BackgroundThe potential role of Community Health Workers (CHWs) in improving maternal and child health outcomes, particularly in low and middle-income countries and in disadvantaged communities, is receiving increased attention. Adequate and focused training is among the key requisites for enhancing CHWs performances and research is necessary to identify effective training methods.MethodsA randomized controlled study was designed to assess the effectiveness of a training course in improving knowledge, attitudes and practices (KAP) of CHWs regarding maternal and infant health. Seventy-eight CHWs belonging to Family Health Units in the city of Recife, Brazil were randomly allocated to intervention and control groups. The intervention group took part in a four-day interactive training course based on an action-oriented guide to perform home visits to pregnant women and their infants throughout pregnancy and infancy until 9 months of age. KAP in intervention group after training and after 1 year were compared to control group and to baseline.ResultsFifty-nine CHWs completed all KAP assessments (31 in intervention and 28 in control group). Baseline characteristics were similar in both groups. At 1 year from training, the intervention group had higher overall KAP score (120.65 vs. 108.19, p < 0.001) as well as knowledge (47.45 vs. 40.54, p < 0.001), practice (53.45 vs. 49.11, p < 0.001) and attitudes scores (19.74 vs. 18.81, p = 0.047) than the control group. Moreover, at 1 year from training, the intervention group maintained significant improvements in overall KAP score (120.65 vs. 106.55, p < 0.001) as well as in knowledge (45.45 vs. 42.13, p < 0.001), and practice (53.45 vs. 45.29, p < 0.001) scores with respect to baseline. In the control group, overall KAP (106.59 vs. 108.19, p = 0.345) as well as separate knowledge, attitudes and practices scores remained unchanged.ConclusionsA four-day interactive training course on action-oriented home visits to pregnant women and infants produced a sustained improvement of CHWs’ KAP and may represent a model to ensure retention of acquired competences.Trial registrationRBR-9gchqr. Date registered: July 21, 2018 (Retrospectively registered).Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1332-x) contains supplementary material, which is available to authorized users.
The Didelphidae are considered solitary opossums with few social interactions, usually limited to mating-related or mother-pouch young interactions. Anecdotal reports suggest that additional interactions occur, including den sharing by a few individuals, usually siblings. Here, we report novel observations that indicate opossums are more social than previously thought. These include nest sharing by males and females of Marmosa paraguayana, Gracilinanus microtarsus and Marmosops incanus prior to the onset of the breeding season and without signs of sexual activity; this is taken to indicate early pairbonding matching and cooperative nest building. We also recorded den sharing among recently weaned siblings of Didelphis aurita and Caluromys philander. In addition, we observed 13 individuals of Didelphis albiventris representing three age classes resting without agonistic interactions in a communal den. These are the first reports of gregarious behaviour involving so many individuals, which are either unrelated or represent siblings from at least two litters, already weaned, sharing the same den with three adults. Sociality in opossums is probably more complex than previously established, and field experimental designs combining the use of artificial nests with camera traps or telemetry may help to gauge the frequency and extent of these phenomena.
Objetivo: Avaliar o efeito de um programa de Visitas Domiciliares Inovadoras (VDI), que é baseado em um guia de orientação, nos conhecimentos e práticas de saúde das mães em relação aos cuidados da criança e durante os períodos pré/pós-natal, e indicadores de saúde materno-infantil (ISMI). Métodos: Estudo transversal e analítico que comparou 195 gestantes e mães que receberam VDI (grupo 1) com o grupo 2, de visitas domiciliares convencionais (VDC), realizado em Unidades de Saúde da Família (USF) de Recife, Pernambuco, entre 2015 a 2016. Dividiram-se 16 equipes de saúde da família em dois grupos: oito equipes receberam treinamento para VDI e oito não receberam. Houve dez VDI com a utilização do guia, durante a gestação e durante os nove meses da criança. As VDC ocorreram uma vez/mês, durante o mesmo período das VDI, mas sem o guia. Após nove meses, as participantes foram entrevistadas através de questionário com conteúdos relacionados à saúde materno-infantil. Resultados: 93 gestantes (49 do grupo 1 e 44 do 2) e 102 mães de crianças (57 do grupo 1 e 45 do 2) responderam aos questionários. Os resultados mostraram melhores indicadores de pré-natal (p=0,005), melhor conhecimento sobre métodos contraceptivos (p
Background Increasing efforts towards quality improvement are necessary in low and middle-income countries to reduce maternal and perinatal mortality and morbidity, and to promote respectful care. In Brazil, perinatal health indicators are below targets in several States despite universal access to perinatal services and very high rates of institutional births, indicating poor quality of care (QoC) as a key issue to be addressed. However, research efforts to develop and test QoC improvement interventions are scarce. We assessed the effects of a 1-year comprehensive quality improvement cycle using a World Health Organization (WHO) assessment and quality tool on maternal and newborn care at hospital level and documented quality improvements obtained. Methods Uncontrolled, unblinded, pre-post study carried out in six maternity hospitals in Pernambuco, Brazil accounting for 29.128 live births in 2014. A standards-based, participatory approach based on a WHO quality assessment and improvement tool for maternal and neonatal care at hospital level. A national team of assessors supervised by international experts carried out baseline and final assessments. An action plan was developed and implemented to address key quality gaps emerging from the baseline assessment and from two supportive supervision visits. Results At baseline, hospitals presented a variety of quality gaps, the majority common to all participating centers. Gaps in case management of normal and complicated deliveries, and in respectful and holistic care were predominant, in both teaching/tertiary and secondary care hospitals. After one year, several improvements were observed, particularly in respectful care during labor and at delivery, in case management of normal labor and delivery, and in neonatal care. Conclusions A systematic participatory approach based on a WHO tool produced important quality improvements in a relatively short time and should be considered for use for large scale quality improvement programs in Brazil and other low and middle-income countries. Its comprehensive, peer-to-peer and action-oriented nature, its capability to document quality improvement over time and to build a quality improvement culture represent important comparative advantages over other quality improvement interventions.
Objective: To compare BCG vaccination involving a single intradermal dose and that involving multiple doses, one given with the multiple puncture technique, in terms of the protective effect against the subsequent onset of asthma. Methods: A retrospective cohort study involving 2,311 individuals having received the BCG vaccine. The patients were classified according to the number of doses of BCG vaccine administered (one; two; or three or more). The minimum follow-up period in order to determine whether there was any protective effect of BCG vaccination regarding the diagnosis of asthma was 10 years. Results: The sample included 1,317 individuals (56.99%) who had received only one BCG dose, 644 (27.87%) who had received two doses, and 350 (15.14%) who had received three or more doses. The number of patients diagnosed with asthma among those who had received one dose, two doses and three or more doses was, respectively, 216 (16.40%), 107 (16.61%) and 50 (14.28%). There were no significant differences among the groups. Conclusions: In the study sample, the prevalence of asthma among individuals having received multiple doses of the BCG vaccine was no different than that observed among those having received a single dose.Keywords: Asthma; BCG vaccine; Immunization, secondary. ResumoObjetivo: Comparar a vacinação com uma única dose de BCG intradérmica com a vacinação com múltiplas doses, uma das quais pela técnica de multipuntura, em relação ao efeito protetor contra o aparecimento posterior de asma. Métodos: Estudo de coorte retrospectivo com 2.311 pessoas vacinadas com BCG. Os indivíduos foram classificados de acordo com o número de doses de vacina BCG recebidas (uma dose, duas doses e três ou mais doses). O tempo mínimo de acompanhamento para verificar se houve algum efeito protetor da vacina BCG em relação ao diagnóstico de asma foi de 10 anos. Resultados: A amostra incluiu 1.317 pessoas (56,99%) que receberam apenas uma dose do BCG, 644 (27,87%) que receberam duas doses e 350 (15,14%) com três ou mais doses. O número de pacientes diagnosticados com asma entre aqueles que receberam uma dose de BCG, duas doses e três ou mais doses foi, respectivamente, 216 (16,40%), 107 (16,61%) e 50 (14,28%). Não houve diferenças significativas entre os grupos. Conclusões: Na amostra estudada, não foi observada uma redução na prevalência de diagnóstico de asma com a revacinação ou com o uso de múltiplas doses da vacina BCG.
Objectives: to describe the process of development and the structure of an action-oriented guide for home visits (HVs) to mothers and infants by Community Health Workers (CHWs
Insulin-like growth factor 2 (IGF2) gene has an important role in fetal growth. It was investigated association of the IGF2/ApaI polymorphism with low birth weight and normal birth weight (as control) in children attended in Hospital Dom Malan Petrolina, PE-Brazil. The genotype frequencies did not differ statistically between low birth weight (AA = 16.22%, AG = 43.24%, GG = 40.54%) and control (AA = 20% AG = 35%, GG= 45% groups) and the allele frequencies were not significantly different (p > 0.05).The observed genotype frequencies in both groups did not deviate significantly from Hardy-Weinberg equilibrium. Then, no significant correlation was found for this polymorphism in the population studied.
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