Community diagnosis and health information systems in low- and middle-income countries

The inalienable human right to the ‘highest attainable standard of health’ has been a focus of the international public health community for more than 50 years. Yet, low- and middle-income countries (LMIC) still struggle with heavy burden of disease, inefficient health systems, and limited resources for improving the health of their citizens. Community diagnosis can inform public health planning and prioritization of resources for the purpose of addressing disparities in health outcomes. However, large amounts of good-quality data from multiple quantitative and qualitative, primary and secondary sources are ideally required in order to effectively assess current state and evaluate future performance against a broad range of important health metrics. Furthermore, information systems and health metrics should not be thought of as static and separate. Rather, they should ideally evolve together in a deliberate, iterative process over time from metrics selected based upon the information that is available (i.e. measure what is measurable) to information systems designed based upon the metrics that are important to measure (i.e. measure what should be measured). This chapter describes community diagnosis, information systems, and health metrics in the context of LMIC, highlighting these concepts and their challenges with examples of studies conducted in these settings.

Level of engagement of recreational physical activity of urban villagers in Luohu, Shenzhen, China

Physical activity is important for health. However, there is a lack of literature related to the physical activity levels of adults living in urban villagers, which is a vulnerable population in China. The aim of this study is to compare the physical activity and sedentary behavior engagements between urban villagers and non-urban villagers using the 2019 Luohu Shenzhen, China Community Diagnosis Questionnaire. A total of 1205 adults living in urban villages and non-urban villages were included in the analysis. Unadjusted and multiple multivariate logistic regression were conducted for the dependent variable of engagement in recreational physical activity, frequency of recreational physical activity per week, and hours spent in sedentary behaviors per day. Descriptive analysis was conducted to identify the reasons for not engaging in physical activity among urban villagers and non-urban villagers. Across the included sample, 29.05% were urban villagers and 70.95% were non-urban villagers. The results suggested that urban villagers are more likely to engage in physical activity than non-urban villager (OR = 1.90, 95% CI [1.40, 2.59], p < 0.001). However, it was also found that urban village status had no significant association for frequency in engaging in physical activity and average hours spent in sedentary behaviors. Both urban villagers and non-urban villages indicated that lack of time, lack of safe and appropriate environment, and working in labor intensive occupations as some of the reasons for not engaging in physical activity. There is a need for tailed interventions and policies for promoting physical activity among urban villagers and non-urban villagers. Additional studies are needed to further our understanding of the physical activity behaviors among urban villagers in China.

A Participatory Community Diagnosis of a Rural Community from the Perspective of Its Women, Leading to Proposals for Action

In primary health care, a community diagnosis is necessary to provide a detailed description of the community as well as an evaluation of the community’s health, including the main factors responsible for it and the needs felt by the population. This article presents a community health diagnosis following a participatory design, taking the perspective of women living in the community, to identify proposals for action. An ethnographic study was carried out in the community of Mañaria (Spain), using semi-structured interviews, in-depth interviews, key informants, participant observation, desk review, and photography. A sample of 21 women were interviewed until reaching saturation of the information. This information was complemented by that provided by five key informants. Data analysis included text analysis, coding, and categorization. Preliminary results were presented to the informants for validation and further refinement, and proposals for action were identified and followed up. Six categories were identified, representing different areas of intervention: population, jobs and economy, public and private spaces, lifestyles, processes of socialization, and health care assets. For each of these areas, the main problems were identified, as were the health care assets and proposals for action. The community diagnosis has been shown to be useful not only to identify health needs but also as an efficacious instrument to trigger social and public health actions that may be undertaken at the institutional level.

Community Diagnosis dan Peningkatan Pengetahuan Penyakit Hipertensi pada Masyarakat RT. 02 Desa Dalam, Kecamatan Alas, Sumbawa

Community diagnosis is a technique to capture the main health problems. Hypertension is a common problem in Indonesian society and is even ignored because the disease development process is not visible. This community service aims to carry out a community diagnosis to see priority problems in the location for further intervention to the community. It was found that hypertension was the main problem. Increasing knowledge of the society about hypertension is conducted by installing posters in the public space.

Strategy to strengthen the traditional milpa family production systems

Objective: To characterize family production units (FPUs) to identify critical points for their activities and propose intervention strategies for them.Design/methodology/approach: The research took place at Yaxcabá municipality, state of Yucatán, Mexico. It is descriptive and its information obtained through 1) a questionnaire in a mobile application compatible with the Android operating system, structured by modules: producer data, FPU characteristics, crops, infrastructure, machinery, equipment, and marketing. The sample size was randomized with replacement, under the maximum variance condition, 2) assessment visits to the farmer’s plots and 3) participatory community diagnosis workshops.Results: The traditional milpa system was oriented to the cultivation of corn, beans and squash of creole origin, for consumption by the FPUs with minimum technologies usage. Through apiculture, producers obtain an economic resource to finance other activities, including those of the milpa. It is, therefore, necessary to strengthen their productivecapacities of this activity with a chain approach, for the diversification of their products and derivatives of their hives that allow their income to increase.Limitations on study/implications: The proposals and intervention strategies may only be applied to the production system in the evaluated area.Findings/conclusions: The strategies for the traditional milpa production should be oriented to food security, biodiversity preservation and the nutritional health of their related population. Apuculture strategies should aim to include producers in the value chain.

PENYULUHAN HIPERTENSI MELALUI WHATSAPP GROUP SEBAGAI UPAYA PENGENDALIAN HIPERTENSI

ABSTRAKArtikel ini merupakan pengabdian masyarakat yang bertujuan untuk meningkatkan pengetahuan dan sikap masyarakat di Desa Aluh-Aluh Besar Kecamatan Aluh-Aluh Kabupaten Banjar dalam mencegah penyakit hipertensi. Berdasarkan hasil diagnosa komunitas, masih banyak didapatkan masyarakat yang terkena hipertensi. Selain itu, berdasarkan informasi yang diperoleh menunjukan masih rendahnya pengetahuan masyarakat mengenai hipertensi. Metode yang digunakan dalam penyuluhan ini adalah 1) perencanaan dan persiapan berupa perizinan, membuat whatsapp grup serta mengundang masyarakat sasaran. Selanjutnya tim menyusun kuesioner pre-post test, membuat materi dan media penyuluhan, 2) pelaksanaan dan proses berupa penyajian materi dan penutupan, 3) monitoring dan evaluasi, monitoring dari program ini adalah dengan selalu mem-booster pengetahuan dan sikap masyarakat, evaluasi dari program ini dapat dilihat dari peningkatan pengetahuan dan sikap masyrakat. Hasil penyuluhan menunjukan peningkatan pengetahuan mengenai penyakit hipertensi dari sebelum 76,9% dan setelah mendapatkan materi menjadi 100% dan terjadi peningkatan sikap dari sebelum 92,3% dan setelah mendapatkan materi menjadi 100%. Kata kunci: penyuluhan; hipertensi; whatsapp grup. ABSTRACTThis article is a community service that aims to improve the knowledge and attitudes of the community in Aluh-Aluh Besar Village, Aluh-Aluh District, Banjar Regency in preventing hypertension. Based on the results of community diagnosis, there are still many people affected by hypertension. It was, based on the information obtained, public knowledge about hypertension was still low. The methods used in this outreach are 1) planning and preparation in the form of licensing, creating whatsapp groups and inviting target communities. Furthermore, the team compiled a pre-post test questionnaire, made counseling materials and media, 2) implementation and process in the form of material presentation and closure, 3) monitoring and evaluation, monitoring of this program is to always increase community knowledge and attitudes, evaluation of this program can seen from the increase in knowledge and attitudes of the community. The results of counseling increased knowledge about hypertension before 76.9% and after the material became 100% and the attitude increased from before 92.3% and after getting the material to 100%. Keywords: counseling; hypertension; whatsapp group.

Single-lead ECGs (AliveCor) are a feasible, cost-effective and safer alternative to 12-lead ECGs in community diagnosis and monitoring of atrial fibrillation

BackgroundCommunity management of atrial fibrillation (AF) often requires the use of electrocardiographic (ECG) investigation. Patients discharged following treatment of AF with fast ventricular response (fast AF) can require numerous ECGs to monitor rate and/or rhythm control. Single-lead ECGs have been proposed as a more convenient and relatively accurate alternative to 12-lead ECGs for rate/rhythm management and also diagnosis of AF. We aimed to examine the feasibility of using the AliveCor single-lead ECG monitor for diagnosis and monitoring of AF in the community setting.MethodsDuring the course of 6 months, this evaluation of a clinical service improvement pathway used the AliveCor in management of patients requiring (1) follow-up ECGs for AF with previously documented rapid ventricular rate or (2) ECG confirmation of rhythm where AF was suspected. Twelve AliveCor devices provided to the acute community medical team were used to produce 30 s ECG rhythm strips (iECG) that were electronically sent to an overreading physician.ResultsSeventy-four patients (mean age 82 years) were managed on this pathway. (1) The AliveCor was successfully used to monitor the follow-up of 37 patients with fast AF, acquiring a combined total of 113 iECGs (median 1.5 ±3.75 per patient). None of these patients required a subsequent 12-lead ECG and this approach saved an estimate of up to £134.49 per patient. (2) Of 53 patients with abnormal pulses, the system helped identify 8 cases of new onset AF and 19 cases of previously known AF that had reverted from sinus back into AF.ConclusionsWe have demonstrated that the AliveCor system is a feasible, cost-effective, time-efficient and potentially safer alternative to serial 12-lead ECGs for community monitoring and diagnosis of AF.

Methodological Approach for Wastewater Based Epidemiological Studies for SARS-CoV-2

Post COVID-19 outbreak, wastewater-based epidemiology (WBE) studies as surveillance system is becoming an emerging interest due to its functional advantage as tool for early warning signal and to catalyze effective disease management strategies based on the community diagnosis. A comprehensive attempt was made in this study to define a methodological approach for conducting WBE studies in the framework of identifying/selection of surveillance sites, standardizing sampling policy, designing sampling protocols to improve sensitivity, adopting safety protocol, and interpreting the data. The methodology was applied to a community and studied its epidemiological status with reference to occurrence, persistence, and variation of SARS-CoV-2 genome load in wastewater system to understand the prevalence of infection. Hourly and daily grab samples were analyzed and compared with the composite samples over a surveillance window of 7 days. Based on the SARS-CoV-2 RNA copies/L, faeces shedding, and volume of sewage generated the infected individuals and the population who are in active phase in the studied community was estimated.