Browsing by Subject "community health workers"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Open Access
    A descriptive study of the community-based follow-up and outcomes of very low birth weight babies discharged from a regional hospital
    (2022) Gondwana de Wit, Thandi Maya; Hendricks, Michael
    Background Neonatal mortality continues to be a significant global health concern, especially in low/middle income countries. In South Africa, neonatal deaths contribute to 32% of the under-five mortality rate, with 48% of these deaths attributed to prematurity. One of the components aimed at reducing neonatal deaths in the Western Cape, is the Home and Community-Based Services (HCBS) for very low birth weight (VLBW) babies. This intervention could reduce neonatal deaths by 25%. This study aimed to describe a VLBW baby cohort discharged from a regional hospital in Cape Town over a year; the HCBS referral process; their follow-up; their outcomes and caregivers' perceptions of the service. Methods This was a retrospective descriptive mixed methods study. Quantitative data from an accredited database were used to describe the VLBW cohort. Meetings with stakeholders and referral form analyses were used to assess the referral pathway and follow-up. Telephonic interviews were held with VLBW babies' caregivers to obtain further quantitative and qualitative data about the HCBS programme. Results During 2018, 169 VLBW babies were included in the population with a mean (SD) gestational age of 30 (±2.21) weeks and median (IQR) birthweight of 1210g (1045-1390g). At delivery, 84.6% had respiratory distress with 60% requiring continuous positive airway pressure; 64% had presumed and 15.3% had suspected or proven nosocomial sepsis. Caregiver characteristics included unbooked pregnancies (10%), primigravida deliveries (15%), smoking (11%), maternal alcohol use (9%), teenage pregnancy (5%), drug addiction (3%) and babies born before hospital arrival (4%) with 14% being referred to a social worker. Folder review showed plans for HCBS referral in only 49 (43.4%) of the cohort, however only 20 (17.7%) referral forms were received by HCBS. Learning about the VLBW HCBS programme identified several challenges relating to the referral process from both the hospital and HCBS side. Overall, the caregivers interviewed had positive perceptions of the HCBS. Those not visited by HCBS felt they would have benefitted from a visit. Conclusion The burden of this medically and socially vulnerable VLBW cohort, who are at high risk of neonatal mortality and morbidity, remains large at this regional hospital - constituting nearly 15% of all their neonatal discharges. Despite the identified challenges, the caregivers' interviewed remained positive about the HCBS. HCBS can play an essential role in providing education, counselling and support following hospital discharge. However, for the HCBS to be fully effective, further promotion, strengthening and monitoring of the referral system is required.
  • Thumbnail Image
    Item
    Open Access
    A systematic review of digital health tools used for decision support by frontline health workers (FLHWs) in low- and middle- income countries (LMICs)
    (2019) De Leeuw, Kirran; Swartz, Alison; Lefevre, Amnesty
    In in low-and middle-income countries (LMIC), where there are very few trained physicians and nurses, community health workers (CHWs) are often the only providers of healthcare to millions of people. Such LMIC are countries that are classified, based on their geographic region and Gross National Income (GNI), as low-middle income by the World Bank Group, the worlds largest development bank. Research has shown digital health tools to be an effective strategy to improve the performance of frontline line health workers. The aim of this review was to systematically examine the literature on digital health tools that are used for decision support in LMIC and describe what we can learn from studies that have used these tools. As part of a larger parent study the following databases were searched: PubMed, Embase, Scopus, CINAHL, Global Health Ovid, Cochrane and Global Idex Medicus, to find ariticles in the following domains: training tools, decision support, data capture, commodity tracking, provider to provider communication, provider to patient communication and alerts, reminders, health information content. These domains were selected based on the World Health Organisation (WHO) framework for classifying digital health interventions. Content from all seven of these domains informed a series of reviews however this review focuses on how digital tools are used to provide decision support to FLHWs. Included studies were conducted in LMIC in Africa, Asia, North America and South America with the most common users of the tools being CHWs. Most tools for FLHW decision-support used in the interventions described in included articles were in either the pilot or prototype phases, and offered maternal and child health care services. Although decision support was the primary digital health function of all these studies, there was considerable variation in the number of digital health functions of each tool with most studies reporting decision support and data capture as their primary and secondary functions respectively. All the studies found their intervention to have beneficial effects on one or more of the following outcomes: beneficiary engagement, provider engagement, health effects and process/outputs. These findings show great potential for the use of decision support digital health tools as a means of improving the outcomes of health systems through; reducing the work load of FLHWs, reducing the costs of health care, improving the efficiency of service delivery and/or improving the overall quality of care.
  • Thumbnail Image
    Item
    Open Access
    Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa
    (2015) Levitt, Naomi S; Puoane, Thandi; Denman, Catalina A; Abrahams-Gessel, Shafika; Surka, Sam; Mendoza, Carlos; Khanam, Masuma; Alam, Sartaj; Gaziano, Thomas A
    BackgroundWe have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management.DesignPatient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained.ResultsThirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system.ConclusionsThe existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment.