**Community Leader Participation to Idenitfy People with Disabilities Unable to Reach Mobile Vaccination Centers in the Piliyandala MOH Area, Colombo, Sri Lanka**

**Indika Ellawala** Office of Medical Officer of Health, Piliyandala, Kalubowila, Sri Lanka

Vaccination coverage for the population over the age of 60 was given priority in Sri Lanka at the initial stages of the vaccination process. After we achieved 90% of coverage from this category, it was evident that there were bedridden and disabled people who were unable to visit the vaccination centers. The main objective of this work was to identify these unvaccinated people with the support of village-level community leaders.

This group of people was quite familiar with the village setup and was able to easily reach each and every family in the village to identify non-vaccinated people for this initiative. Stakeholder discussions were done with the Divisional Secretary and police officers of the area. Identified community leaders were empowered regarding the objective. They were given a target to identify non-vaccinated elderly people and collect their data and contact details. Village-level community leaders, with the help of their subordinates, carried out surveys to identify non-vaccinated people in the village, and public announcements were made to register the non-vaccinated elderly people. After gathering the required data, an action plan was developed for a mobile vaccination program in the area. With the district and provincial level support, we were able to arrange ambulances and emergency treatment equipment. Registration processes were carried out with the help of tri-forces and village-level government officers, and police officers accompanied the health team during these programs. Altogether, six mobile vaccination programs for elderly homes and bedridden and disabled people (door-to-door mobile vaccination) were conducted. During this special program, 217 vaccinations were performed in elderly homes in the area, and 165 home visits were done for mobile vaccination. Contribution of the local political members of the council and the community leaders supported immensely vaccinating several people who were otherwise unable to attend the vaccination clinics. This program was greatly appreciated by the public. Village-level leaders proved to be an effective asset in identifying people with special needs, and eventually, this strategy minimized unnecessary time waste and waste of resources.

Indika Ellawala

Office of Medical Officer of Health, Piliyandala, Kalubowila, Sri Lanka

#### Introduction

Vaccination coverage for the population over the age of 60 was given priority in Sri Lanka at the initial stages of the vaccination process. After we achieved 90% coverage from this category, it was evident that there were bedridden and disabled people who were unable to reach the vaccination centers. The main objective of this work was to identify this unvaccinated category with the help of village-level community group leaders. This group of people was quite familiar with the village setup and were able to reach each and every family in the village to easily identify non-vaccinated people for this initiative.

### Methodology

Stakeholder discussions were carried out with the Divisional Secretary of the area and Police Officers in this area. Identified group leaders were empowered for this work. They were given a target of identifying nonvaccinated elderly people and collecting their data and contact details. Village-level community leaders, with the help of their subordinates, carried out surveys to identify non-vaccinated people in the village and public announcements were made to register non-vaccinated elderly people.

After gathering the required data, an action plan was developed for a mobile vaccination programme in the MOH area. With the help of District and Provincial level support, we were able to arrange ambulances and emergency treatment equipment. Registration processes were carried out with the help of tri-forces and village-level government officers accompanied the health team during these programmes. Altogether, six mobile vaccination programmes were implemented for elderly, bedridden and disabled people (house-to-house mobile vaccination).

#### Results and Discussion

During this special programme, 217 vaccinations were performed in the homes of the elderly in our MOH area and 165 home visits were carried out for mobile vaccination. Local political members of the council and community leaders' huge contributions helped immensely in vaccinating many people who were unable to attend vaccination clinics. This programme was greatly appreciated by the public.

#### Conclusions

Village-level group leaders proved to be very effective in identifying people in special need, and eventually this strategy minimized the unnecessary waste of time and resources.

Community Leader Participation to Identify People with Disabilities Unable to Reach Mobile Vaccination Centers in the Piliyandala MOH Area, Colombo, Sri Lanka

## **Community Participation in Improving COVID-19 Vaccination Programs and Testing Facilities in the Piliyandala MOH Area, Colombo, Sri Lanka**

**Indika Ellawala** Office of Medical Officer of Health, Piliyandala, Kalubowila, Sri Lanka

Considering the current COVID-19 situation in Sri Lanka, testing facilities for early detection of new COVID-19 cases and vaccination programs were the utmost priorities in order to prevent the spread of the disease. As continuous public vaccination programs are carried out to reach healthcare goals within the country, our target was to perform more than 1000 vaccinations per day. One of the major objectives of this project was to receive community participation to upgrade facilities for people who are visiting for vaccination and develop a friendly atmosphere to perform testing for COVID-19 while ensuring the safety of healthcare workers. With the support of the community, the car park of the health institution was converted into a vaccination area. One of the major concerns identified was the possible effects of rain and heat. Thus, a long-term permanent tent was built in order to make the vaccination visit more comfortable for the people.

In addition, the establishment of an end-to-end process for the safe conduct of PCR and RAT to diagnose COVID-19 while ensuring the safety of healthcare personnel involved in the procedure was required. The members of the community voluntarily supported the healthcare team in building a novel, innovative container to perform testing for COVID-19 with their guidance. This unique product developed to perform PCR and RAT ensured the safety of the healthcare personnel, and this container can be utilized for mobile testing as well. Conducting outdoor vaccination for the public on rainy days was not disturbed due to the new modification. Up to now, 128,033 doses have been performed at this center. This is also supported by arranging drive-through vaccination for those who are unable to walk. This outdoor setup was appreciated by the public as it reduced the waiting time, contact with others, and transmission of communicable diseases. By utilizing the new container, more than 10,000 PCR tests and more than 4,000 RATs were performed. Overall, this futuristic method enabled a methodical order in performing tests. Active involvement of the community supported improving the quality of health services provided.

### Conclusions

Gaining the active involvement and support of community groups whenever needed will always help in improving the quality of health services provided.

#### Introduction

Due to the prevailing COVID-19 situation in the country, COVID-19 vaccination programmes and testing facilities for the early detection of new cases were the utmost priorities during this period. As continuous public vaccination programmes are being carried out to reach healthcare goals within the country, we had to perform more than 1000 vaccinations per day. One of the major objectives of this project was to gain community participation to upgrade facilities for people who are coming for vaccination, developing a friendly atmosphere in which to perform testing for COVID-19 and ensuring the safety of healthcare workers.

#### Results and Discussion

The new modification allowed outdoor vaccinations for the public to continue undisturbed on rainy days. To date, 128,033 doses have been administered in this center. It also helped in arranging drive-through vaccination for those who are unable to walk. This outdoor setup was appreciated by the public as it reduced the transmission of communicable diseases. By utilizing the new container, more than 10,000 PCR tests and more than 4,000 RATs were carried out. Overall, this futuristic method enabled methodical order when testing.

#### Methodology

With the help of the community, we wanted to rearrange the car park area into a vaccination area. One of the major concerns we found was the effects of rain and heat. Thus, a long-term permanent tent was built, making the vaccination journey a more comfortable one for people.

We also wanted to arrange an end-to- end process to safely conduct PCR and rapid antigen tests to diagnose COVID- 19, ensuring the safety of healthcare personnel involved in the procedure. The community group willingly supported our team to build a new innovative container to perform testing for COVID- 19 with the guidance of the healthcare sector. This unique product was developed to perform PCR and RAT tests ensured the safety of the healthcare personnel, as this container could be utilized for mobile testing as well.

#### Authors

Indika Ellawala

Office of Medical Officer of Health, Piliyandala, Kalubowila, Sri Lanka

Community Participation in Improving COVID-19 Vaccination Programs and Testing Facilities in the Piliyandala MOH Area, Colombo, Sri Lanka

**The Active Contribution of Mothers' Support Groups in Increasing Well Woman Clinic Attendance in the Target Group (Age 35) from 24% to 70% During the New Normal Period in the Piliyandala MOH Area from October to December 2021**

**Indika Ellawala** Office of Medical Officer of Health, Piliyandala, Kalubowila, Sri Lanka

Well-Woman clinics play an important role in the early detection of NCDs, especially breast and cervical cancer among females. The target population for the clinic is the 35 age cohort. Due to the prevailing COVID-19 situation in the country, Well-Woman clinic coverage for this birth cohort was adversely affected. The main objective of this initiative was to improve the Well-Woman coverage by up to 55% by the end of this year. Medical officers, the Public Health Nursing Sister, and the team analyzed the data up to September 2021 and decided on achievable targets for the public health midwives (PHM) of the area. Gaps were identified, and tasks were given to each PHM to achieve maximum coverage. The main strategy was to increase the coverage by community empowerment through mother-support groups. Since mother-support groups were available in every village, the plan was to utilize the trust and credibility they had developed to increase

Well-Woman coverage. Details about the targeted group of females were obtained from the government agents. The relevant messages were then disseminated via mother-support groups. Mothe-support group members distributed leaflets and shared information about the importance of undergoing the well-woman screening. Tele-counseling of clients and their partners was also done by healthcare workers and mothersupport group members. Community-level discussions organized by mother-support groups via Zoom helped to empower the target group. In addition, outreach special clinics and Sunday clinics were organized as well. Continuous monitoring and evaluation of the performance of PHMs was done in a regular manner. Well-woman coverage of age 35 cohort females increased from 24% at the beginning of October to 59% by the 10th of December 2021. This remarkable achievement in a very short period was achieved due to the involvement of mother-support groups at the village level. Mother-support groups turned out to be a really good strategy for improving the Well-Woman clinic attendance, which was adversely affected due to COVID-19.

Indika Ellawala

Office of Medical Officer of Health, Piliyandala, Kalubowila, Sri Lanka

#### Introduction

The Well Woman clinic is very important in the early detection of NCDs, especially breast and cervical cancer among the women. The 35 year old age cohort was given as the target population for public health midwives. Due to the prevailing COVID-19 situation in 2021, Well Woman coverage for this birth cohort was severely altered. The main objective of this initiative was to improve Well Woman coverage up to 70% by the end of this year.

#### Methodology

Medical officers, Public Health Nursing Sisters and the team analyzed the data up to September 2021 and decided upon achievable targets for the public health midwives. Gaps were identified and tasks were given were given for each midwife to achieve maximum coverage by the end of the year. The main methodology decided on by the team was to increase Well Woman coverage through community empowerment via mothers' support groups.

Since every public health midwife has community groups in every village, which they are closely associated with, we planned to use the trust and credibility they have developed with these groups to increase Well Woman coverage.

After obtaining details about the targeted group of women from the government agents, we began disseminating messages via mothers' support groups to find target group women for the Well Woman clinics.

Mothers' support group members distributed leaflets and shared information about the importance of Well Woman screening. Tele counseling of clients and their partners was also undertaken by healthcare workers and mothers' support group members. clients and their partners was also undertaken by healthcare workers and mothers' support group members.

Community level discussions organized by mothers' support groups via zoom helped to empower the target group. According to the mothers' group suggestions, special outreach clinics and Sunday clinics were organized.

The continuous monitoring and evaluation of the performance of public health midwives was carried out in a regular manner. We arranged appreciations for the best performances at the beginning of this year.

The Active Contribution of Mothers' Support Groups in Increasing Well Woman Clinic Attendance in the Target Group (Age 35) from 24% to 70% During the New Normal Period in the Piliyandala MOH Area from October to December 2021

#### Results and Discussion

The Well Woman clinic coverage of women in the age 35 cohort increased from 24% at the beginning of October to 70% by the 31st of December 2021. This remarkable achievement in such a short amount of time was achieved via the involvement of mothers' support groups at the village level.

#### Conclusion

Mothers' support groups turned out to be a really good strategy in improving Well Woman activities which had been badly disturbed due to COVID-19.

## **Association between Element Content and Autonomic Cardiac Activity in Healthy Young Urban Residents**

**Elena Evstafeva1, Svetlana Tymchenko1, Anna Bogdanova1, Natalia Baranovskaya2, and Irina Evstafeva1** 1V.I. Vernadsky Crimean Federal University, Simferopol, Russian Federation 2Tomsk Polytechnic University, Tomsk, Russian Federation

Cardiovascular disease (CVD) is the leading cause of death globally, with more and more scientists and doctors acknowledging the link between environmental agents and CVD and the importance of a field that some are calling environmental medicine. Heart rate variability (HRV) as a non-invasive indicator of cardiac autonomic modulation is most commonly associated with a higher risk of CVD and mortality in case of reduced HRV-derived parameters. The aim of this study was to assess the autonomic cardiac activity in healthy young individuals related to their element status under background exposure. The concentration of 28 elements was determined by neutron activation analysis (Tomsk, Russia) in the hair of 17-20-year-old healthy young individuals (34 males and 46 females) residents of Simferopol. For the assessment of autonomic cardiac activity, HRV indices were derived from 5-minute recordings at rest (Varicard 2.6, Russia). Na, Ba, Br, Ca, Fe excess, and Cr, Rb deficiency were revealed in most individuals. Na, Br, and Sb levels were significantly higher in males, and Au and Ca hair concentrations were greater in females (0.001≤p≤0.024). Correlations were revealed between La and LFn, LF/HF (r=0.31; p=0.006), HFn (r=-0.31; p=0.006), suggesting sympathetic activation accompanied by a reduction of vagal tone that may be associated with La's ability to displace intracellular Fe, Ca. Correlations were also noted between Rb and LFn (r=0.29; p=0.01), HFn (r=-0.29; p=0.001), and LF/HF (r=0.30; p=0.006) where low hair Rb levels were associated with increased parasympathetic activity determined by the Rb ability to increase the duration of the action potential in human myocardium accompanied by decreases in the force of contraction. In males, correlations found between Br and heart rate (r=-0.44; p=0.01), Mo (r=0.50; p=0.003), and Me (r=0,48; p=0.004) suggest a negative chronotropic effect. The element imbalance was revealed in young individuals under background exposure. Individuals with higher hair La concentration had lower HRV indices. Therefore, cardiac autonomic functions might be altered in cases of element imbalance. Elemental analysis was supported by the grant of the State Council of the Republic of Crimea for young scientists of the Republic of Crimea and by the RFBR grant, project no. 18-29-24212.

Elena Evstafeva1, Svetlana Tymchenko1, Anna Bogdanova1, Natalia Baranovskaya2, and Irina Evstafeva1

1 V.I. Vernadsky Crimean Federal University, Simferopol, Russian Federation

2 Tomsk Polytechnic University, Tomsk, Russian Federation

#### Introduction

Cardiovascular diseases (CVD) are the leading cause of death globally, with more and more scientists and doctors acknowledging the link between environmental agents and CVD as well as the importance of a field that some are calling environmental medicine. Heart rate variability (HRV) as a noninvasive indicator of cardiac autonomic modulation is most commonly associated with a higher risk of CVD and mortality in the case of reduced HRV-derived parameters.

#### Study Aim

The aim was to assess the autonomic cardiac activity in healthy young individuals related to their element status under background exposure.

### Methods

The concentration of 28 elements was determined via neutron activation analysis (Tomsk, Russia) in the hair of 17- to 20-year-old healthy young individuals (34 males and 46 females) who were residents of Simferopol. For the assessment of autonomic cardiac activity, HRV indices were derived from 5 minute recordings at rest (Varicard 2.6, Russia).

#### Results and Discussion

Na, Ba, Br, Ca, Fe excess and Cr, Rb deficiency were revealed in most individuals (Figure 1). Na, Br, Sb levels were significantly higher in males and Au, Ca hair concentrations were greater in females (0.001 ≤ p ≤ 0.024).

Correlations were revealed between La and LFn, LF/HF (r=0.31; p=0.006), and HFn (r=-0.31; p=0.006), suggesting sympathetic activation accompanied by a reduction in vagal tone, which may be associated with La's ability to displace intracellular Fe and Ca.

Correlations were also noted between Rb and LFn (r=0.29; p=0.01), HFn (r=- 0.29; p=0.001), and LF/ HF (r=0.30; p=0.006), where low hair Rb levels were associated with increased parasympathetic activity determined by the ability of Rb to increase the duration of the action potential in the human myocardium accompanied by decreases in the force of contraction.

In males, correlations found between Br and heart rate (r=-0.44; p=0.01), Mo (r=0.50; p=0.003), and Me (r=0,48; p=0.004) suggest a negative chronotropic effect.

Correlations between the chemical element content in the hair were also found (Figure 2.).

*Figure 2. Correlations between the element content in the hair of Simferopol residents (rs – Spearman's rank correlation coefficient, p < 0.05; critical value r = 0.22).*

#### Conclusions

The element imbalance was revealed in young individuals under background exposure. Individuals with higher hair La concentration had lower HRV indices. Therefore, cardiac autonomic functions might be altered in cases of element imbalance.

*Figure 1. The occurrence of deviations from the references based on the results of the hair element analysis in residents of Simferopol (n=80) .*

**Y** *- the proportion of the total number of people, %;* **X** *- chemical elements; numbers above the columns - the absolute number of cases.*

#### Acknowledgments

The authors declare that there are no conflicts of interest regarding the publication of these results. The authors gratefully acknowledge financial support from the research grant Q 18-29-24212 from the Russian Foundation of Basic Research.
