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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front cover © Hannah Maule-Ffinch/Save the Children
Le Burkina Faso est un pays sahélien sans littoral d’une superficie de 274 000 km2 et une
population estimée à 17,4 millions d’habitants en 2013 avec une croissance démographique de
3,1%. C’est l’un des pays les plus pauvres du monde avec un Produit intérieur brut par tête de
684 US...$ (Banque Mondiale, 2013), un indice de développement humain (IDH) de 0,388 et une
incidence de la pauvreté de 46,7% (INSD, 2009). Environ 80% de la population vit directement
ou indirectement de l’agriculture de subsistance au gré des aléas climatiques.
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Advances have been made through expanded interventions delivered through five public health approaches: innovative and intensified disease management; preventive chemotherapy; vector ecology and management; veterinary public health services; and the provision of safe water, sanitation and hygiene. I...n 2015 alone nearly one billion people were treated for at least one disease and significant gains were achieved in relieving the symptoms and consequences of diseases for which effective tools are scarce; important reductions were achieved in the number of new cases of sleeping sickness, of visceral leishmaniasis in South-East Asia and also of Buruli ulcer.
The report also considers vector control strategies and discusses the importance of the draft WHO Global Vector Control Response 2017–2030.
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Lancet Glob Health 2018 Published Online September 12, 2018 http://dx.doi.org/10.1016/S2214-109X(18)30409-1
The CBDRR Manual is a practical ‘how-to’ guide on community-based disaster risk reduction for government and non-government agencies in Lao PDR. It is a commonly agreed document to be referred to by agencies working on CBDRR in Lao PDR. It provides guidance and support for systematic implementat...ion of CBDRR programs by explaining each of the steps as well as tools used.
The manual will also support the Government of Lao PDR (GoL) to monitor CBDRR activities, oversee progress of activities implemented by different actors and locations, provide necessary support on CBDRR technical knowledge as well as provide a reference point for replication of initiatives for local government and implementing agencies.
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The burden of diabetes is enormous, positioning it as one of the main challenges facing public health today. Currently, it is estimated that 62 million people are living with diabetes in the Region of the Americas and projections show its prevalence will continue rising over the following years. The... Region shows the highest number of years of healthy life lost (through either disability or premature death) due to diabetes worldwide. The high costs associated with its treatment produce a heavy economic burden. Its complications can seriously affect the quality of life of people living with diabetes, their families, and society and overload health systems. This report shows the latest internationally comparable data on diabetes and its main risk factors by year, country, and sex. It also includes a summary of the countries health systems’ response to diabetes, including national plans, targets, surveillance, guidelines, and access to essential drugs and technologies, and synthesizes information about diabetes-related complications and the close relationship between diabetes and other pathologies, such as cardiovascular diseases, tuberculosis, and COVID-19. The data presented here reveal that, despite advances in national responses, diabetes continues to expand, and our response remains insufficient. This report aims to draw attention to the urgent need to strengthen efforts to prevent, diagnose, and control diabetes in the Region of the Americas.
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Working Document, September 2017