivered women in 132 facilities within the Ibadan metropolis were surveyed. The mean age of the respondents was 29. 67 years (±5.21). The modes of prevention most commonly reported as being effective were the use of insecticide spray, window nets and ITN. Only 28.2% were using ITNs in the index pregnancy, and 67.2% of the women had had a drug administered for prophylactic purposes in the index pregnancy.

Conclusion

This study demonstrates awareness but poor use of control measures. Additionally, there is poor use of the recommended agent for IPT. The factors militating against the use of these preventive measures need to be urgently explored and addressed.     

Postnatal women's experiences of management of depressive symptoms: a qualitative study

Background

Postnatal depression is a public health problem requiring intervention. To provide effective care, information is needed on the experiences of those with high levels of depressive symptoms who are offered and accept, or decline, psychological intervention postnatally.

Aim

To provide the first integrated in-depth exploration of postnatal women''s experiences of the identification and management of symptoms of depression and the offer and acceptance of postnatal care by health visitors taking part in the PoNDER trial.

Setting

General practice: primary care within the former Trent regional health authority, England.

Method

Thirty women with 6-week Edinburgh Postnatal Depression Scale (EPDS) scores ≥18 and probable depression completed semi-structured interviews. All women had taken part in the Post-Natal Depression Economic Evaluation and Randomised controlled (PoNDER) trial where intervention group health visitors received training in identification of depressive symptoms and provided psychologically informed sessions based on cognitive-behavioural therapy or person-centred counselling principles.

Results

When accepted, psychological sessions were experienced as positive, effective, and ‘ideal care’. Women approved of using the EPDS but did not understand the health visitor''s role in supporting women. Seeking help and accepting sessions depended on women''s perspectives of their health visitor as an individual.

Conclusion

Women''s experience of their health visitors providing psychological sessions to help with postnatal depressive symptoms is highly positive. Women will better accept support from health visitors if they recognise their role in postnatal depression and find them easy to relate to on personal matters. There is a case for specific enhancement of interpersonal skills in health visiting, or alternatively offering a choice of health visitors to women.     

Health seeking behavior by families of children suspected to have malaria in Kabale: Uganda

Background

Malaria is common among communities of Kabale district, and many young children die of the illness. Despite a good distribution of health facilities, able to handle malaria patients, families and individuals tend to depend on self-treatment, or private clinics where drugs used may be of doubtful quality. This study reports on health seeking behaviour by families with children suspected to have malaria.

Methodology

A community-based, cross-sectional survey among 209 rural peasant families living in 12 villages, chosen from the 5 most malaria-affected sub-counties was done. Using a questionnaire, respondents'' reactions to the disease and what decisions they took were recorded. Reasons for choices such as drugs used, location of treatment and malaria control methods were recorded.

Results

Ninety seven percent lived within easy reach of a public health facility. Over 2/3 knew how malaria was transmitted and how it presented. They believed it was best treated at public heath facilities using western type of medicine. Fifty percent of the children, who attended public health units, were treated within 24 of illness. Thirty eight percent of the caretakers knew how to correctly use chloroquine. The caretakers relied on fever, vomiting and refusal to feed as the main symptoms for their diagnosis of malaria. Only 31% of the families sought treatment from government health facilities.Fifty three percent of the families sought treatment from drug shops/vendors. Unfortunately only 38% of the families knew the correct regimen of chloroquine, 4.3% for sulpha-doxine pyrimethamine and 0.5% for quinine. One quarter could afford malaria treatment, and one out of five missed treatment because of poverty. Concerning prevention, 90% stated at least one method but only 21.2% used them.

Conclusions

Despite reasonable knowledge for diagnosis of malaria, awareness of correct treatment is limited. Paradoxically government health units appear to play a minor role in the treatment of malaria.     

Effect of sex education programme on at-risk sexual behaviour of school-going adolescents in Ilorin, Nigeria

Background

Adolescents display sexual behaviours and developmental characteristics that place them at risk for Sexually Transmitted Diseases (STDs). Because young people experiment sexually and because of the consequences of indiscriminate sexual activities on the youth, there is the need to mount sex education programmes that are geared towards enlightenment and appropriate education about sex and sexuality.

Objective

To determine whether Sex Education Intervention Programme would reduce at-risk sexual behaviours of school-going adolescents.

Design

Pre-test, post-test control group quasi-experimental design

Setting

A randomly selected co-educational school in Ilorin Metropolis, Nigeria

Participants

24 school-going adolescents aged 13–19 years

Intervention

Sex Education Programme (treatment group) versus Control programme (placebo)

Main Outcome Measures

Self-reported exposure to sexually transmitted diseases, multiple sex partners, anal sex, oral sex, non use of condom.

Result

When the treatment (intervention) group was compared with the control group in an intention to treat analysis, there were significant differences in at-risk sexual behaviours of the two groups. Those in the intervention group reported less at-risk sexual behaviours than their counterparts in the control group. The treatment group evaluated the intervention programme positively and their knowledge of sexual health improved. Lack of behavioural effect on the control group could be linked to differential quality of delivery of intervention.

Conclusion

Compared with the control group, this specially designed intervention sex education programme reduced at-risk sexual behaviour in adolescents. Based on this finding, it was recommended that sex education be introduced into the curriculum of secondary school education in Nigeria.     

Health care related factors associated with severe malaria in children in Kampala,Uganda

Background

Severe malaria is responsible for the high load of malaria mortality. It is not clearly understood why some malaria episodes progress to severe malaria.

Objective

To determine factors associated with severe malaria in children aged 6 months to 5 years living in Kampala.

Methods

Over a 6-month period, 100 children with severe malaria were matched by age and place of residence with 100 children with non-severe malaria. We collected health care information from care takers.

Results

Mean duration of illness before getting antimalarial treatment was shorter for controls than cases (8hours vs. 20hours, p 0.015). Children with severe malaria were less likely to have been treated with sulphadoxine-pyrimethamine in the preceding 2 weeks (OR 0.2, 95% CI 0.04–0.85, p 0.016). Odds of severe malaria were higher in those who reported lack of protective measures (mosquito coils (OR = 20.63, 95% CI 1.5–283.3, p=0.02 and insecticide sprays OR 10.93, 95% CI 1.13–105.64, p=0.03), although few reported their use.

Conclusions

Early anti-malarial treatment and use of barriers against mosquitoes prevent severe malaria in children. There is need to increase the use of barriers against mosquito bites and to scale up prompt treatment and community-based interventions to reduce the incidence of severe malaria in children.     

Impact of medication and psychological behaviour assessment by community pharmacists in type 2 diabetes mellitus patients after hospital stay

Background

Drug related problem (DRPs) is a key factor which will affect the outcome of therapy and safety.

Objective

To assess the DRPs in type 2 diabetes mellitus (T2DM) patients and psychological aspects of patients by community pharmacists to observe the rate of DRP.

Methods

Prospective randomized controlled intervention study involved T2DM patients and conducted in two community pharmacies at Kanpur from January 2012 to December 2012. The assessment of DRPs was based on the PCNE. Changes in glycosylated hemoglobin (HBA1c), low density lipoproteins (LDL), blood pressure(BP), foot examinations, changes medical and medication utilization were studied. Using as control group, received usual care, and interventional group provided, intervened with use of the standard treatment guidelines (STG). Researcher provided the knowledge to community pharmacists and patients. Baseline and interventional data were collected at 0,3,6,9 and 12 months.

Results

Over the 12 month study, participants'' average HBA1C reduced from 8.9% at initial visit to 7.5%. During this time, the eye examination rate was raised from 31% to 48%, and the foot examination rate was raised from 35% to 50%.

Conclusion

The intervention of pharmacists showed little influence on any of the intermediate health outcomes in T2DM.     

Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer's disease by motor intervention: a controlled trial

OBJECTIVE:

To analyze the effects of motor intervention on the neuropsychiatric symptoms of Alzheimer''s disease and on the caregivers'' burden.

DESIGN:

This is a controlled trial evaluating the effects of a motor intervention program on the neuropsychiatric symptoms.

SETTING:

The intervention was performed on community patients from two university centers specializing in physical exercise for the elderly.

SUBJECTS:

Patients with Alzheimer''s disease were divided into two groups: sixteen received the motor intervention and sixteen controls (five controls were excluded because of clinical intercurrences).

INTERVENTIONS:

Aerobic exercises (flexibility, strength, and agility) and functional balance exercises were conducted over six months for 60 minutes three times per week.

MAIN MEASURES:

Psychopathological features of patients were evaluated with the Neuropsychiatric Inventory and Cornell Scale for Depression in Dementia. Caregivers were evaluated using the Neuropsychiatric Inventory-Distress and Burden Interview. A two-way analysis of variance (ANOVA) was applied to observe interactions (pre- vs. post-intervention; participants vs. controls).

RESULTS:

Patients from the intervention presented a significant reduction in neuropsychiatric conditions when compared to controls (Neuropsychiatric Inventory: F∶11.12; p = 0.01; Cornell Depression scale: F∶11.97; p = 0.01). The burden and stress of caregivers responsible for patients who participated in the intervention significantly decreased when compared to caregivers responsible for controls (Neuropsychiatric Inventory-Distress: F: 9.37; p = 0.01; Burden Interview: F: 11.28; p = 0.01).

CONCLUSIONS:

Aerobic exercise was associated with a reduction in the neuropsychiatric symptoms and contributed to attenuate the caregivers'' burden. However, the researchers were not blinded to the patient''s intervention status, which constitutes an important limitation of this study.     

Likely stakeholders in the prevention of mother to child transmission of HIV/AIDS in Blantyre, Malawi

Objectives

To determine potential partners for pregnant women in the prevention of mother to child transmission of HIV and to determine pregnant women''s perceptions towards selected potential HIV prevention efforts

Design

Cross sectional, questionnaire-administered study

Setting

Ante-natal clinics of eleven public health centers and the major referral and university teaching hospital of Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi

Subjects

A total of 321 pregnant women attending ante-natal clinics

Results

Antenatal women in Blantyre, Malawi obtain health information on HIV/AIDS from the radio (96.3%), health workers (82.2%), religious gatherings (66.7%), friends (54.8%) and newspapers (39.3%). The majority intend to be accompanied by own mother and sister for delivery (52.4% and 15.4% respectively). Almost all (99%) planned to breast feed with 91.8% reporting an intended breastfeeding period of at least 6 months. About 97% of married women reported desire to tell spouse in case of HIV sero-positive results while only 65.1% had ever discussed about HIV with spouse, and only 5.2% had ever attended antenatal clinic with spouse. Whether woman had ever discussed about HIV/AIDS with spouse or not did not influence desire to disclose HIV status to spouse.

Conclusion

Close relatives, spouse and the media are important stakeholders in the health of pregnant women. Programs aimed at prevention of mother to child transmission of HIV should give serious consideration to these partners.     

HIV/AIDS knowledge among undergraduate university students: implications for health education programs in Ghana

Background

Globally, the spread of HIV/AIDS remains on the rise especially among adolescents who are at increased risk of infection. Sexual behavioural change remains one of the most effective ways of preventing further transmission among this vulnerable group.

Objective

To evaluate HIV/AIDS knowledge among undergraduate students'' and how it can be used in HIV prevention strategies in Ghana.

Methods

A cross-sectional study was conducted using structured questionnaires among 324 conveniently selected students enrolled at a tertiary institution in Accra, Ghana.

Results

The mean age of the respondents was 23 years. Although the mean score of the participants'' responses to 12 HIV/AIDS knowledge questions was 7.7 of 12 points, there was an inconsistent level of AIDS knowledge with significant gender difference. While students could identify the transmission modes and preventive measure, they were less knowledgeable about the causative agent of AIDS. Majority of the students reported having received AIDS information from both print and electronic media, but few of them received such information from parents. Although over 90% of the students knew where to access VCT services, 45% of them have not had HIV test.

Conclusion

The data underscore the urgent need for HIV/AIDS-related health education and prevention efforts targeting university students as well as younger age groups in Ghana     

Satisfaction and adherence of patients with amputations to physiotherapy service at public hospitals in KwaZulu-Natal,South Africa

Background

Individuals who have undergone a lower limb amputation require comprehensive rehabilitation from the multidisciplinary team to ensure optimal treatment outcomes and social integration. Physiotherapists play a pivotal role within the multidisciplinary team and offer patients physical and psychosocial rehabilitative care. Determining patients'' satisfaction levels and exploring factors affecting adherence to physiotherapy interventions can inform practice and improve service delivery of rehabilitation within resource poor settings such as South Africa.

Objectives

To determine the level of satisfaction with physiotherapy services rendered to acute and sub-acute in-patients with lower limb amputations and to explore factors affecting adherence to physiotherapy intervention.

Methods

A prospective survey of 35 patients with lower limb amputations from four public hospitals in South Africa was undertaken. A modified version of the Hampstead rehabilitation centre patient satisfaction questionnaire was utilised.

Results

Majority of participants were satisfied with the physiotherapy services whilst a few reported dissatisfaction. Three themes emerged whilst exploring the patients'' experience relating to adherence to physiotherapy programmes. Themes included service delivery, patient-therapist interaction and participation barriers and facilitators.

Conclusion

Recommendations aimed to improve quality of care and healthcare outcomes thereby enhancing the participants'' adherence to the physiotherapy programme.     

Childhood swine flu vaccination uptake in a Welsh general practice: a prospective study

Background

Immunisation of infants is effective and benefits the health of the children immunised as well as the community where uptake is high. Any social inequality in uptake will worsen any social inequalities that already exist.

Aim

To investigate the demographic characteristics of families attending for swine flu vaccination.

Design and setting

A prospective study in a semi-rural general practice in South Wales.

Method

Data were collected by questionnaire, and logistic regression models were used to test for associations between potential risk factors (including family demographic characteristics and the child''s previous vaccination history) and swine flu vaccination uptake.

Results

No evidence was found of any significant associations between potential risk factors and the outcome.

Conclusion

This suggests that social inequality did not affect vaccination uptake in this sample.     

Knowledge and perception of microbicides among healthcare providers in Calabar,Nigeria

Background

With the worldwide spread of HIV/AIDS, the absence of a known cure and the challenges associated with existing prevention methodologies, there is need for new prevention technologies. The successful uptake of healthcare products and services depend, to a large extent, on healthcare providers'' knowledge, perception and attitude regarding them.

Objectives

To determine the knowledge and perception of healthcare providers regarding microbicides.

Methods

A semi-structured questionnaire was administered on 400 randomly selected health care providers in Calabar, Cross River State of Nigeria. Data obtained from the 350 returned questionnaire were analyzed using EPI -Info software version 3.5.1

Results

One hundred and sixty-four (46.9%) respondents were medical doctors while 157 (44.9%) were nurses, 7 (2%) were Pharmacists and 22 (6.2%) belonged to “other” categories. Thirty- two percent knew the advantages of microbicides over condoms. Sixty-eight percent indicated that microbicides would benefit only women while to 27%, it would benefit both men and women. Seventy-five percent of respondents would be willing to act as community advocates for microbicides while 21% would not be willing and 4% were not decided. There was a statistically significant association between professional group and willingness to act as community advocates for microbicides. Medical doctors were more likely to act as advocates than other professional groups (p<0.05). Female respondents were more likely to have correct knowledge regarding microbicides than males (p<0.05)

Conclusion

There are gaps in knowledge regarding microbicides among the health care providers. Capacity building would be successful since the majority are willing to act as community advocates.