Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the del...Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the delivery of immunization services extremely challenging. Vaccinators needed a long walk through the hilly terrain to reach outreach sites. Community mobilizers were unable to go house to house to inform the caregivers to bring children to the site for vaccination. Caregivers were unaware when the vaccinators arrive at the site. As a result, many children missed vaccination or were not vaccinated timely. Age-appropriate vaccination coverage (according to national immunization schedule) in the Sirmaur district was the lowest in the state. Thinking out-of-box to address the communication barriers with the caregivers, the traditional drum beating was used, for the first time in India, in two blocks of the Sirmaur district (Rajpura and Shillai). The initiative was planned and implemented by the district health system with the support of the local community leaders. An exit interview was conducted to know the reach of the drum beating to caregivers, and a baseline and end line household survey was conducted to know the outcome of the initiative on age-appropriate vaccination coverage. Analysis of exit interviews data indicated a very high reach of a drum beating to the caregivers;more than 97% of caregivers in Rajpura and 100% in Shillai heard drum beating, and almost 95% of caregivers in Rajpura and 98% in Shillai knew the purpose of drum beating. Analysis of immunization data from baseline and end line surveys showed improvement in age-appropriate vaccination coverage for all vaccines in Rajpura (by 2.2% for BCG, 15.3% for Pentavalent 1, 14.9% for Pentavalent 2, 14.1% for Pentavalent 3, and 6.5% for Measles/MR). In Shillai, age-appropriate vaccination coverage improved for Pentavalent 1 (by 3.4%), Pentavalent 2 (by 5%) and Measles/MR (by 1.7%). In addition, dropout rates were reduced in both the blocks, particularly in Rajpura Pentavalent 1 to Measles dropout rate was reduced by 13.5%. Both health workers and community leaders had positive perceptions of the drum beating initiative. However, another important lesson learned from the initiative was that both the access and demand-side barriers need to be addressed for the desired improvement of age-appropriate immunization coverage. In Shillai, there was lower coverage improvement and a reduction in dropout rates attributed to vacant positions of vaccinators that caused an issue with access to immunization services to people.展开更多
A community engagement project was designed and implemented to reach 10.6 million population in 13 districts of Uttarakhand state—India, to identify presumptive TB patients (PTBPs) and link to free diagnostics servic...A community engagement project was designed and implemented to reach 10.6 million population in 13 districts of Uttarakhand state—India, to identify presumptive TB patients (PTBPs) and link to free diagnostics services, either through referral or sputum collection and transportation (SCT). The objective of this study is to determine additional yield of TB patients achieved by providing SCT services in comparison to referrals of PTBPs identified in hard-to-reach areas. This was before and after comparative study conducted between April-June 2014 (2Q2014-before) to July-September 2014 (3Q2014-after). SCT was advised for all PTBPs identified from community level interventions between July-September 2014 (3Q2014-after). In 3Q2014, additional 279 (34%) PTBPs were examined in the microscopy centre with an additional 36 (51%) new smear positive (NSP) patient diagnosed. A total of 46 NSP (128%) were contributed by SCT alone. Higher proportion (94%) of TB patients was initiated on treatment in 3Q2014 in comparison to 2Q2014 (91%). SCT as a strategy for early case detection in hard-to-reach difficult terrain yields positive results in comparison to mere referral of PTBPs.展开更多
Missing data are always an issue in community-based longitudinal studies, calling into question the representativeness of samples and bias in conclusions, the research has generated. This may be due to the difficulty ...Missing data are always an issue in community-based longitudinal studies, calling into question the representativeness of samples and bias in conclusions, the research has generated. This may be due to the difficulty of implementing random sampling procedures in these studies and/or the inherent difficulty in sampling hard-to-reach segments of the population being studied. In fact, the ability to accurately study hard-to-reach populations in light of potential bias created by missing data remains an open question. In this study, missing data are defined as both failure to interview potential research participants identified in the sampling frame and failure to retain enrolled research participants longitudinally. Using the sample from the Mobile Youth Survey, a multiple-cohort, longitudinal study of adolescents living in highly impoverished neighborhoods in Mobile, Alabama, we examined sample representativeness and dropout to determine whether missing data led to a nonrepresentative, and therefore, biased sample. Results indicate that even though random procedures are not strictly used to draw the sample, (a) the sample appears to be largely representative of the population that was studied, and (b) attrition is largely uncorrelated with characteristics of those who dropped out. This suggests that it is possible to study with validity hard-to reach populations in community settings.展开更多
Background Schistosomiasis affects over 250 million people worldwide.Despite children and the poor being key risk groups,limited research and control activities target pre-school aged children(PSAC)and hard-to-reach p...Background Schistosomiasis affects over 250 million people worldwide.Despite children and the poor being key risk groups,limited research and control activities target pre-school aged children(PSAC)and hard-to-reach populations.As endemic countries shift the goals of their schistosomiasis programs from morbidity control to disease elimination,there is a need for inclusive planning to cover all affected age groups from all geographical areas and populations to achieve sustainable impact and health equity.Methods We conducted searches in MEDLINE,Web of Science,Embase(Ovid),and LILACS per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Reviews(PRISMA-ScR)guidelines.Quality assessment of identified articles was done using the Joanna Briggs Institute Prevalence Critical Appraisal Tool.Relevant study data were extracted from the articles and entered into Microsoft Excel 2016 for descriptive analysis.Results From the 17,179 screened articles,we identified 13 eligible studies on schistosomiasis in PSAC living in hard-to-reach areas and populations.All identified studies were from sub-Saharan Africa.The mean sample size of the retained studies was 572,with a balanced sex distribution among the young children sampled in each study.Ten studies investigated Schistosoma mansoni,one investigated Schistosoma haematobium,while two covered both S.mansoni and S.haematobium in the target population.The prevalence of S.mansoni among PSAC in the included studies was estimated at 12.9%in Ghana,80.3–90.5%in Kenya,35.0%in Madagascar,9.6–78.0%in Senegal,11.2–35.4%in Sierra Leone,44.4–54.9%in Tanzania and 39.3–74.9%in Uganda.Out of the three studies that investigated S.haematobium,the presence of the infection was reported in only one study carried out in Nigeria.Schistosome infections reported in nearly all studies included in this review were of light intensity.Only one study conducted in Nigeria documented visible hematuria in 17.7%of the PSAC studied.Conclusions The findings document the high prevalence of schistosomiasis among PSAC in hard-to-reach populations and underscore the need to consider this population subgroup when designing the expansion of preventive chemotherapy and schistosomiasis control activities.展开更多
Kiosk is a client centric drop-in centre for TB information and services established in urban and peri-urban (slum) settings to provide outreach services under project Axshya. The main objective of the study was to de...Kiosk is a client centric drop-in centre for TB information and services established in urban and peri-urban (slum) settings to provide outreach services under project Axshya. The main objective of the study was to demonstrate the efficacy and feasibility of scaling-up of the model to provide TB services. The assessment was carried out with the help of project recording and reporting formats used to document the information and services provided in the Kiosk from April 2016 to March 2017. The results from retrospective data analysis for services provided at 20 kiosks benefited 16,871 clients;of these 11,252 (66.7%), 1339 (7.9%), 848 (5%), 2911 (17.2%), (1.4%), 273 (1.6%) benefited with TB information, Flexi-DOT, sputum-collection-transportation (SCT), counselling, and domiciliary care respectively. Through active case finding (ACF);126,893 households were visited and 3593 presumptive-TB-patients received SCT services. A total of 329 TB patients were identified and linked to treatment services of national TB programme. “Kiosk” as a client centric approach would be a novel concept to ensure TB information, TB related services and contribute to ongoing efforts of TB case finding.展开更多
文摘Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the delivery of immunization services extremely challenging. Vaccinators needed a long walk through the hilly terrain to reach outreach sites. Community mobilizers were unable to go house to house to inform the caregivers to bring children to the site for vaccination. Caregivers were unaware when the vaccinators arrive at the site. As a result, many children missed vaccination or were not vaccinated timely. Age-appropriate vaccination coverage (according to national immunization schedule) in the Sirmaur district was the lowest in the state. Thinking out-of-box to address the communication barriers with the caregivers, the traditional drum beating was used, for the first time in India, in two blocks of the Sirmaur district (Rajpura and Shillai). The initiative was planned and implemented by the district health system with the support of the local community leaders. An exit interview was conducted to know the reach of the drum beating to caregivers, and a baseline and end line household survey was conducted to know the outcome of the initiative on age-appropriate vaccination coverage. Analysis of exit interviews data indicated a very high reach of a drum beating to the caregivers;more than 97% of caregivers in Rajpura and 100% in Shillai heard drum beating, and almost 95% of caregivers in Rajpura and 98% in Shillai knew the purpose of drum beating. Analysis of immunization data from baseline and end line surveys showed improvement in age-appropriate vaccination coverage for all vaccines in Rajpura (by 2.2% for BCG, 15.3% for Pentavalent 1, 14.9% for Pentavalent 2, 14.1% for Pentavalent 3, and 6.5% for Measles/MR). In Shillai, age-appropriate vaccination coverage improved for Pentavalent 1 (by 3.4%), Pentavalent 2 (by 5%) and Measles/MR (by 1.7%). In addition, dropout rates were reduced in both the blocks, particularly in Rajpura Pentavalent 1 to Measles dropout rate was reduced by 13.5%. Both health workers and community leaders had positive perceptions of the drum beating initiative. However, another important lesson learned from the initiative was that both the access and demand-side barriers need to be addressed for the desired improvement of age-appropriate immunization coverage. In Shillai, there was lower coverage improvement and a reduction in dropout rates attributed to vacant positions of vaccinators that caused an issue with access to immunization services to people.
文摘A community engagement project was designed and implemented to reach 10.6 million population in 13 districts of Uttarakhand state—India, to identify presumptive TB patients (PTBPs) and link to free diagnostics services, either through referral or sputum collection and transportation (SCT). The objective of this study is to determine additional yield of TB patients achieved by providing SCT services in comparison to referrals of PTBPs identified in hard-to-reach areas. This was before and after comparative study conducted between April-June 2014 (2Q2014-before) to July-September 2014 (3Q2014-after). SCT was advised for all PTBPs identified from community level interventions between July-September 2014 (3Q2014-after). In 3Q2014, additional 279 (34%) PTBPs were examined in the microscopy centre with an additional 36 (51%) new smear positive (NSP) patient diagnosed. A total of 46 NSP (128%) were contributed by SCT alone. Higher proportion (94%) of TB patients was initiated on treatment in 3Q2014 in comparison to 2Q2014 (91%). SCT as a strategy for early case detection in hard-to-reach difficult terrain yields positive results in comparison to mere referral of PTBPs.
文摘Missing data are always an issue in community-based longitudinal studies, calling into question the representativeness of samples and bias in conclusions, the research has generated. This may be due to the difficulty of implementing random sampling procedures in these studies and/or the inherent difficulty in sampling hard-to-reach segments of the population being studied. In fact, the ability to accurately study hard-to-reach populations in light of potential bias created by missing data remains an open question. In this study, missing data are defined as both failure to interview potential research participants identified in the sampling frame and failure to retain enrolled research participants longitudinally. Using the sample from the Mobile Youth Survey, a multiple-cohort, longitudinal study of adolescents living in highly impoverished neighborhoods in Mobile, Alabama, we examined sample representativeness and dropout to determine whether missing data led to a nonrepresentative, and therefore, biased sample. Results indicate that even though random procedures are not strictly used to draw the sample, (a) the sample appears to be largely representative of the population that was studied, and (b) attrition is largely uncorrelated with characteristics of those who dropped out. This suggests that it is possible to study with validity hard-to reach populations in community settings.
文摘Background Schistosomiasis affects over 250 million people worldwide.Despite children and the poor being key risk groups,limited research and control activities target pre-school aged children(PSAC)and hard-to-reach populations.As endemic countries shift the goals of their schistosomiasis programs from morbidity control to disease elimination,there is a need for inclusive planning to cover all affected age groups from all geographical areas and populations to achieve sustainable impact and health equity.Methods We conducted searches in MEDLINE,Web of Science,Embase(Ovid),and LILACS per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Reviews(PRISMA-ScR)guidelines.Quality assessment of identified articles was done using the Joanna Briggs Institute Prevalence Critical Appraisal Tool.Relevant study data were extracted from the articles and entered into Microsoft Excel 2016 for descriptive analysis.Results From the 17,179 screened articles,we identified 13 eligible studies on schistosomiasis in PSAC living in hard-to-reach areas and populations.All identified studies were from sub-Saharan Africa.The mean sample size of the retained studies was 572,with a balanced sex distribution among the young children sampled in each study.Ten studies investigated Schistosoma mansoni,one investigated Schistosoma haematobium,while two covered both S.mansoni and S.haematobium in the target population.The prevalence of S.mansoni among PSAC in the included studies was estimated at 12.9%in Ghana,80.3–90.5%in Kenya,35.0%in Madagascar,9.6–78.0%in Senegal,11.2–35.4%in Sierra Leone,44.4–54.9%in Tanzania and 39.3–74.9%in Uganda.Out of the three studies that investigated S.haematobium,the presence of the infection was reported in only one study carried out in Nigeria.Schistosome infections reported in nearly all studies included in this review were of light intensity.Only one study conducted in Nigeria documented visible hematuria in 17.7%of the PSAC studied.Conclusions The findings document the high prevalence of schistosomiasis among PSAC in hard-to-reach populations and underscore the need to consider this population subgroup when designing the expansion of preventive chemotherapy and schistosomiasis control activities.
文摘Kiosk is a client centric drop-in centre for TB information and services established in urban and peri-urban (slum) settings to provide outreach services under project Axshya. The main objective of the study was to demonstrate the efficacy and feasibility of scaling-up of the model to provide TB services. The assessment was carried out with the help of project recording and reporting formats used to document the information and services provided in the Kiosk from April 2016 to March 2017. The results from retrospective data analysis for services provided at 20 kiosks benefited 16,871 clients;of these 11,252 (66.7%), 1339 (7.9%), 848 (5%), 2911 (17.2%), (1.4%), 273 (1.6%) benefited with TB information, Flexi-DOT, sputum-collection-transportation (SCT), counselling, and domiciliary care respectively. Through active case finding (ACF);126,893 households were visited and 3593 presumptive-TB-patients received SCT services. A total of 329 TB patients were identified and linked to treatment services of national TB programme. “Kiosk” as a client centric approach would be a novel concept to ensure TB information, TB related services and contribute to ongoing efforts of TB case finding.
