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Community health workersinterventionin Northern Syria: Data analysis

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  1. Tez No: 784493
  2. Yazar: RAMA LOULOU
  3. Danışmanlar: DR. PETER CAMPBELL
  4. Tez Türü: Yüksek Lisans
  5. Konular: Halk Sağlığı, Public Health
  6. Anahtar Kelimeler: Belirtilmemiş.
  7. Yıl: 2018
  8. Dil: İngilizce
  9. Üniversite: Charité–Universitätsmedizin Berlin
  10. Enstitü: Yurtdışı Enstitü
  11. Ana Bilim Dalı: Belirtilmemiş.
  12. Bilim Dalı: Belirtilmemiş.
  13. Sayfa Sayısı: 63

Özet

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Özet (Çeviri)

Over the course of seven years of conflict, the situation in north Syria has kept on deteriorating. To address the many unmet needs arising from these circumstances, the Qatar Red Crescent (QRC) Turkey mission has implemented an intervention to develop the role of the Community Health Worker (CHW) in seven health facilities located in northern Syria. 150 CHWs were trained and supported to conduct home visits to promote maternal health care and to raise awareness about infant and young children feeding (IYCF) practices. Literature was reviewed to ascertain the needed definitions and information on maternal health care and infant and young children feeding and to provide insight into the role of interventions using CHWs worldwide. In doing so it was found that interventions by CHWs was usually beneficial in many aspects and can improve health outcomes especially when these are an adjunct to a sound health system, which is not usually the case in northern Syria. The overall goal of this study was to ascertain the evidence for the effectiveness of the community health workers project implemented in seven locations of northern Syria with the support of the Qatar Red Crescent (Turkey). Objectives of the study are to analyze maternal health and infant and young children feeding practices of the mothers and to assess the effectiveness of CHWs intervention in producing improvements in the participants' maternal health and IYCF practices. Study method This study is a retrospective, quantitative study utilising data collected through the Qatar Red Crescent (QRC) Turkey CHW initiative. After defining the study population, inclusion criteria were developed to extract the study population data from the overall raw data. Statistical analysis was carried out using two phases: first, eligible pre-intervention data were analyzed to yield findings about the defined study population. Second, comparison between pre-intervention and post-intervention data was conducted. The data analysis odds ratios were computed using two-by-two contingency tables and logistical regression. Findings Pre-CHW Intervention: The study found a relatively low utilisation of antenatal (51.4% prevalence of four or more visits) and postnatal (31.4%) health care services. However, there was a relatively high rate of in-health facility child delivery (79.32%) and child delivery attended by health professional (98.5%). The compliance for prenatal iron (74.30%) and folate (73.05%) supplements were good, but with low awareness about their benefits (56.40% for iron, 34.90% for folate). Both 6 antenatal and postnatal health care services were significantly associated with women's education level. With an odds ratios 1 to receive antenatal care and postnatal care respectively at 2.06 (95% CI 1.76-2.42) and 1.75 (95% CI 1.44-2.12). Antenatal care services coverage was similar in rural and urban areas (OR 0.95, 95% CI 0.90-1.03) but less in camps (OR 0.89, 95%CI 0.81-0.97). Whereas postnatal care services were higher in camps (OR 1.98 95%CI 1.77-2.22) and urban areas (OR 1.73 95%CI 1.56-1.91) compared to rural areas. Prenatal folate utilisation was higher among women reporting that supplements were available (OR 7.39, 95%CI 6.71- 8.15), among educated women (OR 1.87, 95%CI, 1.44-2.42) 2 , for women who used 4 or more antenatal services (OR 2.37, 95%CI, 2.15-2.61), among urban women (OR 1.82, 95%CI 1.62- 2.043 ), and among women aware of its benefits (OR 5.63, 95%CI 4.90-6.47). And less used among women with 4 or more previous pregnancies (OR 0.86, 95%CI 0.78-0.98). IYCF indicators also revealed a low prevalence of both early initiation of breastfeeding (43.6%) and exclusive breastfeeding for the first 6 months (31.5%), including too early introduction of complementary food (39.5%). Early initiation of breastfeeding was significantly associated with exclusive breastfeeding but this association was affected by the women's residential setting. The association was the strongest for rural women (OR 5.41, 95%CI 4.41-6.62), then for women resident in IDP camps (OR 4, 95%CI 3.37-4.83), and least for urban women (OR 3.21, 95%CI 2.81-3.65). Post-CHW intervention: Following inputs by the CHWs there was clear evidence of improvement in the eight health practices. The odds for compliance of the following indicators were higher post-intervention; antenatal care (OR 2.25, 95% CI 2.09-2.42), postnatal care (OR 1.60, 95% CI 1.45 - 1.76) and inhealth facility child delivery (OR 1.37, 95% CI 1.23-1.52), prenatal utilisation of iron supplements (OR 5.34, 95% CI 4.72-6.05), the prenatal utilisation of folic acid (OR 3.55, 95% CI 3.18-3.96), awareness of folic acid benefits (OR 18.29, 95% CI 15.94-20.8), early initiation of breastfeeding (OR 1.90, 95% CI 1.75-2.07) and exclusive breastfeeding for the first 6 months(OR 2.18, 95% CI 1.99-2.37). Conclusion CHW intervention was helpful in the Syrian post-crisis context, as demonstrated statistically with clear improvement in eight indicators related to maternal health and IYCF. These findings highlight the potential to scale-up or expand to other health facilities in similar circumstances

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