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Talking trash: Perspectives on community environmental health in the Dominican Republic.

ABSTRACT: A safe and healthy natural and built environment is fundamental to children's health and represents a significant determinant of community well-being. We aimed to identify and prioritize environmental health concerns within resource-poor neighborhoods in the Dominican Republic using free-listing and semi-structured focus groups composed of parents and caregivers in the perirural community of Consuelo, Dominican Republic. Transcripts were coded and relevant themes identified using qualitative content analysis. Demographic data and information regarding trash disposal practices were also collected. Participants described common health concerns, including respiratory infections, asthma, vector-borne illnesses, and diarrheal diseases and linked them to environmental hazards in their communities, such as air quality and sanitation. Interventional priorities that emerged included reduction of trash accumulation and trash burning as well as improvement of sanitation facilities.

SUBMITTER: Turner C

PROVIDER: S-EPMC8007031 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Talking trash: Perspectives on community environmental health in the Dominican Republic.

Turner Chloe C Powell Maura A MA Finalle Rodney R RR Westmoreland Kate K Osterhoudt Kevin K Cordero Paulino Ramona R Lowenthal Elizabeth D ED

PloS one 20210329 3

A safe and healthy natural and built environment is fundamental to children's health and represents a significant determinant of community well-being. We aimed to identify and prioritize environmental health concerns within resource-poor neighborhoods in the Dominican Republic using free-listing and semi-structured focus groups composed of parents and caregivers in the perirural community of Consuelo, Dominican Republic. Transcripts were coded and relevant themes identified using qualitative con ...[more]

PMID: 33780494

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Project description:Objectiveto understand both men's and women's beliefs and attitudes regarding public maternity and newborn services, care and quality.Designqualitative, cross-sectional, retrospective study with an observation arm, using community-based participatory research as both the mechanism of enquiry and catalyst for change.Settingfour urban neighbourhoods in the Dominican Republic, selected in collaboration with the Provincial Medical Public Health Director and the partnering local public hospital.Participantsadolescent women (15-20 years of age), adult women (21-49 years of age) and adult men (>19 years of age) from the four neighbourhoods were recruited to participate in focus sessions, personal interviews and/or antenatal observations. A total number of 137 participants were recruited: 27 males, 51 adolescent females and 59 adult females. The attrition rate was 17% (n=23). Dominican and US midwives and nurses, as well as community leaders, comprised the research team.Measurements and findingsfollowing informed consent, self-reported demographics and obstetric history were collected. Twelve focus groups and 12 individual interviews were recorded and transcribed, then qualitatively analysed for content and interpretation of salient themes. Antenatal observations were performed by community leaders to identify patterns of antenatal health-care delivery and utilisation. The main over-riding theme uncovered by the research was 'no me hace caso', or that women and men accessing the maternal health system did not feel valued. The significant amount of time required to receive care was interpreted by the participants as a lack of respect. Finally, the idea of 'cuña' emerged, in which participants noted special treatment for those with social connections to health-care providers. Presentation to the hospital was challenging but resulted in hospital volunteers joining the community volunteer group to collaborate on improving services.Key conclusions and implicationsthis study, conducted in the Dominican Republic, illustrates international collaboration between university researchers, maternity service providers and community members. Community-based participatory research may be an effective mechanism to unite community members and health providers in the common mission to improve maternal-newborn health services.

Project description:Columbus' arrival in the New World in AD 1492 on the northern coast of Hispaniola was followed by a suite of changes in land-use. We reconstruct environmental change from a 225-cm-long sediment core from site Los Indios from an abandoned and sediment-filled meander of the Yaque River, Cibao Valley, northeastern Dominican Republic. The sediment record starts ca. AD 195 (ca. 1755 cal. yr BP) and the history of the meander infill was monitored by changing grain size distributions, organic matter concentration and pollen from wetland plants. From ca. AD 200 to ca. AD 1525, the pollen record indicates a diverse forest assemblage; however, the presence of pollen from potential crop plants suggest nearby small-scale subsistence crop cultivation. More abundant charcoal after ca. AD 1410 shows Amerindians increasingly used fire. The record of grain size distributions shows that the meander was temporarily part of a low energetic drainage system in which bedload and suspended sediments accumulated. After European colonization of Hispaniola increasing spores of coprophilous fungi evidence that Europeans had introduced during the first decades of colonization cattle in the Cibao Valley which gradually resulted in more open forest. The charcoal record around ca. AD 1650 reflects intensive forest clearing, suggesting that small-scale Pre-Colonial practice of crop cultivation became replaced by large-scale agriculture on the moist and nutrient rich soils along the Yaque River. Further deforestation and signals of erosion suggest that the population of colonists and introduced enslaved labour force must have increased rapidly. After ca. AD 1740 charcoal influx decreased suggesting that last deforestation activities used selective cutting to produce fire wood and timber for construction, rather than burning forest in situ. Two centuries after European colonization, by the 18th century, land-use within the Cibao Valley had become a balance between substantial livestock and crop cultivation (pollen grains have evidenced cereals, maize, and potentially also sugar cane, amaranthaceous crops and tobacco). After ca. AD 1950, swamp vegetation of Typha and Cyperaceae decreased, pointing to an almost fully terrestrialized meander with only few bodies of standing water, reflecting the present-day setting. This multiproxy reconstruction of anthropogenic environmental change shows a clear differentiation between an immediate introduction of livestock and after some 150 years the development of a European style agriculture, providing a context for archaeological investigations.

Project description:In the Lao People's Democratic Republic (Lao PDR), village health volunteers play an important role in providing health services including those to reduce the burden of malaria. Over the last two decades, the volunteer network has expanded to bring malaria services closer to communities and contributed to the reduction of malaria cases. However, as malaria test positivity rates decreased, many volunteers have lost motivation to continue providing routine malaria services, and other services they provide may not reflect growing healthcare demands for common diseases in the community. This study explored the perspectives, knowledge and inputs of key health stakeholders and community members in southern Lao PDR on community-delivered models in order to refine the volunteer model in the context of Lao PDR's primary health care sector and malaria elimination goals. Semi-structured interviews with multi-level health stakeholders, participatory workshops with community leaders, and focus group discussions with community members and current village health volunteers were conducted. Deductive followed by inductive thematic analysis was used to explore and categorise stakeholders' perspectives on community-delivered models for malaria elimination. Both stakeholders and community members agreed that village health volunteers are essential providers of malaria services in rural communities. Apart from malaria, community members identified dengue, diarrhoea, influenza, skin infections and tuberculosis as priorities (in descending order of importance) and requested community-based primary health care for these diseases. Stakeholders and community members suggested integrating prevention, diagnosis, and treatment services for the five priority diseases into the current malaria volunteer model. A divergence was identified between community members' expectations of health services and the services currently provided by village health volunteers. Stakeholders proposed an integrated model of healthcare to meet the needs of the community and help to maintain volunteers' motivation and the long-term sustainability of the role. An evidence-based, integrated community-delivered model of healthcare should be developed to balance the needs of both community members and stakeholders, with consideration of available resources and current health policies in Lao PDR.

Dataset Information

Talking trash: Perspectives on community environmental health in the Dominican Republic.

Publications

Talking trash: Perspectives on community environmental health in the Dominican Republic.

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