Public Health Commons^™

Challenges And Opportunities In Implementing And Enforcing India’S Loose Cigarette Sales Ban: A Qualitative Stakeholder Analysis, Mayank Sakhuja, Daniela B. Friedman Ph.D., Mark M. Macauda Phd, Mph, James R. Hebert Scd, Mangesh S. Pednekar, Prakash C. Gupta, James F. Thrasher Ph.D., Ma, Ms

Faculty Publications

Introduction Several Indian states have banned the sale of loose cigarettes, and India is considering a national ban. This study examines the perceptions of policymakers, implementers, and law enforcement officials regarding the implementation and enforcement of this ban. Methods Between May–October 2022, we conducted in-depth interviews with 26 key stakeholders involved in tobacco control in two Indian cities, Delhi (where the ban was not implemented) and Mumbai (where the ban was in effect). Participants included representatives from various government departments such as police, municipal corporations, FDA, health, and civil society organizations / NGOs such as Vital Strategies, World Health Organization, …

Effect Of Improving Food Security On Parenting Practices And Caregiver–Adolescent Relationships: Qualitative Findings Of An Income-Generating Agricultural Intervention In Rural Kenya, Maricianah A. Onono, Lila Sheira, Edward A. Frongillo Jr., Gladys Odhiambo, Pauline Wekesa, Amy Conroy, Elizabeth A. Bukusi, Craig R. Cohen, Sheri D. Weiser

Faculty Publications

Background

Despite the recognised links between food insecurity and parenting, few studies have evaluated the perceived impacts of livelihood or food security interventions on parental practices, intra-household functioning, adolescent behaviour and psychosocial outcomes in HIV-affected households in sub-Saharan Africa.

Aims

The study aimed to understand the perceived effects of food security on parenting practices and how this was experienced by both adolescent girls (aged 13–19 years) and their caregivers in rural Kenya.

Method

We conducted semi-structured, individual interviews with 62 caregiver–adolescent dyads who were participants in the adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a …

Conceptualizing Self-Reported Adverse Childhood Experiences: From Epidemiologic Exposure To Psychometric Latent Variable, Marianna D. Lanoue, Richard W. Hass

College of Population Health Faculty Papers

In this paper, we apply a measurement science perspective to explore both the epidemiologic and psychometric frameworks for the conceptualization, operationalization and assessment of self-reported adverse childhood experiences (srACEs). The epidemiologic paradigm suggests that srACEs are 'exposures', while the psychometric paradigm views responses on srACEs instrumentation as 'indicators'. It is the central premise of this paper that srACEs cannot be both exposures and indicators of scales. We review issues of reliability and validity from both perspectives, examine the degree of agreement between objective and subjective reports of childhood maltreatment and the implications of poor agreement, and conclude that the for …

Impact Of American Thyroid Association's Revised Cancer Management Guidelines On Thyroid Cancer Incidence Trends: A Retrospective Cohort Study, 2000-2020, Pierre Fwelo, Natalia I Heredia, Ruosha Li, Ayrton Bangolo, Vignesh K Nagesh, Simcha Weissman, Xianglin L Du

Faculty, Staff and Student Publications

Background: The past four decades have seen a steady increase in thyroid cancer in the United States (US). This study investigated the impact of the American Thyroid Association (ATA)'s revised cancer management guidelines on thyroid cancer incidence trends and how the trends varied by socioeconomic, histologic, geographic, and racial and ethnic characteristics from 2000 to 2020.

Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER) database to identify thyroid cancer cases diagnosed among US patients between 2000 and 2020. We employed joinpoint regression software to fit, assess, and compare thyroid cancer incidence trends over time stratified by …

Health Literacy On Physical Therapy Among Senior Citizens With Physical Disability And Community Health Workers, Kriza G. Ganotisi, Faye Angelene J. Barangay, Andrew A. Galang, Wina Frances Q. Lazaro, Christopher U. Rivera, Ryan Dean T. Sucgang

Philippine Journal of Physical Therapy

Introduction. This study was conducted to determine the health literacy on physical therapy (PT) among senior citizens with physical disability and community health workers (CHWs). Specifically, it identified the sociodemographic profile of the CHWs and senior citizens with physical disability, their extent of health literacy on PT as to prose, document and numeracy and how health policies, availability of PT programs, and available equipment and facilities for the rendition of PT services affect their health literacy.

Methods. This study employed a descriptive research design. The respondents of the study involved 18 CHWs and 29 senior citizens. It was conducted in …

From The Ocean To Our Kitchen Table: Anthropogenic Particles In The Edible Tissue Of U.S.. West Coast Seafood Species, Summer D. Traylor, Elise F. Granek, Marilyn Duncan, Susanne Brander

Environmental Science and Management Faculty Publications and Presentations

Microplastics (MPs) and other anthropogenic particles (APs) are pervasive environmental contaminants found throughout marine and aquatic environments. We quantified APs in the edible tissue of black rockfish, lingcod, Chinook salmon, Pacific herring, Pacific lamprey, and pink shrimp, comparing AP burdens across trophic levels and between vessel-retrieved and retail-purchased individuals. Edible tissue was digested and analyzed under a microscope, and a subset of suspected APs was identified using spectroscopy (μFTIR). Anthropogenic particles were found in 180 of 182 individuals. Finfish contained 0.02–1.08 AP/g of muscle tissue. In pink shrimp (Pandalus jordani), the average AP/g was 10.68 for vessel-retrieved and …

Improved Adherence To Lipid Screening In The Pediatric Cardiology Clinic: A Quality Improvement Project, Rachel Magnan, Thomas Murphy, Lauren Rosenthal, Aparna Prasad, Anjali Chelliah, Stuart Kaufman, Donna Timchak, Lindsey Mcphillips, Saira Siddiqui

Department of Pediatrics Faculty Papers

INTRODUCTION: Lipid screening identifies at-risk patients to facilitate cardiovascular risk reduction. National pediatric guidelines recommend universal lipid screening between 9-11 and 17-21 years of age. We aimed to improve adherence to lipid screening for all age-appropriate outpatient pediatric cardiology visits from a baseline of 35% to 90% between November 2021 and July 2023.

METHODS: All outpatient visits for patients 9-11 and 17-21 years were included. Chart review and an Epic electronic health record report identified patients screened, lipid test results, and need for further testing. A P-chart was generated. After establishing a baseline for 8 weeks, interventions, including an Epic …

Assessing State Laws And Regulations On Radon In Us Childcare Centers, Benjamin Poku, Sayed Hussaini

Journal of Global Awareness

In the US, radon is the second most significant contributor to lung cancer, following smoking. Despite this, there is a notable absence of state-level measures and guidelines aimed at managing and mitigating the risks associated with exposure to radon gas. The objective of this research was to investigate whether state-level laws regarding radon in childcare centers have a correlation with the proportion of counties in each state that fall under radon zone 1 (with levels exceeding 4 pCi/L). The research method was secondary analysis. Data was gathered from multiple sources, including the EPA radon website, academic journals, official state government …

Importance Of The Hemoglobin Glycation Index For Risk Of Cardiovascular And Microvascular Complications And Mortality In Individuals With Type 2 Diabetes (Endocrinol Metab 2024;39:732-47, Claudia Regina Lopes Cardoso Et Al.), Stuart A. Chalew

School of Medicine Faculty Publications

No abstract provided.

Managing The Cost Of Services For People With Disabilities: An International Approach. Part I: Poland, Dana Pugh, Jaroslaw Richard Romaniuk

Faculty Scholarship

Introduction: The cost of care for people with disabilities is rising, whereas all forms of support for them are decreasing. Countries and communities develop different ways to serve the disabled. We examined the comprehensive state of care from the perspective of cost management of services for individuals with disabilities in Poland. Method: This paper is based on a review of relevant international literature, with a special focus on the situation in Poland. A keyword search was completed in both Polish- and English-language databases. Results: In Poland, people with disabilities usually live with their families, and specialized services are offered outside …

Dental Clinic Deserts In The Us: Spatial Accessibility Analysis, Md Shahinoor Rahman, Jeffrey C. Blossom, Ichiro Kawachi, Renuka Tipirneni, Hawazin W. Elani

School of Public Health Faculty Publications

IMPORTANCE: Little is known about the spatial accessibility to dental clinics across the US. OBJECTIVE: To map the spatial accessibility of dental clinics nationally and to examine the characteristics of counties and US Census block groups with dental care shortage areas. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of US dental clinics in 2023 using data from the IQVIA national practitioners' database, which includes 205 762 active dentists. Data were analyzed from November 2023 to April 2024. EXPOSURES: Socioeconomic characteristics of block groups and counties including rurality, area deprivation, racial and ethnic segregation, and uninsured population. MAIN OUTCOMES AND MEASURES: Enhanced …

Measurement Of Breast Artery Calcification Using An Artificial Intelligence Detection Model And Its Association With Major Adverse Cardiovascular Events, Suzanne Rose, Josette Hartnett, Zachary Estep, Daniyal Ameen, Shweta Karki, Edward Schuster, Rebecca Newman, David Hsi

Department of Medicine Faculty Papers

Breast artery calcification (BAC) obtained from standard mammographic images is currently under evaluation to stratify risk of major adverse cardiovascular events in women. Measuring BAC using artificial intelligence (AI) technology, we aimed to determine the relationship between BAC and coronary artery calcification (CAC) severity with Major Adverse Cardiac Events (MACE). This retrospective study included women who underwent chest computed tomography (CT) within one year of mammography. T-test assessed the associations between MACE and variables of interest (BAC versus MACE, CAC versus MACE). Risk differences were calculated to capture the difference in observed risk and reference groups. Chi-square tests and/or Fisher's …

Global Prevalence Of Helicobacter Pylori Antibiotic Resistance Among Children In The World Health Organization Regions Between 2000 And 2023: A Systematic Review And Meta-Analysis, Aryan Salahi-Niri, Ali Nabavi-Rad, Tanya Marie Monaghan, Theodore Rokkas, Michael Doulberis, Amir Sadeghi, Mohammad Reza Zali, Yoshio Yamaoka, Evelina Tacconelli, Abbas Yadegar

Faculty, Staff and Students Publications

Background: Helicobacter pylori infection causes gastritis, peptic ulcers, and gastric cancer. The infection is typically acquired in childhood and persists throughout life. The major impediment to successful therapy is antibiotic resistance. This systematic review and meta-analysis aimed to comprehensively assess the global prevalence of antibiotic resistance in pediatric H. pylori infection.

Methods: We performed a systematic search of publication databases that assessed H. pylori resistance rates to clarithromycin, metronidazole, levofloxacin, amoxicillin, and tetracycline in children. The WHO region classification was used to group pooled primary and secondary resistance estimates along with 95% confidence interval (CI). H. pylori antibiotic resistance rates …

Relative Survival, Conditional Survival, And Causes Of Death In Patients With Early Gastric Cancer, With A Focus On Differences Between Cardia And Non-Cardia Cancer, Anas Elgenidy, Omar Alomari, Mohamed Marey Hesn, Anas Khaled, Sarah A Nada, Mostafa Elsayed, Ali Mahmoud, Mohammed Al-Mahdi Al-Kurdi, Ahmed M Afifi, George Cholankeril

Faculty, Staff and Students Publications

Background: Many researchers believe that cardia (CGC) and non-cardia (NCGC) are two different types of tumors, having different features like incidence rate, risk factors, geographical location, and socioeconomic status. This study aims to investigate the causes of death (COD) survival rates among early gastric cancer patients with a focus on differences between CGC and NCGC.

Methods: This retrospective study employed SEER*stat software (version 8.3.92) to analyze the SEER 17 plus dataset (2000–2019). Standardized mortality ratios (SMR) were computed. Relative survival and conditional survival post-diagnosis were calculated using R software (version 4.1.0) among the different subgroups.

Results: Within the follow-up period, …

The Percentage Of Sacroiliac Fusions Done In The U.S. By Non-Surgical Specialties Has Increased, Mathew Cyriac, Bela P. Delvadia, Julianna E. Winter, Jacob S. Budin, Olivia C. Lee, William F. Sherman

School of Medicine Faculty Publications

BACKGROUND: Surgical fusion of the sacroiliac (SI) joint is often performed to manage chronic lower back or buttock pain. When Current Procedural Terminology (CPT) codes were introduced, SI joint fusion procedures were done primarily by orthopaedic surgeons and neurosurgeons. The purpose of this study was to examine the utilization of SI joint fusion CPT codes by physician specialty over time. METHODS: A retrospective cohort study was conducted using the PearlDiver database. The database was queried using CPT codes to identify patients who underwent SI joint fusion via percutaneous, open, or trauma codes. Specialties queried included surgical specialties (orthopaedic surgery and …

Addressing Over-The-Counter Proton Pump Inhibitor Overuse: Strategies For Pharmacists To Enhance Patient Care, Brenna Hissong, Giang Nguyen, Alexander Defranco, Layla Dials, Jordyn Linfield, Haley Brown, Joshua Honaker, Samantha Mccord, Alaina Kortokrax

Pharmacy and Wellness Review

Proton pump inhibitors (PPIs) are among the most commonly prescribed and widely used medications for the treatment of gastrointestinal (GI) disorders. PPIs irreversibly inhibit the H+/K+-ATPase enzyme, effectively reducing gastric acid secretion and providing sustained relief for acid-related conditions. With the approval of over-the-counter (OTC) PPIs, the number of individuals taking these medications for prolonged periods of time without routine monitoring for the appropriateness of therapy has increased. The overuse of OTC PPIs can be attributed to a number of factors, including ease of access, perceived safety, inadequate understanding of OTC PPI treatment intervals, and a lack of awareness regarding …

Fda Approves Neffy®- First Nasal Spray For Anaphylaxis, Abigail Carter, Penlope Mazivanhanga, Haylee Whyde, Rileigh Rahrig, Ashley Jacob, Anna Spalvieri, Joshua Honaker, Samantha Mccord, Andrew Roecker

Pharmacy and Wellness Review

Between 1.6 and 5.1% of the United States population have experienced anaphylaxis, a severe allergic reaction.1 Anaphylaxis occurs when someone is exposed to an allergen, most commonly foods, medications, and insect venom. Epinephrine is the first-line agent for anaphylaxis treatment, and it is critical to administer this medication immediately after the onset of anaphylactic symptoms to prevent worsening that could lead to death. Epinephrine, more commonly known as EpiPen® or Auvi-Q®, has historically only been available as an intramuscular (IM) injection. Many people are afraid, anxious, or uneducated on how to properly give someone an IM injection, causing anaphylaxis treatment …

Fda Greenlights Early-Stage Trial For Investigational Long Covid Treatment: Phase Ii Evaluation Pending, Arin Wade, Maria Nguyen, Allie Honigford, Kennedy Kosikowski, Minhwan Yang, Rebecca Willier, Joshua Honaker, Samantha Mccord, Theresa Hempleman

Pharmacy and Wellness Review

Long coronavirus disease (COVID) is a condition that affects millions of individuals worldwide. Long COVID manifests as persistent symptoms following acute COVID-19. These symptoms can include, but are not limited to, fatigue, cognitive dysfunction, and chronic inflammation often lasting for months and significantly impairing patients' quality of life. As the number of Long COVID cases continues to rise and major global health organizations begin to standardize Long COVID’s mechanisms and diagnosis, there is an increasing demand for effective treatments that can address its complex nature. While some therapies, such as metformin and hyperbaric oxygen therapy (HBOT) have shown promise in …

Priorities To Care Within The Military Health System: A Mixed Methods Study On Military Spouse Access To Care During Covid-19 On Okinawa, Elayne L. Wilson

Theses & Dissertations

Military spouses in Okinawa experienced denial of care at military treatment facilities and off base Japanese healthcare facilities during the COVID-19 pandemic. Over two years of travel restrictions further contributed to difficulties accessing healthcare while stationed on the island with their active-duty spouse. This study examined the implications of a priority-based access system through the TRICARE program implemented due to limited resources during COVID-19 and its impact on military spouses in a scarce medical resource environment. This concurrent mixed-methods research used a survey tool developed by Community First Hawaii to quantify access to healthcare and in-depth interviews to further explore …

Sparkled: Social Programming In Kids Affects Risk Of Latent Endothelial Disease, Rebecca Drakowski

Theses & Dissertations

Background: Social Health Programming (SHP) is a holistic intervention that can empower communities to address modifiable risk factors for poor cardiovascular health, including suboptimal nutrition or psychosocial stressors. SHP participation has been shown to increase dietary intake of fruits and vegetables, decrease perceived stress, and improve cardiovascular endurance. However, it is unknown how SHP participation during adolescence affects carotenoid serum levels, hair cortisol concentrations (biological marker of chronic stress), or vascular reactivity index (VRI; measure of subclinical cardiovascular health).

Methods: Adolescent girls and young adult women (12–29-year-old) were enrolled in this observational cohort study. Serum, hair, and saliva samples were …

A Comprehensive Usability And Economic Analysis Of Heat-Related Wearable Technologies: Applications To Occupational Health, Ryan T. Cannady

Theses & Dissertations

The purpose of this research was to analyze the usability and economic considerations of real-time wearable technologies that are implemented in occupational settings to assess risk of heat stress and heat strain. The study population included current agriculture workers and Department of Energy (DOE), Environmental Management (EM) contractors. We employed a mixed-methods approach to comprehensively analyze the usability and economic considerations of heat-related technologies. Specifically, our approach assessed three distinct aspects the applications of these technologies in occupational settings to comprehensively address our research objective: (1) worker perceptions of heat-related wearable technologies, (2) field-based assessment of these heat-related wearable technologies, …

Efficacy Of Probiotics For Treatment Of Acute Or Persistent Diarrhoea In Children From Birth Till 10 Years: Systematic Review And Meta-Analysis, Anmol Minaz, Ridwa Alam, Uswa Jiwani, Khadija Vadsaria, Ahmad Khan, Aqsa Ishaq, Samar Sultan, Marium Mohsin, Ashraf Sharif, Yasir Bin Nisar, Jai K. Das, Sajid Bashir Soofi, Shabina Ariff

Centre of Excellence in Women and Child Health

Background: Numerous studies have investigated the efficacy of probiotics in treating acute and persistent diarrhoea. However, probiotics have not been established as a recommended management option for diarrhoeal illness by the World Health Organization (WHO). Therefore, we conducted a systematic review of randomised controlled trials to assess the efficacy of probiotics for the management of acute and persistent diarrhoea in children.
Methods: A systematic search on PubMed, CINAHL, Wiley Cochrane Library, Scopus, Clinicaltrials.gov, and WHO International Clinical Trials Registry Platform (ICTRP) was performed. All studies published in the year 2000 and onwards that assessed the use of probiotics in the …

Bio-Preparedness In A Global Context: Multi-Site International Study Investigating Global Health Security Challenges In Egypt, Oman, And The United States, Rima M. Al Balushi

Theses & Dissertations

The COVID-19 pandemic exposed myriad vulnerabilities globally within public health systems, from inadequate bio-risk management in laboratories to overwhelming utilization of hospital resources and disparities in vaccine access and uptake. The Global Health Security Index (GHSI), which critically evaluates health security domains including health systems and risk environments, reports serious weaknesses in global health security. This dissertation aims to investigate critical aspects of global health security domains by examining factors impacting biosafety and biosecurity capacities in laboratories in Egypt, healthcare resource utilization in hospitals in Oman relating to acute respiratory infections (ARI), and COVID-19 vaccine uptake in the United States. …

Protocol For Culturing Patient-Derived Organoids Of Cervical Cancer, Rui Wang, Timothy Harris, Dalissa Negrón-Figueroa, David Lo, Allison Judge, D'Shaunique Walters, Bo Jiang, Lauren E Colbert

Faculty, Staff and Student Publications

Herein, we present a protocol for culturing patient-derived organoids (PDOs) of cervical cancer that includes workflows for tumor biopsy/resection tissue and cytobrush-sampled cells. We describe steps for PDO culture initiation, including rinsing, gentle dissociation, Lymphoprep separation, and cell assessment, as well as seeding cells from surgical and cytobrush tissue digestion. We then provide guidance on PDO maintenance and passage and techniques for producing conditioned medium. Overall, this protocol serves as a valuable guide for establishing and maintaining cervical cancer PDOs. For complete details on the use and execution of this protocol, please refer to Colbert et al.

The Camden Study - A Pregnancy Cohort Study Of Pregnancy Complications And Birth Outcomes In Camden, New Jersey, Usa., Stephanie Shiau, Xinhua Chen, Ayana April-Sanders, Ellen C Francis, Shristi Rawal, Megan Hansel, Kehinde Adeyemi, Zorimar Rivera-Núñez, Emily S Barrett

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Pregnancy is a unique stage of the life course characterized by trade-offs between the nutritional, immune, and metabolic needs of the mother and fetus. The Camden Study was originally initiated to examine nutritional status, growth, and birth outcomes in adolescent pregnancies and expanded to study dietary and molecular predictors of pregnancy complications and birth outcomes in young women.

METHODS: From 1985-2006, 4765 pregnant participants aged 12 years and older were recruited from Camden, NJ, one of the poorest cities in the US. The cohort reflects a population under-represented in perinatal cohort studies (45% Hispanic, 38% non-Hispanic Black, 17% White …

"Does Anyone Believe Me"?: The Traumatization Of Domestic Violence Survivors In The Criminal Justice System, Olivia Depalma

Master of Arts in Human Services

Survivors of domestic violence are often subject to chronic trauma as well as a heightened risk of injuries and mental health problems and disorders. The intention of the author is to focus on how trauma impacts a survivor’s ability to maneuver and interact with the criminal justice system (CJS). Prior studies have shown how survivor’s behaviors, usually the result of trauma, can lead to misconceived notions and beliefs in court officials and those involved in the CJS. Survivors will often face judgment, doubt, and criticism in the CJS, and this can impact their willingness to come forward, report the abuse, …

Racial And Ethnic Differences In Outcomes Of Neonates Born At Less Than 30 Weeks' Gestation, 2018-2022, Nansi S. Boghossian, Marco Geraci, Erika M. Edwards, Jeffrey D. Horbar

Faculty Publications

Importance: Previous research has examined outcomes among very preterm newborns by the birthing parent's race and ethnicity, but knowledge about these trends during the COVID-19 pandemic is limited. Objective: To examine trends in outcomes among Black, Hispanic, and Asian preterm newborns compared with White preterm newborns. Design, Setting, and Participants: This cohort study (2018-2022) took place at 774 neonatal intensive care units in the Vermont Oxford Network. Participants were newborns born at 22 to 29 weeks' gestation. Exposure: Race and ethnicity. Main Outcomes and Measures: The primary outcomes were mortality and complications, including respiratory distress syndrome, necrotizing enterocolitis (NEC), early-onset …

Assistive Technology Abandonment With Veterans And Leisure Activities, Tara Lamson, Lee Ann Hoffman, Mary Greer

Fall 2024 OTD Capstone Symposium

Veterans using assistive technology (AT) often face barriers that limit their participation in meaningful leisure activities, negatively impacting their mental health and quality of life. This project aimed to address these challenges by developing an educational program focused on improving AT management, reducing abandonment, and promoting leisure engagement. A needs assessment of veterans in Abilene, TX, revealed critical issues, including barriers to leisure, limited community involvement, and gaps in AT maintenance education. The program delivered web-based and in-person resources on AT use, adaptive leisure strategies, and equipment recycling. Key outcomes included enhanced social participation, improved independence, and sustainable solutions for …

Use Of Adventure To Address Play Deprivation In Children And Teens Raised In Conflict, Kristin Salisbury, Mary Jan Greer

Fall 2024 OTD Capstone Symposium

Youth raised in conflict often experience extrinsic and intrinsic factors that contribute to play deprivation and occupational injustice. These factors are reviewed through interviews with stakeholders and participants and observed while embedded in an adventure program for foster and adopted youth and in a refugee camp for families and children. Current literature reveals underlying factors that contribute to play deprivation for these youth, including conditions resulting from trauma and developmental delays due to the absence of play engagement. The poster reviews the programmatic components necessary for addressing these factors through whole-person play-based programming. It considers using adventure-based programming to introduce …

Community, State And Professionalism: Negotiating The Experience Of Community Health Workers In The Provision Of Maternal And Child Health Services In Tanzania, Chakupewa Joseph Mpambije

Journal of Humanities and Social Sciences

Research on community health workers (CHWs) has been on the increase in the past decades in Tanzania, focusing on the provision of maternal and child health (MCH) services. While performing their tasks, CHWs work within three constructs: the community, the state, and their professionalism. However, as CHWs work within these constructs, there exists scanty literature which discourses their experiences within the realm of the community, the state and their professionalism. This review aimed to articulate how these constructs facilitate or inhibit CHWs’ performance in improving MCH services. It employed a scoping review method in which peer-reviewed articles and grey literature …