Experiences and perspectives of community health workers from implementing treatment for schistosomiasis using the community directed intervention strategy in an informal settlement in Kisumu City, western Kenya
Experiences and perspectives of community health workers from implementing treatment for schistosomiasis using the community directed intervention strategy in an informal settlement in Kisumu City, western Kenya
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DOI：
10.1186/s12889-016-3662-0
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发表时间：
2016-09-15
影响因子：
4.5
通讯作者：
Mwinzi, Pauline N.
中科院分区：
文献类型：
--
作者：
Odhiambo, Gladys O.;Musuva, Rosemary M.;Mwinzi, Pauline N.
背景资料：社区指导的干预战略已被用于在非洲开展各种保健干预，包括控制被忽视的热带病。虽然土发委会的方法在控制盘尾丝虫病和淋巴丝虫病方面取得了良好的效果，但在控制城市穷人血吸虫病方面的效用尚待确定。采用纵向定性研究，我们探讨了经验，机遇，挑战以及建议的社区卫生工作者（CHWs）参与后，在每年的大规模药物管理（MDA）活动，血吸虫病使用CDI的方法在城市setting.Methods：非结构化的开放式小组讨论后，每年的MDA活动完成与CHWs进行。在小组讨论期间使用数字录音机从CHW获得叙述，逐字转录并翻译成英语（如适用）。使用ATLAS.ti进行数据的专题分解。结果：从社区卫生工作者的角度来看，在城市环境中实施CDI的机会，包括社区卫生工作者的存在，他们的监督结构和他们对干预领域的知识，以及将MDA与其他健康干预措施相结合的机会。在利用土发委会战略实施MDA方面，提到了一些挑战，其中包括缺乏激励措施、担心副作用、对治疗的误解和不信任、在不卫生的环境条件下工作困难、不安全和时间不足。一个关键的建议，促进更有效的MDA使用CDI的方法是分配更多的时间来exercise.Conclusion：本研究的结果支持使用CDI的可行性，实施MDA的血吸虫病在城市地区的非正式住区。广泛的社区宣传和提供激励措施可能有助于解决上述与利用土发委会战略实施农村发展援助有关的挑战。本研究报告中强调的机会可能对其他可能考虑采用土发委会战略在城市环境中展开干预的方案具有价值。
Background: The Community Directed Intervention (CDI) strategy has been used to conduct various health interventions in Africa, including control of Neglected Tropical Diseases (NTDs). Although the CDI approach has shown good results in the control of onchocerciasis and lymphatic filariasis with respect to treatment coverage using community drug distributors, its utility in the control of schistosomiasis among urban poor is yet to be established. Using a longitudinal qualitative study, we explored the experiences, opportunities, challenges as well as recommendations of Community Health Workers (CHWs) after participation in annual mass drug administration (MDA) activities for schistosomiasis using the CDI approach in an urban setting.Methods: Unstructured open-ended group discussions were conducted with CHWs after completion of annual MDA activities. Narratives were obtained from CHWs using a digital audio recorder during the group discussions, transcribed verbatim and translated into English where applicable. Thematic decomposition of data was done using ATLAS.ti. software, and themes explored using the principle of interpretative phenomenological analysis (IPA).Results: From the perspective of the CHWs, opportunities for implementing CDI in urban settings, included the presence of CHWs, their supervisory structures and their knowledge of intervention areas, and opportunity to integrate MDA with other health interventions. Several challenges were mentioned with regards to implementing MDA using the CDI strategy among them lack of incentives, fear of side effects, misconceptions regarding treatment and mistrust, difficulties working in unsanitary environmental conditions, insecurity, and insufficient time. A key recommendation in promoting more effective MDA using the CDI approach was allocation of more time to the exercise.Conclusion: Findings from this study support the feasibility of using CDI for implementing MDA for schistosomiasis in informal settlements of urban areas. Extensive community sensitization and provision of incentives may help address the aforementioned challenges associated with implementing MDA using the CDI strategy. Opportunities highlighted in this study may be of value to other programmes that may be considering the adoption of the CDI strategy for rolling out interventions in the urban setting.