Community health workers (CHWs) have long played an important role in the management of complex health problems, especially in resource-poor settings. Although there is a large literature regarding the use of CHWs aro...Community health workers (CHWs) have long played an important role in the management of complex health problems, especially in resource-poor settings. Although there is a large literature regarding the use of CHWs around the world, there is little detail about how these workers are selected, trained and utilized in the field. Lesotho has one of the highest rates of HIV in the world, with an estimated 25% of the general population infected with the disease;at the same time, there is a significant health human resources shortage in Lesotho with an estimated 60% of health posts left vacant. Community health workers have the potential to play a major role in HIV treatment scale-up in the country, and in 2006, a CWH-based project called 'The Rural Initiative' was started in the remote mountain regions of the country. More than 1000 CHWs were trained and employed through this program between June 2006 and December 2008. This paper will review the CHW program in detail, with a focus on recruitment, training, ongoing supervision and support, and the larger public health implications of the CHW program in Lesotho. It is hoped this program can serve as a practical model for other programs working with or in need of CHWs.展开更多
BACKGROUND While Crohn’s disease has been studied extensively in high-income countries,its epidemiology and care in low and lower-middle income countries(LLMICs)is not well established due to a lack of disease regist...BACKGROUND While Crohn’s disease has been studied extensively in high-income countries,its epidemiology and care in low and lower-middle income countries(LLMICs)is not well established due to a lack of disease registries and diagnostic capacity.AIM To describe the published burden,diagnostic/treatment capacity,service utilization,challenges/barriers to individuals with Crohn’s in LLMICs and their providers.METHODS We conducted a scoping review utilizing a full search strategy was developed and conducted in PubMed,Embase and World Health Organization Global Index Medicus.Two independent reviewers screened the titles and abstracts of all of the publications found in this search,reviewed selected publications,and extracted relevant data,which underwent descriptive review and was analyzed in Excel.RESULTS The database search yielded 4486 publications,216 of which were determined to be relevant to the research questions.Of all 79 LLMICs,only 21(26.6%)have publications describing individuals with Crohn’s.Overall,the highest number of studies came from India,followed by Tunisia,and Egypt.The mean number of Crohn’s patients reported per study is 57.84 and the median is 22,with a wide range from one to 980.CONCLUSION This scoping review has shown that,although there is a severe lack of populationbased data about Crohn’s in LLMICs,there is a signal of Crohn’s in these settings around the world.展开更多
Background:The coronavirus disease 2019(COVID-19)is a highly infectious respiratory disease.There is no recommended antiviral treatment approved for COVID-19 in Sierra Leone,and supportive care and protection of vital...Background:The coronavirus disease 2019(COVID-19)is a highly infectious respiratory disease.There is no recommended antiviral treatment approved for COVID-19 in Sierra Leone,and supportive care and protection of vital organ function are performed for the patients.This study summarized the clinical characteristics,drug treatments,and risk factors for the severity and prognosis of COVID-19 in Sierra Leone to provide evidence for the treatment of COVID-19.Methods:Data of 180 adult COVID-19 patients from the 34th Military Hospital in Freetown Sierra Leone between March 31,2020 and August 11,2020 were retrospectively collected.Patients with severe and critically ill are classified in the severe group,while patients that presented asymptomatic,mild,and moderate disease were grouped in the non-severe group.The clinical and laboratory information was retrospectively collected to assess the risk factors and treatment strategies for severe COVID-19.Demographic information,travel history,clinical symptoms and signs,laboratory detection results,chest examination findings,therapeutics,and clinical outcomes were collected from each case file.Multivariate logistic analysis was adopted to identify the risk factors for deaths.Additionally,the clinical efficacy of dexamethasone treatment was investigated.Results:Seventy-six(42.22%)cases were confirmed with severe COVID-19,while 104 patients(57.78%)were divided into the non-severe group.Fever(56.67%,102/180)and cough(50.00%,90/180)were the common symptoms of COVID-19.The death rate was 18.89%(34/180),and severe pneumonia(44.12%,15/34)and septic shock(23.53%,8/34)represented the leading reasons for deaths.The older age population,a combination of hypertension and diabetes,the presence of pneumonia,and high levels of inflammatory markers were significantly associated with severity of COVID-19 development(P<0.05 for all).Altered level of consciousness[odds ratio(OR)=56.574,95%confidence interval(CI)5.645–566.940,P=0.001],high levels of neutrophils(OR=1.341,95%CI 1.109–1.621,P=0.002)and C-reactive protein(CRP)(OR=1.014,95%CI 1.003–1.025,P=0.016)might be indicators for COVID-19 deaths.Dexamethasone treatment could reduce mortality[30.36%(17/56)vs.50.00%(10/20)]among severe COVID-19 cases,but the results were not statistically significant(P>0.05).Conclusions:The development and prognosis of COVID-19 may be significantly correlated with consciousness status,and the levels of neutrophils and CRP.展开更多
文摘Community health workers (CHWs) have long played an important role in the management of complex health problems, especially in resource-poor settings. Although there is a large literature regarding the use of CHWs around the world, there is little detail about how these workers are selected, trained and utilized in the field. Lesotho has one of the highest rates of HIV in the world, with an estimated 25% of the general population infected with the disease;at the same time, there is a significant health human resources shortage in Lesotho with an estimated 60% of health posts left vacant. Community health workers have the potential to play a major role in HIV treatment scale-up in the country, and in 2006, a CWH-based project called 'The Rural Initiative' was started in the remote mountain regions of the country. More than 1000 CHWs were trained and employed through this program between June 2006 and December 2008. This paper will review the CHW program in detail, with a focus on recruitment, training, ongoing supervision and support, and the larger public health implications of the CHW program in Lesotho. It is hoped this program can serve as a practical model for other programs working with or in need of CHWs.
文摘BACKGROUND While Crohn’s disease has been studied extensively in high-income countries,its epidemiology and care in low and lower-middle income countries(LLMICs)is not well established due to a lack of disease registries and diagnostic capacity.AIM To describe the published burden,diagnostic/treatment capacity,service utilization,challenges/barriers to individuals with Crohn’s in LLMICs and their providers.METHODS We conducted a scoping review utilizing a full search strategy was developed and conducted in PubMed,Embase and World Health Organization Global Index Medicus.Two independent reviewers screened the titles and abstracts of all of the publications found in this search,reviewed selected publications,and extracted relevant data,which underwent descriptive review and was analyzed in Excel.RESULTS The database search yielded 4486 publications,216 of which were determined to be relevant to the research questions.Of all 79 LLMICs,only 21(26.6%)have publications describing individuals with Crohn’s.Overall,the highest number of studies came from India,followed by Tunisia,and Egypt.The mean number of Crohn’s patients reported per study is 57.84 and the median is 22,with a wide range from one to 980.CONCLUSION This scoping review has shown that,although there is a severe lack of populationbased data about Crohn’s in LLMICs,there is a signal of Crohn’s in these settings around the world.
基金This work was supported by the National Grand Program on Key Infectious Disease(No.2018ZX10103002-001-007)the Biosafety Special Program(No.19SWAQ 13).
文摘Background:The coronavirus disease 2019(COVID-19)is a highly infectious respiratory disease.There is no recommended antiviral treatment approved for COVID-19 in Sierra Leone,and supportive care and protection of vital organ function are performed for the patients.This study summarized the clinical characteristics,drug treatments,and risk factors for the severity and prognosis of COVID-19 in Sierra Leone to provide evidence for the treatment of COVID-19.Methods:Data of 180 adult COVID-19 patients from the 34th Military Hospital in Freetown Sierra Leone between March 31,2020 and August 11,2020 were retrospectively collected.Patients with severe and critically ill are classified in the severe group,while patients that presented asymptomatic,mild,and moderate disease were grouped in the non-severe group.The clinical and laboratory information was retrospectively collected to assess the risk factors and treatment strategies for severe COVID-19.Demographic information,travel history,clinical symptoms and signs,laboratory detection results,chest examination findings,therapeutics,and clinical outcomes were collected from each case file.Multivariate logistic analysis was adopted to identify the risk factors for deaths.Additionally,the clinical efficacy of dexamethasone treatment was investigated.Results:Seventy-six(42.22%)cases were confirmed with severe COVID-19,while 104 patients(57.78%)were divided into the non-severe group.Fever(56.67%,102/180)and cough(50.00%,90/180)were the common symptoms of COVID-19.The death rate was 18.89%(34/180),and severe pneumonia(44.12%,15/34)and septic shock(23.53%,8/34)represented the leading reasons for deaths.The older age population,a combination of hypertension and diabetes,the presence of pneumonia,and high levels of inflammatory markers were significantly associated with severity of COVID-19 development(P<0.05 for all).Altered level of consciousness[odds ratio(OR)=56.574,95%confidence interval(CI)5.645–566.940,P=0.001],high levels of neutrophils(OR=1.341,95%CI 1.109–1.621,P=0.002)and C-reactive protein(CRP)(OR=1.014,95%CI 1.003–1.025,P=0.016)might be indicators for COVID-19 deaths.Dexamethasone treatment could reduce mortality[30.36%(17/56)vs.50.00%(10/20)]among severe COVID-19 cases,but the results were not statistically significant(P>0.05).Conclusions:The development and prognosis of COVID-19 may be significantly correlated with consciousness status,and the levels of neutrophils and CRP.
