Browsing by Subject "CHW"

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    Influence of social support on childhood vaccine uptake in a migrant community in Roatan, Honduras
    (2019-04-01) Watkins, Kathryn
    According to the World Health Organization, greater social support from family, friends, and community members is correlated with better health outcomes. In the migrant community of La Colonia on the island of Roatán, Honduras, most residents are lower-income, young families who emigrate from the mainland seeking better job and educational opportunities. In the process of migration, families typically lose social support networks and structures they previously had access to. In a study in 2016, our team found that in comparison to the rest of Roatan, children living in La Colonia had lower vaccination coverage. In the current study, we sought to examine the role of social support on childhood vaccine uptake in La Colonia. In summer 2018, we completed fifty surveys of mothers with young children living in La Colonia. The survey included standardized social support questions to evaluate linkages between self-reported social connectedness and vaccine uptake. In addition, two focus groups with mothers of young children living in La Colonia were conducted to understand the ways that mothers leverage social support networks and CHW interactions to access and provide healthcare. Vaccination uptake among young children in La Colonia was above 97% for all but one vaccine; however, we found that some mothers reported difficulty accessing vaccines related to a lack of social support. We did not find any statistically significant relationship between vaccine uptake and social support from our survey social support scale, likely due to high vaccine uptake and small sample size of children with accessible vaccine cards at the time of the survey (n=35). We also found that mothers view churches as an acceptable social apparatus for dissemination of health knowledge and community-based childhood interventions. These results suggest that building social support in migrant communities is important for uptake of preventive behaviors, particularly vaccines, although more research is needed to determine if a statistically significant relationship exists between social support and vaccine uptake. Churches could be leveraged as venues to offer interventions aimed at increasing vaccine uptake and community knowledge about benefits of vaccinations.
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    Use and Limitations of Malaria Rapid Diagnostic Testing in Sub-Saharan Africa: a Systematic Review & Longitudinal Study in Western Kenya
    (2017) Boyce, Matthew R

    The World Health Organization recommends parasitological confirmation of malaria prior to treatment. Malaria rapid diagnostic tests (RDTs) represent simple, mobile diagnostic technologies that are used in a variety of contexts to overcome limitations of other techniques. Malaria RDTs increase the availability and feasibility of accurate diagnoses and may result in improved quality of care. Though RDTs are used in a variety of contexts, no studies have compared how well or effectively RDTs are used across different contexts and types of care providers. This report is composed of two related works: a systematic review and a longitudinal study. The systematic review was conducted to describe the diagnostic use of RDTs in formal health facilities, the community, drug shops and schools. A comprehensive search of the Pubmed database was conducted to evaluate RDT execution, test accuracy, or adherence to test results in sub-Saharan Africa. Overall, RDTs were performed safely and effectively by community health workers provided they receive proper training, but analogous information was largely absent for formal health care workers. Tests were generally accurate across contexts, except for in drug shops where lower specificities were observed. Adherence treatment guidelines based on RDT results was higher among drug shop vendors and community health workers, while adherence was more variable among formal health care workers, most notably with negative test results. Malaria RDTs are generally used well, though compliance with recommended treatment based on test results is variable – especially in the formal health care sector. However, their use by community health workers (CHWs) remains in question due concerns about long-term trends relating to blood safety, the interpretation of test results, and adherence to treatment protocols. In addition to the systematic review, a longitudinal study was conducted to determine if CHWs maintained their competency at conducting RDTs over a 12-month timeframe, and if this competency varied with various socio-demographic measures. 103 CHWs in Kenya were recruited into longitudinal study to compare RDT execution at the time of training and 12 months post-training. Community health workers performed RDTs at acceptable levels, with at least 80% of CHWs completing 18 of the 22 steps correctly. Quality of performance did not decrease over the 12 months. Socio-demographic characteristics including being younger than 50 years of age, and previous experiences with malaria RDTs were correlated with better performance over time. Community health workers provided very accurate interpretation of RDT results, especially when considering only strong-positive and negative test results. Training in using Deki reader devices was associated with better performance in interpreting RDT results. In conclusion, CHWs perform RDTs sufficiently, maintain competency for at least 12 months, and better performance can be associated with certain characteristics. The results of both studies hold important implications for health policy and future multidisciplinary research.