India Health Action Trust, 404 - 4th Floor, 20-A Ratan Square, Vidhan Sabha Marg, Lucknow, Uttar Pradesh, 226001, India.
University of Manitoba, Institute for Global Public Health, R070 Med Rehab Building, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada.
BMC Public Health. 2021 Nov 6;21(1):2027. doi: 10.1186/s12889-021-12047-2.
Uttar Pradesh (UP), India continues to have a high burden of mortality among young children despite recent improvement. Therefore, it is vital to understand the risk factors associated with under-five (U5) deaths and episodes of severe illness in order to deliver programs targeted at decreasing mortality among U5 children in UP. However, in rural UP, almost every child has one or more commonly described risk factors, such as low socioeconomic status or undernutrition. Determining how risk factors for childhood illness and death are understood by community members, community health workers and facility staff in rural UP is important so that programs can identify the most vulnerable children.
This qualitative study was completed in three districts of UP that were part of a larger child health program. Twelve semi-structured interviews and 21 focus group discussions with 182 participants were conducted with community members (mothers and heads of households with U5 children), community health workers (CHWs; Accredited Social Health Activists and Auxiliary Nurse Midwives) and facility staff (medical officers and staff nurses). All interactions were recorded, transcribed and translated into English, coded and clustered by theme for analysis. The data presented are thematic areas that emerged around perceived risk factors for childhood illness and death.
There were key differences among the three groups regarding the explanatory perspectives for identified risk factors. Some perspectives were completely divergent, such as why the location of the housing was a risk factor, whereas others were convergent, including the impact of seasonality and certain occupational factors. The classic explanatory risk factors for childhood illness and death identified in household surveys were often perceived as key risk factors by facility staff but not community members. However, overlapping views were frequently expressed by two of the groups with the CHWs bridging the perspectives of the community members and facility staff.
The bridging views of the CHWs can be leveraged to identify and focus their activities on the most vulnerable children in the communities they serve, link them to facilities when they become ill and drive innovations in program delivery throughout the community-facility continuum.
尽管印度北方邦（Uttar Pradesh，简称 UP）最近有所改善，但五岁以下儿童死亡率仍然居高不下。因此，了解与五岁以下儿童死亡和严重疾病发作相关的风险因素至关重要，以便开展旨在降低 UP 五岁以下儿童死亡率的项目。然而，在 UP 的农村地区，几乎每个孩子都有一个或多个常见的风险因素，例如社会经济地位低或营养不良。确定农村 UP 的社区成员、社区卫生工作者和医疗机构工作人员如何理解儿童疾病和死亡的风险因素非常重要，以便项目能够确定最脆弱的儿童。
本定性研究在 UP 的三个地区进行，这些地区是一个更大的儿童健康项目的一部分。与社区成员（有五岁以下儿童的母亲和户主）、社区卫生工作者（认证社会卫生活动家和助理护士助产士）和医疗机构工作人员（医务人员和护士）进行了 12 次半结构化访谈和 21 次焦点小组讨论，共有 182 名参与者参加。所有互动都被记录、转录并翻译成英文，按主题进行编码和聚类进行分析。本研究呈现的是围绕儿童疾病和死亡的感知风险因素而出现的主题领域。
在三个群体中，对于确定的风险因素的解释视角存在关键差异。一些观点完全不同，例如住房位置为什么是一个风险因素，而其他观点则是趋同的，包括季节性和某些职业因素的影响。家庭调查中确定的儿童疾病和死亡的经典风险因素通常被医疗机构工作人员视为关键风险因素，但社区成员却不这样认为。然而，社区成员和医疗机构工作人员经常表达重叠的观点，社区卫生工作者则架起了两者之间的桥梁。
社区卫生工作者的桥梁作用可以利用来识别和关注他们服务的社区中最脆弱的儿童，在他们生病时将他们与医疗机构联系起来，并在整个社区-医疗机构连续体中推动项目交付的创新。
