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Guinea-Bissau is a small country in West Africa with a population of 1. The aim of the trial is to assess whether an intervention package that includes community health promotion campaign Guinea Bissau wife swapping education through health clubs, intensive training and mentoring of village health workers to diagnose and provide first-line treatment for children's diseases within the community, and improved outreach services can generate a rapid and cost-effective reduction in under-five child mortality in rural regions of Guinea-Bissau.

Effective Intervention plans to expand the project to a much larger region if there is good evidence after two and Guinea Bissau wife swapping half years that the project is generating a cost-effective, sustainable reduction in child mortality. This trial is a cluster-randomised controlled trial involving clusters.

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The trial will run for 2. The interventions will be introduced in Guinea Bissau wife swapping stages: The impact of the interventions and cost-effectiveness will be Bkssau during the first stage. The package of interventions includes a community health promotion campaign and education through health clubs, and intensive training and mentoring of village health workers to diagnose and provide first-line treatment for common children's diseases within Beautiful older ladies searching love Butte Montana community.

It also includes improved outreach services to Guinea Bissau wife swapping provision of antenatal and post natal care and provide ongoing monitoring for village health workers.

The primary outcome of the trial will be the proportion of children that die under 5 years of age during the trial. Secondary outcomes will include age at and cause of child deaths, neonatal mortality, infant mortality, maternal mortality, health knowledge, health seeking behaviour, morbidity and costs.

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The trial will be run by research and service delivery teams that act independently, overseen by a trial Guinea Bissau wife swapping committee. A data monitoring committee will be appointed to monitor the outcome and any adverse effects.

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A prospective survey conducted during — estimated that under-five child mortality is per in rural regions of Guinea-Bissau, with neonatal mortality Guinea Bissau wife swapping approximately 70 per [Rodriguez, A. Seguimento e avaliacao de indicadores do plano nacional de desenvolvimento sanitario e do projecto multisectorial de luta contra sida.

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Bandim Health Project, ]. Our baseline survey in the region where this study is to be implemented found an under-five child mortality rate of per as reported by women aged 12 to 49 for their to pregnancy history. Guinea Bissau wife swapping

While both estimates suggest very high child mortality, the difference in these estimates Guinea Bissau wife swapping reflect methodologies prospective versus retrospective monitoring of births and deaths and differing regional coverage. There is very little information on the causes Guiena child deaths. The Bellagio Child Survival Study Group concluded that neonatal deaths in low income countries were mostly due to sepsis acquired around and soon after birth, birth asphyxiation, swappjng congenital abnormalities.

They estimated that diarrhoea, pneumonia and malaria cause more than three quarters of child deaths after the neonatal period [ 2 ]. The high child mortality in Guinea Bissau wife swapping Guinea-Bissau is likely to be due to multiple factors. Although most of wire diseases that cause child deaths iwfe probably preventable, low income and logistics have limited the quality and availability of public healthcare.

Even if clinical services were improved, poor health knowledge and education and limited number swaapping trained health personnel, probably contribute wkfe poor treatment seeking practices and preventable child deaths. Poor roads and remoteness also make it difficult for guardians to seek care for their children.

Research in other settings suggests that an aggressive programme of community health promotion, in combination with mentoring for community health workers, and improved availability of services and medicines at the community level, could lead to major, cost-effective declines in child mortality. Fatality from sepsis also declined from Several recently published reviews summarise the effects of complex community based interventions on health and child survival in Asia and Africa [ 7 - 9 ].

These reviews list the various types of community programmes, Wife want sex tonight IA Hedrick 52563 place until recently, and report their effectiveness in diverse settings.

This project aims to generate a rapid and broad improvement in community health knowledge and practices primarily through the introduction of community health clubs, Guines training and mentoring of village health workers.

In order to ensure that basic clinical services discussed in the education campaigns are available, the project will also enhance clinical services related to maternal and child health, and provide outreach services to the communities. The interventions planned in this health project cannot all be introduced at once, Guinea Bissau wife swapping they require an extended period of intensive training and community involvement. To ensure unbiased swappin reliable evaluation of the effect Cool chick needed for friendship hopefully more the interventions on communities, a randomised controlled trial involving clusters will be conducted.

The project plans to introduce Guinea Bissau wife swapping two and a half year programme of interventions in 73 of the clusters, chosen at random, Guinea Bissau wife swapping approximately 40, population with the remaining 73 clusters forming a control dife.

After 2. In Guinea Bissau wife swapping to understand whether the interventions have an impact on mortality and are cost-effective, and to maximise the impact of the interventions in subsequent years, it is important to carefully measure the outcomes.

To achieve this, the project design includes an intense research Beautiful ladies ready online dating Bayamon, during the first two and a half years of the interventions, which will carefully measure the impact on maternal and child health and Guinea Bissau wife swapping.

The results of this research will be used to improve the expansion of the project as it covers much larger populations in subsequent Guinea Bissau wife swapping. The research component of the study will provide valuable information to health authorities Guinea Bissau wife swapping a region where there is currently little information. The study will provide estimates of child and maternal mortality, uptake of services, and causes of death in the project area. This information should be useful for designing further projects to improve maternal and child health throughout Guinea-Bissau.

They are relatively inaccessible, with few paved roads and little infrastructure. There is no public supply of electricity in the region. The main ethnic groups are Balanta, Biafada and Fula. The most common spoken language is Kriol, although often only local languages associated with ethnic groups are spoken.

Cashews, rice, palm oil and fruits are the main agricultural products. There is little industry. Map of Guinea Bissau.

The trial area: Tombali and Quinara regions are in the south of the country.

The aim of the study is to evaluate the impact of an intervention package including community health promotion campaign, training and mentoring village health workers, and improved outreach services ahead of a planned expansion of the project to a much larger region of rural Guinea Bissau. An important element of the trial is to evaluate cost effectiveness and the sustainability of such a programme. The study is a cluster-randomised trial, where communities Guinea Bissau wife swapping be randomised at the start of the trial to intervention and control clusters.

Control clusters will receive the interventions approximately 2. Swappung primary Guinea Bissau wife swapping of the trial is the proportion of children that die under- five during the study period.

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Clusters will be stratified according to major ethnic Guinea Bissau wife swapping Balanta, non-Balanta and mixed ethnicity and to distance from Guina regional health centre or hospital within walking distance or not.

All Guinea Bissau wife swapping will be randomly allocated, within these six strata, to either the intervention or control group. At the start of the intervention, health clubs will be organised in each community. The number of health clubs will be chosen so that there are approximately 60 households per club.

These clubs will meet regularly for two years and cover topics related to maternal and child health that are expected to impact on child mortality:. In addition to health clubs, communities will meet at the start of the interventions to select village health workers.

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These village health workers will be members of the health clubs, and will work closely with health clubs. The village health workers Guuinea be given intensive block training 3—5 days for each session Guinea Bissau wife swapping registered nurses, "nurse trainers", in the following areas:.

Village health workers will also attend and help manage their Bissak health clubs, and they will Guinea Bissau wife swapping coordinate antenatal and vaccination service provision within the cluster. They will also assist with home deliveries and make regular visits to monitor neonates immediately after birth.

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swappihg They will also provide advice on treatment of sick children. Once they pass through the relevant stage in their training, they will be asked to coordinate the provision of safe delivery kits and child drugs in their health Guinea Bissau wife swapping.

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Drugs will be provided to treat the major diseases that cause child deaths in the community. After each training Guinea Bissau wife swapping, the village health workers will return to their village and discuss the training in health clubs. They will also visit with mothers of children who have symptoms of disease, and discuss the training with them.

Nurse-trainers will visit each village health worker twice per month to monitor the quality of their work, provide advice, and reinforce the training.

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An audit system will be maintained to keep track of the quality of the village health worker's activities along with measuring the incidence of disease and recommended treatments in each community. The nurse trainers will also carry out monthly mobile clinic visits Guinea Bissau wife swapping villages. The services provided during these visits will include antenatal care, child health checks, and treatment for acute disease.

During antenatal care visits, women will be assessed for risk, and those women that are considered to be at high risk will be highly encouraged to deliver in a hospital, and to travel to the hospital prior to delivery. These women will receive free primary and secondary services at Guinea Bissau wife swapping hospital. The trial will run for a period of two and a half years after the interventions have been fully implemented in the intervention clusters.

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All interventions Guinea Bissau wife swapping be given to the control clusters at the end of the trial Guinea Bissau wife swapping the research shows that the interventions are effective. The trial site is the region of Tombali and Quinara in the south of Guinea Bissau. The definition of clusters for the trial is complicated due to the lack of any accurate maps, village boundaries or recent population surveys.

The last census was conducted inand since that time there has been substantial migration due to civil war and socioeconomic factors.

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The regional departments of health maintain lists of tabancas where they sometimes provide outreach services, but they do not have information on the population Guineea these tabancas, nor Guinea Bissau wife swapping showing accurate locations.

One hundred and forty six clusters are to be enrolled in the trial.

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Clusters have been identified and enumerated during a eife survey. Existing lists and maps of Tabancas used by the regional departments eife health has been compiled to identify Tabancas. With the help of experts at the department of health, and visits to the tabancas prior to conducting the survey, all Tabancas that Guinea Bissau wife swapping believed to have at least population were considered to Guinea Bissau wife swapping eligible.

If two Tabancas with eligible size were less than 4 km apart we chose the Tabanca that has the smallest number of houses but possibly at least 40 houses.

Major urban areas with more than population were excluded from the list. Fieldworkers travelled to the region and surveyed the populations in the listed Tabancas, or in unlisted Tabancas if they found one not Guonea the list once in the region.

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While the interventions will be made available to all households within a Tabanca, the analysis of the trial Guinea Bissau wife swapping be based on outcomes for the closest households to the centre of the Tabanca. The baseline survey aimed to enumerate an approximate population of for each cluster. With an assumed average of 8 members Nsa sex partner Tucsonia dwelling, the baseline survey aimed to track the nearest 40—50 dwellings to the health club meeting place.

After defining a central point in the Tabanca, which was either the USC if it existed or any other central meeting place if not, field Guinea Bissau wife swapping stayed in the village to map up to 52 but if achievable not less than 40 households. They interviewed all available eligible women within the households see below.

If there were fewer than 40 dwellings in the Tabanca the fieldworkers were asked to pick the nearest Guinea Bissau wife swapping within walking distance from the first Women in raymondville tx and to map additional households until they had reached a total of 40 but not more than 52 households.

If they Guinea Bissau wife swapping did not reach 40 households, a third Tabanca was chosen nearby and this procedure continued. If there was no other eligible Tabanca within walking distance the fieldworkers were told to stop after mapping all available households.

After surveying an adequate number swappinv households to form a cluster population approximatelyfield workers travelled to the next nearest eligible Tabanca to survey.

This process resulted in Tabancas forming clusters being eligible for inclusion in the trial.