Background: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expan...ding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).
Methods: We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.
Findings: The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (−0.8 percentage points (pp) (95% credible interval: −2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: −0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (−0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (−0.6 per 1000 (95% CI −2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges.
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Health Systems in Transition. Vol. 5 No.3 2015
Anxiety Disorders
Chapter F.4
Policy
July 2012
Working Paper No. 3
Ghana is attracting global attention for efforts to provide health insurance to all citizens through the National Health Insurance Scheme (NHIS). With the program’s strong emphasis on maternal and child health, an expectation of the program is that members will have increased use of relevant servi...ces. The NHIS does appear to enable pregnant women to access services and allow caregivers to seek care early for sick children, but both the quantitative and qualitative assessments also indicated that the poor and least educated were less likely to have insurance than their wealthier and more educated counterparts.
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In many of Myanmar’s contested regions, healthcare services are provided through two parallel governance systems – by the government’s Ministry of Health, and by providers linked to ethnic armed organizations. Building upon efforts to build trust between these two actors following ceasefires s...igned in 2011 and 2012, the new National League for Democracy-led government offers an unprecedented opportunity to increase cooperation between these systems and to ensure health services reach Myanmar’s most vulnerable populations.
The report provides an overview of existing health service arrangements in these areas, from both the Ministry of Health and from ethnic and community-based health organizations. It then unpacks the concept of “convergence”, highlighting key opportunities and policy recommendations for both government and non-government actors.
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Some of the key findings of the report include:
Almost 80% of the general public are concerned about developing dementia at some point and 1 in 4 people think that there is nothing we can do to prevent dementia
35% of carers across the world said that they have hidden the diagnosis of de...mentia of a family member
Over 50% of carers globally say their health has suffered as a result of their caring responsibilities even whilst expressing positive sentiments about their role
Almost 62% of healthcare providers worldwide think that dementia is part of normal ageing
40% of the general public think doctors and nurses ignore people with dementia
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The coronavirus disease 2019 (COVID-19) pandemic has created a global and gendered crisis that is compounding existing inequalities and disproportionately affecting girls and women. Emerging evidence from the COVID-19 crisis in 2020 shows school closures, disruptions in essential services and rising... poverty contributed to girls’ increased risk of female genital mutilation (FGM). School closures limited the monitoring and reporting of cases of FGM. Rising household monetary poverty may have contributed to families adopting negative coping mechanisms, including having girls undergo FGM as a precursor to marriage to reduce household costs. A report from the United Nations Population Fund (UNFPA) estimates 2 million additional cases of FGM by 2030 due to the pandemic.
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New research exposes how women and children are disproportionally affected by climate migration, which puts them at greater risk of gender-based violence, child labour and exploitation.
Governments must ensure the safety and protection of women and girls in climate emergencies, including the safe... and equal access to basic services, food, and healthcare before, during, and after disasters. Women must also be included in decision making in their communities so they can lead on resilience building and address gendered issues of migration and displacement.
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DIAGNOSING PTSD IN CHILDHOOD | The following literature review addresses the developmental and domain-specific consequences of previous and current diagnostic criteria for posttraumatic stress disorder (PTSD) in pre-adolescent children. PTSD was introduced in 1980 to capture extreme responses follow...ing a traumatic event. I analyze the evolution of the disorder’s diagnostic criteria toward a more developmentally conscious structure. I also examine instances in which these criteria lack developmental consistency: (1) preschool PTSD is the only diagnostic subtype despite the fact that childhood development also differentiates traumatic expressions in older children from adolescents and adults; and (2) many of the PTSD epidemiological data that have been reanalyzed under the most recent (DSM-5) typology only refer to adolescent and adult samples although many researchers have
demonstrated that developmental alterations to DSM-IV and DSM-IV-TR criteria produce significantly higher prevalence rates in children.
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The intended purpose of this compendium is to provide program managers, organizations, and policy makers with a menu of indicators to better “know their HIV epidemic/know their response” from a gender perspective. The indicators in the compendium are all either part of existing indicators used i...n studies or by countries or have been adapted from existing indicators to address the intersection of gender and HIV. The indicators can be measured through existing data collection and information systems (e.g. routine program monitoring, surveys) in most country contexts, though some may require special studies or research.
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The first chapter provides an overview of gender and domestic violence in the HIV and AIDS discourse and their interconnect-
edness. It analyses literature regarding gender and HIV transmission, domestic violence, and HIV and AIDS. It then discusses how gender roles impact the effects of AIDS.
The... second chapter outlines implications of these findings for policy and practice. This section provides a definition for mainstreaming and deals with various aspects of mainstreaming HIV, AIDS and gender.
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Barriers to HIV Services and Treatment for Persons with Disabilities in Zambia
The 80-page report documents the obstacles faced by people with disabilities in both the community and healthcare settings. These include pervasive stigma and discrimination, lack of access to inclusive HIV prevention ed...ucation, obstacles to accessing voluntary testing and HIV treatment, and lack of appropriate support for adherence to antiretroviral treatment. The report also describes the sexual and intimate partner violence women and girls with disabilities face, and the need for the government and international donors to do more to ensure inclusive and accessible HIV services.
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