<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Until recently, the ex...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> 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.展开更多
Introduction:Current strategies for chronic viral hepatitis prevention and control include immunization,prevention of mother-to-child transmission,expanded testing,antiviral therapy,and national drug price negotiation...Introduction:Current strategies for chronic viral hepatitis prevention and control include immunization,prevention of mother-to-child transmission,expanded testing,antiviral therapy,and national drug price negotiations.To achieve this effectively,Shanghai has implemented a communitybased pilot program that integrates public health and clinical care for chronic viral hepatitis management.Methods:This study evaluated the effectiveness of Shanghai’s community-based healthcare program at three time points(2012,2019,and 2023),assessing key indicators including antiviral treatment rates and disease status changes and risk of hepatocellular carcinoma.Data were managed using EpiData 3.1,with descriptive statistics and chi-square tests performed using SPSS 29.0.Results:The study enrolled 1,478,1,901,and 7,714 patients in 2012,2019,and 2023,respectively.During the management period,the number of enrolled patients increased substantially from baseline.The antiviral treatment rates in 2019 and 2023 reached 64.5%and 58.2%,with both significantly higher than the baseline rate of 24.5%in 2012.Concurrently,abnormality rates for hepatitis B virus deoxyribonucleic acid(HBV DNA),alanine aminotransferase(ALT),total bilirubin(TBIL),and fibrosis indices decreased significantly in 2019 and 2023.The 2023 aMAP score further revealed a decline in hepatocellular carcinoma risk among managed patients(32.2%vs.26.3%).With enhanced community healthcare capacity,14.1%(2019)and 18.2%(2023)of patients accessed community dispensing services,aligning with the strategy to decentralize testing and treatment for disease elimination.Conclusions:Community-based healthcare management for chronic hepatitis in Shanghai provides patients with decentralized hepatitis-related testing and treatment services,creating an effective environment for chronic viral hepatitis prevention and control and would favorable for the viral hepatitis elimination efforts.展开更多
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...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.展开更多
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> 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.
基金Supported by the Shanghai Three-year Action Plan to Strengthen the Public Health System(Grant No.GWVI-9)the Shanghai Municipal Health Commission Youth Project(Grant No.20224Y0333).
文摘Introduction:Current strategies for chronic viral hepatitis prevention and control include immunization,prevention of mother-to-child transmission,expanded testing,antiviral therapy,and national drug price negotiations.To achieve this effectively,Shanghai has implemented a communitybased pilot program that integrates public health and clinical care for chronic viral hepatitis management.Methods:This study evaluated the effectiveness of Shanghai’s community-based healthcare program at three time points(2012,2019,and 2023),assessing key indicators including antiviral treatment rates and disease status changes and risk of hepatocellular carcinoma.Data were managed using EpiData 3.1,with descriptive statistics and chi-square tests performed using SPSS 29.0.Results:The study enrolled 1,478,1,901,and 7,714 patients in 2012,2019,and 2023,respectively.During the management period,the number of enrolled patients increased substantially from baseline.The antiviral treatment rates in 2019 and 2023 reached 64.5%and 58.2%,with both significantly higher than the baseline rate of 24.5%in 2012.Concurrently,abnormality rates for hepatitis B virus deoxyribonucleic acid(HBV DNA),alanine aminotransferase(ALT),total bilirubin(TBIL),and fibrosis indices decreased significantly in 2019 and 2023.The 2023 aMAP score further revealed a decline in hepatocellular carcinoma risk among managed patients(32.2%vs.26.3%).With enhanced community healthcare capacity,14.1%(2019)and 18.2%(2023)of patients accessed community dispensing services,aligning with the strategy to decentralize testing and treatment for disease elimination.Conclusions:Community-based healthcare management for chronic hepatitis in Shanghai provides patients with decentralized hepatitis-related testing and treatment services,creating an effective environment for chronic viral hepatitis prevention and control and would favorable for the viral hepatitis elimination efforts.
基金provided by Ministry of Education,Culture,Sports,Science and Technology(MEXT)Government of Japan
文摘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.
