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INTRODUCTION Despite decades of experience with community health workers (CHWs) in a wide variety of global health projects, there is no established conceptual framework that structures how implementers and researchers can understand, study and improve their respective programs based on lessons learned by other CHW programs. OBJECTIVE To apply an(More)
The purpose of this study is to evaluate the effectiveness of highly active antiretroviral therapy (HAART) in preventing mother-to-child transmission (PMTCT) of HIV in breastfeeding women in rural Zimbabwe. During a severe socio-economic crisis in 2005-2007, 82 eligible HIV-positive pregnant women between 14-36 weeks gestation were initiated on HAART with(More)
Acknowledgements: The authors would like to express our appreciation to the entire staff of Possible in Achham who dedicate themselves to providing excellent healthcare to the patients of Achham; to Dr. Borgny Ween at Oslo and Akershus University College of Applied Sciences for her valuable assistance in preparing this manuscript, for her contributions to(More)
INTRODUCTION There are well-established protocols and procedures for the majority of common surgical diseases, yet surgical services remain largely inaccessible for much of the world's rural poor. Data on the process and outcome of surgical care expansion, however, are very limited, and the roll-out process of rural surgical implementation in particular has(More)
PROBLEM In hospitals in rural, resource-limited settings, there is an acute need for simple, practical strategies to improve healthcare quality. SETTING A district hospital in remote western Nepal. KEY MEASURES FOR IMPROVEMENT To provide a mechanism for systems-level reflection so that staff can identify targets for quality improvement in healthcare(More)
BACKGROUND Nepal's Female Community Health Volunteer (FCHV) program has been described as an exemplary public-sector community health worker program. However, despite its merits, the program still struggles to provide high-quality, accessible services nation-wide. Both in Nepal and globally, best practices for community health worker program implementation(More)
Pandey and others reported the first case of visceral leishmaniasis (VL) in the Far Western Hills region of Nepal. 1 At our hospital in the Achham district, which neighbors the Doti district described in the Pandey and others report, we recently had a case of VL in a 17-year-old woman who presented with advanced disease. We transferred her to a hospital in(More)
BACKGROUND Surveillance systems are increasingly relying upon community-based or crowd-sourced data to complement traditional facilities-based data sources. Data collected by community health workers during the routine course of care could combine the early warning power of community-based data collection with the predictability and diagnostic regularity of(More)
INTRODUCTION Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector(More)
BACKGROUND Zimbabwe underwent a socioeconomic crisis and resultant increase in food insecurity in 2008-9. The impact of the crisis on Tuberculosis (TB) incidence is unknown. METHODS Prospective databases from two mission hospitals, which were geographically widely separated, and remained open during the crisis, were reviewed. RESULTS At the Howard(More)