Posyandu stands for "Pos Pelayanan Terpadu" in Bahasa meaning "Integrated Service Post," which is a community-based health center providing primary health care and services for mothers and children in Indonesia. Each Posyandu is served by five Posyandu Cadres who are community health workers and responsible to deliver essential health services and education to their communities. Our project, in Central Lombok district at Nusa Tenggara Barat province, Indonesia has been focusing on improving sick child care, specifically on tackling childhood pneumonia within project area. We facilitated capacity building of posyandu cadres for counseling and health education of caregivers at community and to encourage them visiting Posyandu and to seek care for pregnant women and sick child from nearby puskesmas and polindes (these are community based static health facilities). During January - August 2022, we trained 1100 posyandu cadres and equipped them with pictorial flipbook with health education and counseling messages. We retrieved monthly care seeking data from puskesmas and polindes as well as monthly attendance data from posyandu centers through routine health management information system for January 2022 to February 2023. Comparing pre-training (January – August 2022) and post-training (September 2022 – February 2023) data, we found statistically significant increase in mean numbers of pregnant women and children under five years of age for whom caregivers sought health, nutrition and immunization services from Puskesmas and Polindes in respective communities. Monthly average number of pregnant women and sick child who were brought to nearby Puskesmas and Polindes for care during January to August 2022 was 1553 which was increased to 1844 during September 2022 – February 2023 (p < 0.001). The monthly average attendance of mothers and children at Posyandu from January to August 2022 was 12,751, which was increased to 14,677 during September 2022 – February 2023 (p < 0.001). This incremental attendance at Posyandu and increased care seeking from puskesmas and polindes can potentially be attributable to counseling-education session by trained and skilled posyandu cadres and it reconfirms the worthiness of additional efforts and investment for capacity and skill building of posyandu cadres to improving community health in rural Indonesia.

Background: This is the final of 10 papers that describe the implementation of the Expanded Census-Based, Impact- Oriented Approach (CBIO+) by Curamericas/Guatemala in the Cuchumatanes Mountains of the Department of Huehuetenango and its effectiveness in improving the health and well-being of women and children in a population of 98,000 in three municipalities. The CBIO+ Approach consists of three components: the CBIO (Census-Based, Impact-Oriented) Approach, the Care Group Approach, and the Community Birthing Center Approach.

Methods: Each of the preceding papers was summarized. An assessment was made regarding the degree to which the initial implementation research hypotheses were confirmed. The total field cost per capita for operation of the Project was calculated. An assessment of the cost-effectiveness of the Project was made based on the estimated impact of the Project, the number of lives saved, and the number of disability-adjusted life years averted.

Results: The Project attained a number of notable achievements in terms of expanding the coverage of key maternal and child health interventions, improving the nutritional status of children, reducing the mortality of children and mothers, providing quality care for mothers at the Community Birthing Centers (Casas Maternas Rurales) that integrate traditional midwives (comadronas) into the care of women during childbirth at the birthing centers, as well as empowering women and building social capital in the communities. CBIO+ is considered to be an effective and affordable approach that was particularly notable for its capacity to engage communities in the process of improving the health of mothers and children. Overall, there is strong and consistent evidence in support of the research hypotheses. The findings did produce evidence of declines in under-5 and maternal mortality, but they were not as robust as had been hoped.

Conclusion: CBIO+ is an approach that is effective in engaging communities in the process of improving the health of their mothers and children and in reducing health inequities in this marginalized, difficult-to-reach population of Indigenous Maya people. The CBIO+ Approach is cost-effective and merits further development and broader application.

Background. Global health prevention and treatment approaches must consider and address the contributors to poor health outcomes, defined as the social determinants of health. African regions top the list of disease incidents and death rates. Ghana, West Africa, has a significant need for healthcare and community health services. To support this need, the Gold Coast Medical Foundation conducts annual mission trips to communities in Ghana and provides primary, preventive, and community-level services. In 2022 ten sites were visited.

Methods. The current study explored factors that comprise the social determinants. We categorized healthcare services by care sites and communities (rural and urban). Health conditions were classified by clinic sites and communities. Ghana-specific social determinants, including malnourishment, healthcare needs, infrastructure, community location, and education, were explored.

Results. Care was provided to 3,374 patients in rural (N=3, 30%) and urban (N=7, 70 %) communities. Age groups served were 0-18 (N=624,18%), 19-39 (N=512,15%), 40-54 (N=1136,34%), 55-64 (N=357,11%), 65-74 (N=194,6%) and 75 and older (N=551,16%), with most patients being middle age and older (N=2,238, 67%). More females (66%) were treated than males (34%). Non-infectious (35.6%) and infectious (31.1%) diseases topped the list. Findings indicated site (X²=68.56, df=50, p=.042) and community-specific differences (X²=766.0, df=594, p=.000) in conditions treated. Infectious (X²=6.019, df=1, p=.014), inherited (X²=3.62, df=1, p=.057), and non-infectious (X²=17.46, df=1, p=.000) conditions were significant. Controlling for social determinants and community location, the significant predictor of the disease burden was aging-related conditions (β=-2.75, p=.010).

Conclusions. Adverse health determinates must be explored and addressed throughout the regions of the world to reduce the global health burden. African regions top the list of disease incidents and death rates. Findings will inform the reduction of the disease burden in Ghana.

Pulmonary tuberculosis is a major public health problem in India. The relationship between perceived social support and tuberculosis medication adherence remains unexplored in India. This cross-sectional study aimed to examine the association of perceived social support with medication dose interruption and its frequency among patients with pulmonary tuberculosis in Western India. A sample of 477 participants was recruited from three directly observed treatment centers (DOTS). Demographic and clinical characteristics along with the assessment of perceived social support (Multidimensional Scale of Perceived Social Support; MSPSS) were collected. Descriptive statistics were reported, and binomial and multinomial regression models were used for analysis. Perceived social support presented a significant association with tuberculosis medication dose interruption and its frequency. Compared to those with high social support, respondents with low social support were 2.6 times significantly more likely to miss their doses (p<0.001). Participants who reported low family support were 4.1 times significantly more likely to miss their doses when compared with participants with high family support (p<0.001). Findings suggest that social support is a crucial factor in improving medication dose interruption among pulmonary tuberculosis patients in India and can potentially have significant implications for the development of intervention strategies. The study recommends a need for establishing a patient-centric policy focusing on social support to promote patient well-being and potentially ensure adherence to tuberculosis treatment.

Background: Sodium intake and blood pressure are increasing in sub-Saharan Africa, but there is limited contextual evidence for public health interventions that are effective at addressing this challenge. We assessed the effect of a novel school-based intervention on sodium intake and blood pressure amongst young adolescents (age 11-14 years) and their parents or caregivers.

Methods: In this cluster-randomised controlled trial, 26 primary schools in Karonga and Lilongwe districts in Malawi were randomly assigned (1:1) to maintain the routine curriculum (control) or a 10-week school-based series of lessons and participatory activities delivered to adolescents in standard 6, designed to promote the reduction of sodium intake within their household as an agent of change. The co-primary outcomes were change in sodium intake (assessed by 24 hour urine collection) and blood pressure of adolescents at 12 weeks. Secondary outcomes were change in sodium intake and blood pressure of parents or caregivers at 12 weeks, and change in blood pressure of all participants at 52 weeks. Analysis was by intention-to-treat. This trial is registered at ISRCTN 13909759.

Findings: A total of 732 randomly selected adolescents, and 1,236 adult participants were surveyed at baseline. Participation by adolescents was high, with overall attendance of 87% to intervention activities. After 12 weeks, no significant intervention effect was observed on the sodium intake of adolescents (adjusted difference= -0.17g/24h, 95% CI -0.63–0.29, p=0.44) or adults (adjusted difference= -0.59g/24h, -0.59–0.16, p=0.26); or on the blood pressure of adolescents or adults at either 12 or 52 weeks. In post-hoc analysis, there was a significant intervention effect at 12 weeks when restricted to adults with relatively high (>4g/24h) baseline sodium intake (adjusted difference= -0.57g/24h, -1.1–0.05, p=0.03).

Interpretation: Despite the intervention being comprehensively developed, positively received, and reaching through to parents; it did not reduce sodium intake or blood pressure. This lack of effect may be related to a lower baseline sodium intake than observed in previous research. School-health interventions are a pragmatic and efficient platform for the delivery of health education to communities; but were not effective at reducing sodium intake and blood pressure in this setting.