Shadow Puppets and Neglected Diseases (2): A Qualitative Evaluation of a Health Promotion Performance in Rural Indonesia.
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SUBMITTER: Williams C
PROVIDER: S-EPMC6313519 | biostudies-literature | 2018 Dec
REPOSITORIES: biostudies-literature
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Shadow Puppets and Neglected Diseases (2): A Qualitative Evaluation of a Health Promotion Performance in Rural Indonesia.
Williams Courtney C Stewart Donald E DE Bendrups Dan D Laksono Budi B Susilo Joko J Amaral Salvador S Kurscheid Johanna J Gray Darren J DJ
International journal of environmental research and public health 20181212 12
Performing arts used as a method of spreading health information dates back to the origins of storytelling. However, interventions in developing, non-Western countries typically utilize Western entertainment forms. This qualitative investigation assesses responses to an intervention designed around traditional Javanese shadow puppetry (<i>wayang kulit</i>). Semi-structured interviews provided in-depth responses from a sample (N = 12) of villagers. Responses analyzed both cross-case and within-ca ...[more]
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Project description:'Rama and the Worm' is a shadow puppet production targeting neglected diseases in Central Java. It is an entertainment-based intervention study to promote health by reducing the impact of parasitic diseases such as soil-transmitted helminths (STH). The study uses traditional Javanese shadow puppetry (wayang kulit) as a vehicle in village communities to disseminate health messages and promote behaviour change to prevent diseases caused, primarily, by inadequate sanitation and poor hygiene. The health education messages contained in the play, although using traditional characters and themes, required the creation of a completely new narrative script, using characters and plot lines familiar to the wayang kulit repertoire, but placing them in new situations that relate specifically to health promotion objectives. The intervention was piloted in a village in Central Java, Indonesia using a pre/post design with both qualitative and quantitative analysis. A total of 96 male and female villagers, aged between 7 and 87 years, provided both baseline and follow up data. Participant knowledge and behaviours related to gastrointestinal and helminth-related disease were assessed before and after the intervention through a questionnaire administered by interview. Results revealed statistically significant improvements in both knowledge (48.6% pre-intervention score vs. 62.8% post-intervention score, p < 0.001) and behaviour (77.4% vs. 80.6%, p = 0.004) related to gastrointestinal and helminth disease. Findings of the study indicate the wayang kulit performance is an effective health education tool. The results provide proof of concept with scaling up the next step forward. The wayang kulit production provides a significant additional component for an integrated, comprehensive approach to reduction and elimination of STH infection.
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Project description:BACKGROUND: Rickettsioses are one of the most important causes of systemic febrile illness among travelers from developed countries, but little is known about their incidence in indigenous populations, especially in West Africa. METHODOLOGY/PRINCIPAL FINDINGS: Overall seroprevalence evaluated by immunofluorescence using six rickettsial antigens (spotted fever and typhus group) in rural populations of two villages of the Sine-Saloum region of Senegal was found to be 21.4% and 51% for spotted fever group rickettsiae for Dielmo and Ndiop villages, respectively. We investigated the role of tick-borne rickettsiae as the cause of acute non-malarial febrile diseases in the same villages. The incidence of rickettsial DNA in 204 blood samples from 134 (62M and 72F) febrile patients negative for malaria was studied. DNA extracted from whole blood was tested by two qPCR systems. Rickettsial DNA was found in nine patients, eight with Rickettsia felis (separately reported). For the first time in West Africa, Rickettsia conorii was diagnosed in one patient. We also tested 2,767 Ixodid ticks collected in two regions of Senegal (Niakhar and Sine-Saloum) from domestic animals (cows, sheep, goats, donkeys and horses) by qPCR and identified five different pathogenic rickettsiae. We found the following: Rickettsia aeschlimannii in Hyalomma marginatum rufipes (51.3% and 44.8% in Niakhar and Sine-Saloum region, respectively), in Hyalomma truncatum (6% and 6.8%) and in Rhipicephalus evertsi evertsi (0.5%, only in Niakhar); R. c. conorii in Rh. e. evertsi (0.4%, only in Sine-Saloum); Rickettsia massiliae in Rhipicephalus guilhoni (22.4%, only in Niakhar); Rickettsia sibirica mongolitimonae in Hyalomma truncatum (13.5%, only in Sine-Saloum); and Rickettsia africae in Rhipicephalus evertsi evertsi (0.7% and 0.4% in Niakhar and Sine-Saloum region, respectively) as well as in Rhipicephalus annulatus (20%, only in Sine-Saloum). We isolated two rickettsial strains from H. truncatum: R. s. mongolitimonae and R. aeschlimannii. CONCLUSIONS/SIGNIFICANCE: We believe that together with our previous data on the high prevalence of R. africae in Amblyomma ticks and R. felis infection in patients, the presented results on the distribution of pathogenic rickettsiae in ticks and the first R. conorii case in West Africa show that the rural population of Senegal is at risk for other tick-borne rickettsioses, which are significant causes of febrile disease in this area.
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Project description:INTRODUCTION:Birthing centres (BC) in Nepal are mostly situated in rural areas and provide care for women without complications. However, they are often bypassed by women and their role in providing good quality maternity services is overlooked. This study evaluated an intervention to increase access and utilisation of perinatal care facilities in community settings. METHODS:This longitudinal cross-sectional study was conducted over five years in four villages in Nepal and included two BCs. An intervention was conducted in 2014-2016 that involved supporting the BCs and conducting a health promotion programme with local women. Population-based multi-stage sampling of women of reproductive age with a child below 24 months of age was undertaken. Household surveys were conducted (2012 and 2017) employing trained enumerators and using a structured validated questionnaire. The collected data were entered into SPSS and analysed comparing pre- and post-intervention surveys. RESULTS:The intervention was associated with an increase in uptake in facility birth, with an increase in utilisation of perinatal services available from BCs. The post-intervention survey provided evidence that women were more likely to give birth at primary care facilities (OR 5.60, p-value <0.001) than prior to the intervention. Similarly, the likelihood of giving birth at a health facility increased if decision for birthplace was made jointly by women and family members for primary care facilities (OR 1.76, p-value 0.023) and hospitals/tertiary care facilities (OR 1.78, p-value 0.020. If women had less than four ANC visits, then they were less likely to give birth at primary care facilities (OR 0.39, p-value <0.001) or hospitals/tertiary care facilities (OR 0.63, p-value 0.014). Finally, women were less likely to give birth at primary care facilities if they had only primary level of education (OR 0.49, p-value 0.014). CONCLUSION:BCs have the potential to increase the births at health facilities and decrease home births if their services are promoted by the local health promoters. In addition, socio-economic factors including women's education, the level of women's autonomy and having four or more ANC visits affect the utilisation of perinatal services at the health facility.
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Project description:BackgroundControl of preventive chemotherapy-targeted neglected tropical diseases (PC-NTDs) relies on strengthened health systems. Efficient health information systems provide an impetus to achieving the sustainable development goal aimed at ending PC-NTD epidemics. However, there is limited assessment of surveillance system functions linked to PC-NTDs and hinged on optimum performance of surveillance system attributes. The study aimed to evaluate surveillance system attributes based on healthcare workers' perceptions in relation to PC-NTDs endemic in Kenya.MethodsA cross-sectional health facility survey was used to purposively sample respondents involved in disease surveillance activities. Consenting respondents completed a self-administered questionnaire that assessed their perceptions on surveillance system attributes on a five-point likert scale. Frequency distributions for each point in the likert scale were analysed to determine health workers' overall perceptions. Data was analysed using descriptive statistics and estimated median values with corresponding interquartile ranges used to summarise reporting rates. Factor analysis identified variables measuring specific latent attributes. Pearson's chi-square and Fisher's exact tests examined associations between categorical variables. Thematic analysis was performed for questionnaire open-ended responses.ResultsMost (88%) respondents worked in public health facilities with 71% stationed in second-tier facilities. Regarding PC-NTDs, respondents perceived the surveillance system to be simple (55%), acceptable (50%), stable (41%), flexible (41%), useful (51%) and to provide quality data (25%). Facility locality, facility type, respondents' education level and years of work experience were associated with perceived opinion on acceptability (p = 0.046; p = 0.049; p = 0.032 and p = 0.032) and stability (p = 0.030; p = 0.022; p = 0.015 and p = 0.024) respectively. Median monthly reporting timeliness and completeness rates for facilities were 75 (58.3, 83.3) and 83.3 (58.3, 100) respectively. Higher-level facilities met reporting timeliness (p < 0.001) and completeness (p < 0.001) thresholds compared to lower-level facilities.ConclusionHealth personnel had lower perceptions on the stability, flexibility and data quality of the surveillance system considering PC-NTDs. Reporting timeliness and completeness rates decreased in 2017 compared to previous surveillance periods. Strengthening all surveillance functions would influence health workers' perceptions and improve surveillance system overall performance with regard to PC-NTDs.
| S-EPMC7903773 | biostudies-literature
Project description:BackgroundDespite known gender-specific differences in terms of prevalence, transmission and exposure to neglected tropical diseases (NTDs), there is limited discussion of the influence of gender in NTD programmes and interventions. There is a paucity of research on how gender interacts with NTD service provision and uptake. This study, part of broader implementation research in Ethiopia, applied a gender lens to health seeking for five NTDs: lymphatic filariasis, podoconiosis, schistosomiasis, soil-transmitted helminth infection and trachoma.Methodology/principal findingsThe study was conducted in a district of the Southern Nations, Nationalities, and Peoples' Region of Ethiopia where the five NTDs are prevalent. A qualitative methodology was adopted to explore participants' perspectives and experiences. Data generation methods included 20 interviews and four focus group discussions. Community members, volunteer Health Development Army leaders, Health Extension Workers and a range of health workers at the health post, health centre and hospital level (n = 59) were purposively sampled. Interviews and focus group discussions were audio recorded, transcribed verbatim into English then analysed through open coding, drawing on constant comparative methods. Gender related factors affected care seeking for NTDs and were described as reasons for not seeking care, delayed care seeking and treating NTDs with natural remedies. Women faced additional challenges in seeking health care due to gender inequalities and power dynamics in their domestic partnerships. Participants recommended raising community awareness about NTDs, however this remains problematic due to gender and social norms around appropriate discourse with members of the opposite gender.Conclusions/significanceThe findings from this study provide crucial insights into how gender interacts with accessing health services, at different levels of the health system. If we are committed to leaving no one behind and achieving universal health coverage, it is essential to address gender disparities to access and utilisation of interventions delivered by national NTD programmes.
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Project description:BACKGROUND: Over the past two decades, international health policies focusing on the fight against the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis (TB), malaria, and those diseases that address maternal and child health problems, among others, have skewed disease control priorities in China and other Asian countries. Although these are important health problems, an epidemic of chronic, non-communicable diseases (NCDs) in China has accounted for a much greater burden of disease due to the ongoing rapid socioeconomic and demographic transition. DISCUSSION: Although NCDs currently account for more than 80% of the overall disease burden in China, they remain very low on the nation's disease control priorities, attracting marginal investment from central and local governments. This leaves the majority of patients with chronic conditions without effective treatment. International organizations and national governments have recognized the devastating social and economic consequences caused by NCDs in low- and middle-income countries, including China. Yet, few donor-funded projects that address NCDs have been implemented in these countries over the past decade. Due to a lack of strong support from international organizations and national governments for fighting against NCDs, affected persons in China, especially the poor and those who live in rural and less developed regions, continue to have limited access to the needed care. Costs associated with frequent health facility visits and regular treatment have become a major factor in medical impoverishment in China. This article argues that although China's ongoing health system reform would provide a unique opportunity to tackle current public health problems, it may not be sufficient to address the emerging threat of NCDs unless targeted steps are taken to assure that adequate financial and human resources are mapped for effective control and management of NCDs in the country. SUMMARY: The Chinese government needs to develop a domestically-driven and evidence-based disease control policy and funding priorities that respond appropriately to the country's current epidemiological transition, and rapid sociodemographic and lifestyle changes.
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Project description:This study aims to analyze the efficiency performance of conventional and Islamic rural banks in Indonesia, specifically, Bank Perkreditan Rakyat (BPR) and Bank Pembiayaan Rakyat Syariah (BPRS). Using a DEA approach, the results indicate that both BPR and BPRS are still inefficient in terms of the intermediation role but are efficient in production. Furthermore, the Tobit estimation show that these two efficiency results are positively affected by location and the capital adequacy ratio (CAR). These rural banks operating in cities tend to have a higher level of efficiency than otherwise. Moreover, the higher the capital, the more efficient both Islamic and conventional rural banks in terms of production and intermediation.
| S-EPMC7371765 | biostudies-literature
Project description:BackgroundNigeria carries the highest burden and diversity of neglected tropical diseases (NTDs) in sub-Saharan Africa and is preparing to scale up its efforts to control/eliminate these diseases. To achieve this it will require a range of internal technical support and expertise for mapping, monitoring and evaluating, operational research and documenting its success. In order to begin to evaluate this potential in Nigeria, this study collated and analysed information for lymphatic filariasis (LF), onchocerciasis, schistosomiasis and soil-transmitted helminths (STH), which are currently being targeted with preventive chemotherapy through mass drug administration (MDA).Methodology/principal findingsInformation from 299 scientific articles published on the selected NTDs in 179 journals between January 2008 and September 2013 was extracted and systematically compiled into a geo-referenced database for analysis and mapping. The highest number of articles was from the southern geo-political zones of the country. The majority of articles focused on one specific disease, and schistosomiasis and STH were found to have the highest and most wide ranging research output. The main type of study was parasitological, and the least was biotechnological. Nigerian authors were mostly affiliated with universities, and there was a wide range of international co-authors from Africa and other regions, especially the USA and UK. The majority of articles were published in journals with no known impact factor.Conclusions/significanceThe extensive database and series of maps on the research capacity within Nigeria produced in this study highlights the current potential that exists, and needs to be fully maximized for the control/elimination of NTDs in the country. This study provides an important model approach that can be applied to other low and middle income countries where NTDs are endemic, and NTD programmes require support from the expertise within their own country, as well as internationally, to help raise their profile and importance.
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Project description:The common practise of artificially rearing some lambs from prolific meat breeds of sheep constitutes a welfare issue due to increased mortality rates and negative health issues. In this multidisciplinary study, we investigated the possible short and mid-term advantages of artificially feeding fresh ewe’s milk instead of commercial milk replacer on lambs’ growth, health and welfare. Romane lambs were either separated from their mothers on D3 and fed with Lacaune ewes’ milk (LAC, n=13) or milk replacer (REP, N=15), or they were reared by their mothers (MOT, n=15). On D45, they were weaned, gathered in single sex groups until the end of the study on D150. Lamb performance and biomarkers of overall health were assessed by measuring: growth, dirtiness of the perianal area, enteric pathogens in the faeces, total antioxidant status and redox status assessed by plasma reduced (GSH)/oxidized (GSSG) glutathione ratio, and immune response after vaccination against chlamydiosis. As an exploratory approach, blood cell transcriptomic profiles were also investigated. Last, Qualitative Behaviour Assessment was performed as an integrated welfare criteria. LAC and REP never differed in their average daily gain but grew less than MOT lambs in the early suckling period and just after weaning. No effect was detected afterwards. On D30, LAC and REP lambs had lower total antioxidant and higher redox status than MOT lambs but did not differ among themselves. LAC and MOT had a cleaner perianal area than REP lambs on D21, while faecal pathogen infection did not vary between the treatment groups. After vaccination, LAC also had a stronger immune response on D90 compared to REP lambs. Transcriptome analysis performed on D150 showed differential gene expression, mainly in relation to inflammatory, immune and cell cycle response, between male lambs of the LAC group and those of the MOT and REP groups. Based on Qualitative Behaviour Assessment, LAC lambs never differed from MOT lambs in their general activity and varied from REP only on D21; REP lambs were always more agitated than MOT lambs. In conclusion, artificial milk feeding impaired early growth rate, health, and emotional state mainly during the milk feeding period and at weaning. Feeding artificially reared lambs with fresh ewe's milk partly mitigated some of the negative effects induced by milk replacer but without achieving the full benefit of being reared by the mother.
2020-11-23 | GSE131763 | GEO
Project description:Understanding the complex population biology and transmission ecology of multihost parasites has been declared as one of the major challenges of biomedical sciences for the 21st century and the Neglected Zoonotic Diseases (NZDs) are perhaps the most neglected of all the Neglected Tropical Diseases (NTDs). Here we consider how multihost parasite transmission and evolutionary dynamics may affect the success of human and animal disease control programmes, particularly neglected diseases of the developing world. We review the different types of zoonotic interactions that occur, both ecological and evolutionary, their potential relevance for current human control activities, and make suggestions for the development of an empirical evidence base and theoretical framework to better understand and predict the outcome of such interactions. In particular, we consider whether preventive chemotherapy, the current mainstay of NTD control, can be successful without a One Health approach. Transmission within and between animal reservoirs and humans can have important ecological and evolutionary consequences, driving the evolution and establishment of drug resistance, as well as providing selective pressures for spill-over, host switching, hybridizations and introgressions between animal and human parasites. Our aim here is to highlight the importance of both elucidating disease ecology, including identifying key hosts and tailoring control effort accordingly, and understanding parasite evolution, such as precisely how infectious agents may respond and adapt to anthropogenic change. Both elements are essential if we are to alleviate disease risks from NZDs in humans, domestic animals and wildlife.
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