Changes and Development of Home and Community Based Elderly Care Service Policies in China

This paper analyzes the current situation of the development of home and community based elderly care service in China,points out the existing problems,and puts forward improvement measures,aiming to deepen the understanding of HCBS and promote the theoretical research and practice of community home-based elderly care service.

Community Based Survey Methodology for Maternal Healthcare Utilization: Gujarat, India

Background: About 60% of institutional births occur in the private sector in Gujarat due to limited availability of obstetricians in the government. Chiranjeevi Yojana (CY), a voucher-like program initiated in 2007, accredits private obstetricians who are reimbursed by the state government to provide free delivery care to eligible women i.e. below poverty line and tribal. One million women have delivered under the CY program yet there are no large community based studies of the program. Methodology of a prospective community study is described here. Methods/Designs: A prospective cohort study was done in 142 villages across 3 districts in Gujarat between July, 2013 and November, 2014. A detailed survey was done by trained researchers to ascertain maternal healthcare information including antenatal, intra-partum and post-partum care, place of delivery, birth outcomes, out of pocket expenses etc. Results: 54,955 households were surveyed. 73% of all households had poverty documentation. 4274 mothers who delivered in the study period were included. Discussion: This paper is description of the methodology of a large community based survey and household and individual level characteristics. The survey was nested in a larger project to evaluate the CY program in the state of Gujarat.

Community Based Management of Severe Acute Malnutrition: The MSF Experience from an Urban Slum Setting in Bangladesh

Background: Until recently, the experience on implementing community based management of acute malnutrition (CMAM) among children has been largely based in African settings. While the government in Bangladesh is yet to scale up CMAM approach, there is still paucity of knowledge on the experience of CMAM within the complex milieu of an urban slum context. In Kamrangirchar slum, Dhaka, Bangladesh, this paper describes a CMAM programme performance and outcomes run by Médecins Sans Frontières (MSF)/Doctors without Borders, in light to performance indicators set by MSF and the Sphere minimum standards. Methods: This was a descriptive retrospective study using routinely collected programme data of children admitted with severe acute malnutrition between May 2010 and November 2011. Kamrangirchar is an urban slum of a large migrant population in Dhaka, Bangladesh. Results: There was a total of 640 new admissions, of whom 333 (52%) were males. The median age was 18 months (Inter-quartile range (IQR) 12 - 41). 599 children had a reported nutritional outcome at discharge from ambulatory therapeutic feeding centre (ATFC), this included: cure rate of 69% with an average length of stay of 68.8 (SD ± 46.0) days and average weight gain of 3.8 g/kg/day (SD ± 2.7). The lost-to-follow-up rate was 18% and 5% reported to the programme that they will leave the slum and go back to their villages. These performance indicators did not meet the threshold level indicators set by MSF and Sphere standards. Conclusions: Our experience highlights the need for developing more adapted and contextualised indicators for assessing the performance of CMAM programmes in settings such as urban slums. Community engagement in the process of developing relevant standards is crucial. Nutrition humanitarian actors have a vital role to collaborate with local authorities to contextualize and refine these standards.

Cardiovascular Risk Factors in South-Eastern Nigeria: A Community Based Survey

Background: Cardiovascular risk factors play a major role in cardiovascular disease burden worldwide. The prevalence is known to be in the increase especially in the developing countries. There is need for timely community based studies in order to keep tab with the current scope. It is against this background that we embarked on this cross-sectional community based study of the prevalence of selected cardiovascular risk factors in semi-urban community in Abakaliki Southeastern part of Nigeria in October 2016. Method: The consecutive consenting persons of 18 years and above were screened for selected cardiovascular risk factors in October 2016. Results: A total of 1074 adults were seen (males-567, females-507) with age range of 18 - 80 years and mean age of 35.63 ± 12.45 years. They were predominantly farmers, petty traders and artisans. The identified CVD risk factors were hypertension 285 (26.4%), alcohol abuse 131 (12.1%), obesity 122 (11.3%), diabetes 97 (9%), family history of stroke 87 (8.1%), smoking 74 (6.9%) and previous stroke 29 (2.7%). Conclusion: The cardiovascular risk factors were quite prevalent with male preponderance of alcohol abuse and smoking.

Participatory and integrated watershed management and community based organgzanon

In Iran, and in order to encourage local watershed management, community based organizations （CBO） like ＂cooperatives of watershed＂, ＂construction groups＂ and ＂watershed management groups＂ have been established to obtain resident＇s cooperation in activities eormeeted with protection, reclamation and exploitation of natural resources in the basins that lead to sustainability within watershed management. This study was done as a ease study to explore the role of Remeleh Group （RG） as a CBO in the management of the ＂Kharkheh＂ sub-basin. Participatory action and learning method was used. Participatory tools including natural resources mapping, flow diagram, transect walk, semi-structured interview and brainstorming were applied. Making the conclusion, it was found that the CBO of Remeleh Group cause： （1） Enhancement of social capital through encouraging cooperation and participatory practices, creating new communication among local residents and outsiders, reducing conflicts and promoting the solidarity among communities in the sub basin of Karldaeh; （2） Sustain livelihood and economic situation through agricultural intensification and livelihood diversification （gardening and agriculture together and reducing migration）; （3） Conservation of environmental and natural recourses via the implementation of watershed activities like vine, terracing, bunding and destocking, seedling, and check dams; （4） Empower local people through carrying out training on the watershed practices.

Association between visual status and mental health status in Thai rural elderly:a community-based study

AIM：To evaluate the association between visual impairment（VI） and mental health or social engagement in older adults living in rural Thailand.METHODS：Data for this cross-sectional study were drawn from a community survey conducted in 2015 in Saraburi Province,Thailand.Participants were 327 adults aged ≥50 y.VI was assessed using presenting distance visual acuity.Mental health and social engagement were evaluated in face-to-face interviews using validated questionnaires.After determining the prevalence of VI and relevant sociodemographic characteristics,multivariate regression analysis was used to evaluate the impact of VI on mental health and social engagement.RESULTS：The prevalence of VI was 18.3%.Major causes were refractive error（58.3%） and cataract（35%）.Factors associated with VI in the crude analysis were：older age [odds ratio（OR） 8.08],unemployment（OR 2.72）,widowhood（OR 2.47）,being divorced/separated（OR 3.27）,smoking（OR 2.09） and disability in activities of daily living（OR 2.35）.Protective factors were undergoing eye screening at least once a year（P=0.029） and obesity（P=0.005）.VI was significantly associated with low social engagement（adjusted OR 4.13） but not with poor mental health（P〉0.05）.CONCLUSION：Although VI older adults reported less participation in social activities,there is no significant association between VI and poor mental health.Annual eye examinations may prevent VI in older adults.Information about employment and anti-smoking should be targeted to older adults with VI.

The contribution of a non-governmental organisation’s Community Based Tuberculosis Care Programme to case finding in Myanmar:trend over time

Background:It is estimated that the standard,passive case finding(PCF)strategy for detecting cases of tuberculosis(TB)in Myanmar has not been successful:26%of cases are missing.Therefore,alternative strategies,such as active case finding(ACF)by community volunteers,have been initiated since 2011.This study aimed to assess the contribution of a Community Based TB Care Programme(CBTC)by local non-government organizations(NGOs)to TB case finding in Myanmar over 4 years.Methods:This was a descriptive study using routine,monitoring data.Original data from the NGOs were sent to a central registry within the National TB Programme and data for this study were extracted from that database.Data from all 84 project townships in five regions and three states in Myanmar were used.The project was launched in 2011.Results:Over time,the number of presumptive TB cases that were referred decreased,except in the Yangon Region,although in some areas,the numbers fluctuated.At the same time,there was a trend for the proportion of cases treated,compared to those referred,that decreased over time(P=0.051).Overall,among 84 townships,the contribution of CBTC to total case detection deceased from 6%to 4%over time(P<0.001).Conclusions:Contrary to expectations and evidence from previous studies in other countries,a concerning reduction in TB case finding by local NGO volunteer networks in several areas in Myanmar was recorded over 4 years.This suggests that measures to support the volunteer network and improve its performance are needed.They may include discussion with local NGOs human resources personnel,incentives for the volunteers,closer supervision of volunteers and improved monitoring and evaluation tools.

Community based interventions for the prevention and control of Non-Helmintic NTD

In this paper,we aim to systematically analyze the effectiveness of community based interventions(CBI)for the prevention and control of non-helminthic diseases including dengue,trypanosomiasis,chagas,leishmaniasis,buruli ulcer,leprosy and trachoma.We systematically reviewed literature published up to May 2013 and included 62 studies in this review.Findings from our review suggest that CBI including insecticide spraying;insecticide treated bednets and curtains;community education and cleanliness campaigns;chemoprophylaxis through mass drug administration;and treatment have the potential to reduce the incidence and burden of non-helminthic diseases.Lack of data limited the subgroup analysis for integrated and non-integrated delivery strategies however,qualitative synthesis suggest that integrated delivery is more effective when compared to vertical interventions;however,such integration was possible only because of the existing vertical vector control programs.Community delivered interventions have the potential to achieve wider coverage and sustained community acceptance.Eradicating these diseases will require a multipronged approach including drug administration,health education,vector control and clean water and sanitation facilities.This would require high level governmental commitment along with strong partnerships among major stakeholders.

Evaluation of Gray Leaf Spot Tolerant Genotypes from CIMMYT in the Highland Maize Production Eco-systems of Bhutan

Bhutan is a small landlocked country located in the eastern Himalayas. Over 69% of the population is engaged in agriculture. Rice, maize, wheat, barley, buckwheat and millets are the major cereal crops cultivated. Rice is the most preferred food crop of the Bhutanese. Maize is a primary food crop after rice and it ranks first among food crops in production. The cultivation ranges from less than 300 m asl （metres above sea level） nearly up to 2,800 m asl. In 2007, a new, extremely serious problem of GLS （gray leaf spot） in maize that was previously never reported in Bhutan was confirmed. This disease spread rapidly in the highland maize growing areas causing production losses of over 50% to 70%. All the maize varieties cultivated in the country were found to be highly susceptible to the disease. In order to contain this devastating disease, the national maize program drew short and long term strategies with the help of a CIMMYT Expert. As an immediate short term action to contain GLS, systemic fungicide Tilt 25 EC （active ingredient propiconazole） was supplied free of cost to the farmers. A longer term strategy pursued was the introduction, e＇valuation and selection of GLS tolerant genotypes for the highland ecosystem. Over 100 GLS tolerant genotypes vcere introduced from CIMMYT Colombia, Mexico, Zimbabwe and Nepal. These materials were initially evaluated in a disease hotspot sites and then further tested in multi-location trials in GLS affected areas across the country. Farmers were engaged for Participatory Variety Selection by organizing farmer＇s field days at the trial sites. Finally, in 2011 considering the need of GLS tolerant varieties for farmers, two GLS tolerant genotypes ICAV305 and S03TLYQAB05 were provisionally released. In the 2011 season, these two provisionally released genotypes were put under large scale demonstration in the GLS affected areas in nine districts across the country. In 2012, the two genotypes were formally released by the Technology Release Committee of the Ministry of Agriculture and Forest. Rapid seed increase of the new varieties was initiated through farmers from Community Based Seed Production groups and so far 75% seed replacement of GLS affected farmers has been accomplished.

Perceptive insight into incentive design and sustainability of participatory mangrove management: a case study from the Indian Sundarbans

Incentive design is among the decisive factors behind active community participation and long-term sustainability of participatory forest management. Especially in case of mangroves, where multiple interests apply, it requires a careful integration of several ecological, economic and institutional factors. The primary objective of this paper is to understand the basis of incentive design and make a comprehensive inquiry into the existing incentive mechanism of participatory mangrove management in Indian Sundarbans. The qualitative and in-depth assessment was derived against a conceptual framework that contains three main determinants: (1) resources availability, (2) control mechanism, and (3) perception of end-users. The study deploys the results of various participatory exercises such as structured interviews with forest officials, focus group discussions with 10 Joint Forest Management Committees and semi-structured interviews with 119 mangrove users. In general, we observed an over-cautious, hierarchical and safety-margin-based incentive design with distinct bifurcation of communities over the adequacy and effectiveness of derived benefits. Although, the incentives are diverse and align well with the overall conservation of mangroves, they are considered to be insufficient by nearly half of the mangrove users. The main issues that were observed to hinder effective community participation can be summarized as (1) serious restrictions on access to economically exploitable mangrove products, (2) passive involvement of vulnerable occupational groups, and (3) lack of trust and conflicting interests between the officials and the communities. Although the existing preventive management of mangroves can be justified considering the magnanimity of the Indian Sundarbans, it can severely impair community participation and emerge as a clear threat to future sustainability. To secure greater participation of the communities, we propose small scale, innovative developmental incentives to supplement traditional forest-resource-based incentives.

Strategy to Overcome Barriers of Rainwater Harvesting, Case Study Tanzania

There are socio-technological challenges towards extension of the application of rainwater harvesting (RWH) practices in developing countries. An attempt to address this was done using the Mnyundo Primary School, Tanzania, as a study area for evaluating the technical, economic, and social challenges of RWH practices. A storage water level monitoring gauge was used so as to simplify rainwater quantity control and utilization strategy. Basic quality control components such as first flush tank were incorporated so as to reduce the particle load flowing into the storage. Cost reduction strategies such as the one (1) company one (1) community campaign were applied to address the cost implication. To enhance ownership, participatory approach of the beneficiaries in all stages including planning, designing and implementation was adopted. In order to ensure project sustainability, training on how to operate and maintain were provided as well as a maintenance manual to impart a sense of ownership. For the challenges of imparting RWH practices in Tanzania, 19 solutions have been identified and they include provision of RWH manuals, guidelines and regulations, government incentives, and promotion of self-financing initiatives. For developing countries, the study proposes the following strategies: establishing relevant regulations and research centers, enhancing individual and community financial stability, conducting demonstration projects, and increased investment by government on promotion.

Mobile Application for Research Knowledge Sharing and Dissemination: The Case of Nm-Aist Univeristy Tanzania

The utilization of mobile and web applications has surpassed all other platforms in terms of disseminating researchers’ knowledge among diverse communities throughout the world. The current method of disseminating researchers’ knowledge to the communities in the Arusha region in Tanzania is through meetings, workshops, and focus group discussions held by researchers, agricultural extension officers and community members after every three months or during field study. Yet the strategy is inefficient and ineffective in practice. The purpose of this study was to determine the most efficient and successful method of disseminating knowledge in communities. The study began with a qualitative phase, utilizing an interpretive technique and a qualitative multiple case study research design. The Arusha region in Tanzania was selected as a case study where different social activities were undertaken, including farming, livestock keeping, tourism activities and fishing. Individual participants were interviewed by using a semi-structured questionnaire. In addition, focus group discussions were conducted to gather more information regarding the needs of the mobile application. Through the implementation of the application, the second phase of the study led to the development of a mobile application that includes community members, agricultural extension officers, and researchers that will enable anyone to install the application on their mobile phones to access knowledge regarding activities undertaken in Arusha. According to the findings of the first phase of the research, a substantial percentage of community members own mobile phones, and hence a mobile application would be sufficient. The research also found that most researcher-community interactions occur at the data collection and intervention assessment (field trials) stages. Hence, the mobile application will benefit community members, district agricultural, irrigation, and cooperative officers (DAICO), and researchers.

Community Perspective to Agricultural Heritage Conservation and Tourism Development

The rich biodiversity and cultural patterns of agricultural heritage sites are preserved unconsciously in the traditional way of life of local communities.They are also attractive resources for tourism development,which supports the conservation of agricultural heritage systems （AHS） while providing benefits for local communities.As a typical case study,a Globally Important Agricultural Heritage System （GIAHS） site with a Rice-Fish-Duck agricultural system （RFDS） in Congjiang County of South West China is introduced to illustrate the community approach to agricultural heritage conservation and sustainable tourism development.The concept of a community approach to agricultural heritage is dynamic both in terms of conservation and livelihood adaptation.Six elements in the concept model and their relationship were analyzed.The community is the core element and the other five are：local community identity,livelihoods,local sustainable tourism development,the farming system,biodiversity and cultural patterns in the site.All are interconnected and thus support the agricultural heritage conservation of agricultural heritage and the development of sustainable tourism in the heritage sites.

The World Health Organization road map for neglected tropical diseases 2021-2030:implications for onchocerciasis elimination programs

In its new roadmap for neglected tropical diseases,the World Health Organization proposes three important strategic shifts:(i)Stronger accountability which shifting from process to impact indicators;(ii)Intensified cross-cutting approaches;and(iii)Stronger country ownership.In this paper we discuss the implementation of these three strategies in the setting of a high onchocerciasis disease burden in South Sudan.

Reflections on the Myth of Tourism Preserving “Traditional” Agricultural Landscapes

The renewed interest in ＂cultural landscapes＂ is a global phenomenon to be explained in a multi dimensional way.The process of revalorising traditional habitats,people and their way of living in a particular environment,is closely linked to the introduction of heritage as ＂a cultural,social and economic construct＂.The recognition of cultural landscapes as a new category on the world heritage list （UNESCO） since the 1990s,emphasises the importance of the human-environment interaction and the need for understanding the dynamics of landscapes in time and space.Values are changing and new opportunities emerge for a ＂dynamic preservation＂ of iconic landscapes and traditional communities.A cross disciplinary understanding of interacting processes is essential to plan and manage sustainable heritage（land）scapes.Various pilot projects and case studies-world-wide-lead to critical reflections about the sustainability of heritage landscapes and the sovereign role of tourism.The perspective of ＂Globally Important Agricultural Heritage Sites＂ （GIAHS）,supported by economic resources generated by tourism,requires a research-based approach analysing opportunities and expectations,assessing strategic policies and top down politics.