Post 1These farmers overseas need to be educated on the parasite.docx

Post 1
These farmers overseas need to be educated on the parasite
problem abroad. The government needs to step in and subsidize
some sort of medication program, and have spot checks on who
has the most outbreak. Also the heard numbers need to be
limited. Another way would be to come up with a way to spray
the areas the animals have been grazing. There are some ways to
cure the problem for the short term, by rotational grazing,
mineral blocks and fecal egg counts. In the southern part of the
U.S we also have a lot more parasite resistance as they do
overseas, but with our producers they have better standards of
medicating animals, and overall herd management.
Post 2
I agree with you that education is so important, especially
overseas where there are some livestock owners that lack
knowledge about how to manage parasites or use drugs for
treatment. I'm not sure about how many veterinarians there are
in certain countries or how much they're relied on in flock
management, but if they're not available to help educate these
producers, I agree with you that it would be great if the
government could step in and help. These parasites are costing
countries millions of dollars, so I would think their government
would want to help. I liked that you brought up the fact that
herd numbers need to be limited because as we learned in our
small ruminant parasite lecture, overstocking is the biggest
problem on small ruminant farms.
Running head: FORMATIVE AND OUTCOME EVALUATION
1
FORMATIVE AND OUTCOME EVALUATION 3

Formative and Outcome Evaluation
Implementation of my marketing plan will rely on execution of
the laid out steps in two phases involving, the members of staff
in the cafeteria and the promotional team working to draw
students towards the suggested meal plan. First, I will require
the promotion team to put on exquisite outfits that draw the
attention of the teens in middle school towards the cafeteria.
Secondly, I will require the team to talk with potential
customers passing by the cafeteria in a friendly tone and offer
the meal plan to those who listen to them. In marketing, an
excellent pitch of the product being promoted catches most
consumers’ attention and in cases where the strategy is
ineffective, meal samples can be offered at the beginning of the
week.
The second phase will involve the delivery of high quality
breakfast meals to the students visiting the cafeteria in an
exquisite fashion. The aim of this phase is to supersede the
expectations of the teens and provide them with a high variety
of healthy and affordable foods (Parker & Thorson, 2009). The
members of staff should serve the students politely and follow
up on the customer’s level of satisfaction by making enquiries.
The aim of this phase is to ensure acceptance of the healthy
meal plan and minimize rejection for students with varying food
preferences.
The marketing plan will be executed over a period of one
month, which will involve feasibility tests and constant
interactions with the students. A feedback channel such as a
suggestion box will be required in the cafeteria for weekly
evaluation of the student’s perception about the food (Parker &
Thorson, 2009). One of the tools that will be vital in this first
month is a sample of available foods for inquisitive students to
taste and have a feel of what the program has to offer. The
sampling marketing strategy is expensive and can only be
conducted on every Monday for the four weeks when the
program will be launched. Moreover, the cafeteria staff will
collect student’s feedbacks every Friday and recommendations

will be considered for implementation in the next week.
Two of the potential barriers that may affect the
implementation process include the pricing structure of the
foods and the individual preference of teen customers. Pricing
is a potential barrier because the cost of food determines what
most people consume since it is a reflection of their income
(Kennedy et al., 2014). Middle school teens rely on their
parents for revenue to purchase the items they require on a daily
basis. Food accounts for most of the expenditure of school-
going teens and price is a crucial determinant of what type of
food they consume.
On the other hand, school-going teens display a high
inclination towards snacks, soft drinks and other processed
foods that attract their taste experience. Most snacks are high on
processed sugars, which improve their taste and create an
extraordinary craving among school-going teens. Take for
instance, pizza one of the most widely consumed foods among
teens in middle school. The exceptional taste of pizza makes it
very attractive to school-going children, and they prefer a slice
of pizza over a slice of bread or any other healthy grained
foods.
The cafeteria has to overcome these two potential barriers
for the health program to be successful in the long run.
Although it is difficult to alter individual preference for snacks
and processed foods, the pricing strategy is within the
administration’s control. Healthy foods are slightly more
expensive than processed foods due to the costly path taken to
acquire them fresh from the producers and the additional
preservation cost (Hillestad & Berkowitz, 2012). However, the
cafeteria should not seek to make profits from this program by
setting up high mark up prices for the sake of introducing the
program into the market.
Instead, the pricing strategy should meet the break-even level so
that the program does not operate on a loss and it remains
sustainable in the long run. To address the pricing barrier, the
prices of foods should be set at an affordable level.

Additionally, the program will design a combination of
breakfast offers that lower the prices significantly while
maximizing the sales level.
The first month of the program should provide a clear
image of how the suggested meal plan will perform in the long
run after several months of implementation. Communication
with the students and promotional talks advocating for this
healthy meal will be used to influence their perception about
healthy food (Kennedy et al., 2014). Recommendations made in
the suggestion box will be evaluated on a weekly basis and the
most feasible ones implemented in the following week. For
instance, students may provide feedback on the quality of
services received and the environment we provide for
consumption of their breakfast. The members of staff at the
cafeteria could look into this suggestion by having several
members undergo service training while the layout of the
cafeteria could be remodeled to improve convenience. The
implementation plan will achieve success by reflecting on the
weekly performance and initiating the necessary modifications
to drive up the sales.
References
Hillestad, S. G., & Berkowitz, E. N. (2012). Health care
market strategy: From planning to action (4th ed.). Burlington,
MA: Jones & Bartlett Learning.
Kennedy, A., Rogers, A. Chew-Graham, C., Blakeman, T.,
Bowen, R.,Gardner, C., … Protheroe, J. (2014). Implementation
of a self-management support approach (WISE) across a health
system: A process evaluation explaining what did and did not
work for organizations, clinicians, and patients. Implementation
Science, 9(1), 1–28. Note: Retrieved from Walden Library
databases.
Parker, J. C., & Thorson, E. (Eds.). (2009). Health
communication in the new media landscape. New York, NY:
Springer.

Running head: FORMATIVE EVALUATION IN MARKETING
PLAN DEVELOPMENT 1
FORMATIVE EVALUATION IN MARKETING PLAN
DEVELOPMENT 4
Formative Evaluation in Marketing Plan Development
Formative evaluation (FE) draws upon various conceptions and
impact practices from models, theories, and frameworks in
education, social psychology, communication, and marketing.
The value of this process stretches to the field of healthcare as
well, where it proves helpful in various healthcare functions.
One of those areas in which the significance of formative
evaluation is profound and well-documented is marketing
(Hillestad & Berkowitz, 2012). Comparable to the business
meadow, in healthcare, it FE is highly applicable in the
development of marketing plans (Cooper et al., 2011).
Therefore, how is it applicable in instituting marketing plans?
How can formative evaluation methods be incorporated in the
design of health care services marketing plans, and how could
this be important for the practice of health care administration?
Consider my marketing plan, which is designed to promote
nutrition among teens, especially in middle schools. Data shows
that teens form the economically active population and make the
most nutritional mistakes leading to the high cases of obesity.
In this case, formative evaluation methods would be useful in
identifying the prospective clients for the nutrition promotion
products that the company offers. My product strategy involves
the positive impact that breakfast has on Continuous
Assessment Tests scores and classroom behaviors. Contrarily,
the pricing strategy entails costs and recommendations that will
be helpful in lowering the barriers of implementing a Grab-N-
Go breakfast. For instance, in case of student rejection, the
school faculty can offer a variety of foods each day, and they
can present foods in a manner that students find more attractive.
The plan also incorporates a placement strategy erected to guide
the location that breakfast is sold and consumed in middle

schools. The sales will minimize the amount of time needed to
purchase while the consumption allows students to eat breakfast
where they can interact with other students. My promotional
strategy involves recommendations for promoting the program
to various teens around the state. I think that we can use older
teens and other high school students to promote regular
breakfast consumption. In addition, in promoting the program,
parents or teachers can use word of mouth, school websites and
even signs placed in front of schools to reach out to students
who are having trouble grasping the importance of the program.
Furthermore, with the aid of the Alabama Department of Public
Health, my plan can be successfully implemented.
In this plan, FE would be handy in two ways, namely (i) during
the project set up and (ii) during the implementation of the plan.
In the first case, FE would come in during the identification of
requirements. In the first place, it would facilitate products’
target population identification. Effective marketing plans focus
on manifold, specified audience segments (Hillestad &
Berkowitz, 2012). Formative evaluation is expedient in
ascertaining high-priority subdivisions by collecting
information regarding the most relevant categories of
individuals to the marketing goals. According to Miake-Lye et
al. (2011), successful businesses heavily rely on understanding
customers’ needs and offering them products and services that
meet them. FE is applicable in drawing knowledge about these
needs, consequently enabling firms to streamline their products
and services as well as their goals alongside the lines of the
needs. In my example, for instance, the strategy would help
identify the able and willing nutrition interventions clients, and
the option that appeals to most of them, as Miake-Lye et al.
(2011) suggest. As such, one of the leading roles of FE in the
development of marketing plans in healthcare is by identifying
needs.
In the second case, FE would play an essential role in
facilitating and enhancing the implementation of the marketing
plan. My marketing plan, like many others, is comprehensive

and sophisticated. Because of this factor, it contains functions
that work and those that does not, as well as numerous
unexpected outcomes. Such factors need monitoring and
regulation unless they bring the whole plan down. FE would
offer the solution to this quandary in my project. According to
(Hillestad & Berkowitz, 2012), FE is virtually mandatory in
processes that are prone to unexpected outcomes and where
following and capturing successful feedback is difficult. The
rationale is that FE enhances the implementation of projects.
Thus, it would help enable my plan to achieve its anticipated
outcomes.
The method would also be expedient in assessing,
understanding, and addressing process changes in the plan.
Cooper et al. (2011) aver that FE facilitates the understanding
of virtually all process changes. The tool would facilitate the
screening of not only what would be working and what would
not be working but also pinpointing the actual reason for such
consequences. In this way, the method would make the
implementation of the project successful by pointing out faults
and ironing them out.
All these make FE a pillar of marketing plan development and
implementation in healthcare and afar. Its main advantage,
arguably, is that it aids plans to achieve their outcomes
effectively and successfully. In this connection, the tool brings
about continuous improvement besides enabling future plans.
FE is particularly useful for complex settings and projects as it
refines composite interventions. The tool is involved in all
stages of marketing planning, and this is what makes it the
backbone of the process as well as other projects.
References
Hillestad, S. G., & Berkowitz, E. N. (2012). Health care market
strategy: From planning to action (4th ed.). Burlington, MA:
Jones & Bartlett Learning.
Cooper R. L., Cloud R., Besel K., & Bennett A. J. (2010).

Improving access to substance abuse treatment services for
consumers with AIDS: A formative evaluation. Journal of
Evidence-Based Social Work, 7(1/2), 115–129. Note: Retrieved
from Walden Library databases.
Miake-Lye, I. M., Amulis, A., Saliba, D., Shekelle, P. G.,
Volkman, L. K., & Ganz, D. A. (2011). Formative evaluation of
the telecare fall prevention project for older veterans. BMC
Health Services Research, 11(1), 119–127.
Running head: CULTURALLY CRITICAL FACTORS
CULTURALLY CRITICAL FACTORS 4
Culturally Critical Factors
Introduction
The promotion of a health service marketing program on
obese youths from a diverse, economically active society
compels that I identify the most sensitive and appropriate
cultural elements. This healthcare marketing plan would focus
on a culturally sensitive care which reflects the capacity to
value clients’ feelings, attitudes, or situations towards
promoting their wellness (Fregidou-Malama & Hyder, 2015).
This response would act on clients' shared ethnicity, nation,
cultural heritage, and language, thereby creating the feeling of
client satisfaction. The program plan would structure the care
with professionalism and relevancy to the client's wishes and
expectations. It would require every medic on the team to
develop a keen interest to patients, conduct themselves
professionally and on time to create satisfaction (Caliendo &
Gehrsitz, 2016). This plan would also seek the display of
warmth, support, empathy, genuineness, and respect for patient
interactions.
The plan would comprise strategies of learning client
patterns of communication in terms of verbal or written
approaches, thus affirming their community values. More so, we
would seek clarification on whether the clients regard

relationships during service delivery or speed and efficiency.
The plan would address their racial and, linguistic and cultural
variations by employing a team comprising of members from
the local community (Caliendo & Gehrsitz, 2016). This strategy
would make them feel part of the program and not an outsiders.
This plan would address the issue of cultural diversity by
building relationships with clients and their families. This
approach would attract business partnerships between caregivers
and clients families, especially if they are Asians, Africans,
Hispanic, and Arabs. These groups have a culture that values
healthy relationships. The plan would design a strategy that
includes females in the program to deal with the issue of gender
variations for these obese youth (Fregidou-Malama & Hyder,
2015). The plan would proactively create links with the relevant
institutions towards enrolling obese children from low-income
families for health funds. This approach would prevent the
health institution from incurring losses in this healthcare system
business.
The Impact of Culturally sensitive Elements and Considerations
Scholars have depicted that culturally critical factors play
a crucial role in caregiving marketing. Poor communication,
between the caregiver and the ever vulnerable contemporary
youth clients, is likely to harm the plan by destroying the trust
between them (Fregidou-Malama & Hyder, 2015). Clients may
refuse to share their personal information which could have
influenced proper interventions. Poor communication could also
create doubts among the clients in regards to the level of
experience among caregivers. This situation would also
interfere with client satisfaction, thereby threatening to tarnish
and invalidate the professionalism of the facility and program.
The friendship between clients, especially the Arabians,
Africans, and Hispanics, would often lead to long-lasting
business relationships and enhance loyalty. The weak
correlation between such clients would affect the current and
future business transactions in service delivery (Caliendo &
Gehrsitz, 2016). Similarly, the isolation of cultural and

linguistic element from the plan would not only isolate clients
from the program but also establish a communication barrier. As
a result, clients would refuse to participate in the program and
turn, affect the business side of the healthcare service delivery.
Conclusion
Conclusively, clients from wealthy families are usually
sensitive to quality health care services. Lack of satisfaction in
service delivery due to underperformance or using wrong
procedures could attract legal measures and hefty penalties.
This plan would consider the business side of the healthcare
facility by addressing the financial needs of clients from low-
income families. Lack of proactive strategy to address their
business needs would cause economic losses to the healthcare
facility. This facility would have to offer services on credit,
especially in emergency cases with the uncertainty that clients
will pay their bills.
References

Caliendo, M. & Gehrsitz, M. (2016). Obesity and the labor
market: a fresh look at the weight penalty. Econ Hum Biol:
23:209–25.
Fregidou-Malama, Maria & Hyder, Akmal. (2015). Impact of
culture on Marketing of Health Care Services- Elekta in Brazil:
International Business Review, Elsevier, Vol. 24 (3): Pp 530-
540.
Running head: MARKETING PLAN TO PROMOTE HEALTH
CARE SERVICES 1
MARKETING PLAN TO PROMOTE HEALTH CARE
SERVICES 3
Marketing Plan to Promote Health Care Services
Describe the health literacy of your target audience for your
marketing plan.
Health literacy is the ability of an individual to obtain and
process health information (Gabarron, Lau & Syed-Abdul,
2016). Ideally, this information helps people make health
decision either for themselves or for close relatives (Skurka,
2017). The youth who are my target audience typically lack
numerical skills. Thus they can be said to be health literate.
These individuals can accomplish everything that has to do with
numerals but cannot calculate cholesterol or measure
medications.
Additionally, the youth are in no position to share the history of
their health with healthcare facilitators. Moreover, the youth
who are my target audience are not in a place to navigate the
healthcare system. Thus are not suited to locate health service
providers in their surrounding communities. Also, the youth do
not have adequate information on nutrition, and therefore they
end up consuming the wrong diet (Skurka, 2017). This is the
reason why the youth are suffering from obesity. I believe that
the target audience of the marketing plan can be described as
relatively health literate. They are always engaging in self-

health care and the management of diseases but lack some other
aspects of health literacy.
Explain how your marketing plan will address the health
literacy of your target audience.
My market plan will be aimed at the youth; thus, I will use the
most popular social media platforms among the youth. In the
plan, I will reinforce the importance of being health literate. I
will include as many health topics as possible as a way to make
the youth health erudite. Some of the topics that I will include
in the market plan include the need to have a proper diet, causes
of diseases, and the need to exercise regularly. This information
will ensure that the audience is aware of health information and
can apply the knowledge when need be (Skurka, 2017).
Moreover, in the plan, I would ensure I explain how the human
body works to give the audience a glimpse of what to expect
from their body. With this information, the youth would not
become very worried when they are diagnosed with different
illnesses that are not very serious.
Describe two strategies you might take to best tailor the
messages in your marketing plan to promote uptake within your
target audience and explain why.
The youth are mostly on social media; thus, social media will be
the most effective way to reach a large number of youths. The
radio and television is also another platform that I intend to use
as the youth are active contributors on broadcast and cable
television. I mean to come up with a message that is appealing
and is clear for a more fundamental understanding. The message
will be enhanced with audio and video files. This move will
make the message more attractive to young people since they
resonate well with these type of messages (Skurka, 2017).
Additionally, I intend to share the message on Instagram,
Facebook, Twitter, and Pinterest as they are very popular with
the youth. I will sponsor the messages on social media so that
the message can reach as many youths as possible.
Social media is a sufficient market tool for the youth as they
can use these platforms to share and engage (Parvanta, Nelson

& Harner, 2018). On social media, the youth will participate in
the benefits of proper nutrition as represented in my message.
Moreover, I will continue sponsoring the message until the
youth get the message and become more literate on health
issues. In the end of the marketing period, I believe that the
strategy will be successful.
References
Top of Form
Gabarron, E., Lau, A., & Syed-Abdul, S. (2016). Participatory
health through social media.
London: Academic Press is an imprint of Elsevier
Parvanta, C., Nelson, D., & Harner, R. (2018). Public health
communication: Critical tools and strategies. Burlington, MA:
Jones & Bartlett Learning.
Skurka, M. F. (2017). Health information management:
Principles and organization for health information services.
Hoboken, New Jersey: Jossy-Bass & Pfeiffer Imprints, Wiley.
Bottom of Form
Running head: PROMOTING OBESITY HEALTHCARE PLAN
PROMOTING OBESITY HEALTHCARE PLAN 2
Promoting Obesity Health Care Plan
The Target Client the Health Services Marketing Plan
The rural populations experience higher rates of obesity
due to the lack of information available to them in regards to
healthy living, balanced diets, and health risk awareness.
Regarding my initiative of providing the youth population with

obesity mitigation interventions, my target population would be
the multicultural migrant children from the rural area. These
clients would be between the ages of 3 to 16 years old with
other isolated cases (Caliendo & Gehrsitz, 2016). Most of these
clients would be school going children between 6 to 16 years of
age. The majority of these patients will reside with their parents
or guardians.
These target clients are associated with patterns of
consuming high calorie meals and sugary snacks. They also
seem to lack suitable exercising facilities thus do not engage in
physical exercises. Most of my clients came from families that
purchase easy to make inexpensive freezer meals that last
longer. The majority of their combined annual family income is
less than $50,000. Some of the parents would initially reject
obesity interventions for their children due to the lack of proper
orientation on the importance of healthy living. Other parents
will reject the intervention due to traditional beliefs that being
fat is normal or a sign of wellness and happiness (Puhl & Heuer,
2010). In time, their parents will value these new services and
will take their obese children in for intervention.
Hurdles of and Promoting a Healthcare Marketing Plan
Economic Barrier
Promoting obesity mitigation project on a low-income rural
population will encounter numerous hurdles. First, the parents
and guardians of my clients would likely have limited resources
to pay for the obese treatment. Their uninsured state would
further make it difficult for them to attend these mitigation
sessions. Parents whose children have health insurance coverage
would still face burdensome cost-sharing via premium
payments, deductibles, and copayments (Puhl & Heuer, 2010).
The underinsured will not be able to obtain the required types of
healthcare services which are often costly. This factor is likely
to interfere with the general service delivery program in the
form of transport, outreach, administrative overhead, and high-
risk care.
I would address this financial obstacle by creating a

health fund to help pay for the visits of obese clients that cannot
afford the cost of the mitigation services. I would also help
them acquire public health insurance to protect their health
needs in the marginalized region. This voucher would help to
cater to the needs of the patient and my business services
(Caliendo & Gehrsitz, 2016). Further, I would seek for internal
monetary help from the community hospital in the city through
legal structures towards impacting lives in this rural area.
Informational Barrier
I also expect to experience informational obstacles,
thereby increasing the costs of crucial activities such as
outreach and advertisement strategies. These are necessary
methods that could help to orientate the population on the need
for obese mitigation and healthy living. Lack of this
information is likely to cause a low client enrollment rate.
Parents with literacy problems will remain in the dark about the
entire program, thereby keeping their obese children at homes
(Puhl & Heuer, 2010). I would develop strategic and optimistic
advertisement approaches that integrate the local language to
reach every sector of these rural populations. For example, I
would engage my team to create and distribute eye-catching
posters across all sections of the rural population. I would also
involve the already existing team of service supporters in an
anti-obese community tour across the region towards informing
the populations about our obese mitigation services. I could
subdivide my group into various mobile service supporters to
offer services across the area and engage the enrolled children
to overweight mitigation interventions.

References
Caliendo M, & Gehrsitz M. (2016). Obesity and the labor
market: a fresh look at the weight penalty. Econ Hum Biol:
23:209–25.
Puhl RM, & Heuer CA.(2010). Obesity stigma: important
considerations for public health. Am J Public Health 2010;
100:1019–28.
Running head: AGENCY VISION AND MISSION 1
AGENCY VISION AND MISSION 2
Health Agencies and Marketing Plans
Alabama Department of Public Health has a variety of services
and programs that it offers to its diverse population. It provides
clinical, environmental, home and community services to its
local residents. The clinical services include family planning,
cancer screening, tuberculosis screening, and health insurance
for children among other things. Environmental services, on the
other hand, are put in place to ensure standards in several
health-related and environmental service areas are on point to

protect the public from injury and to prevent the spread of
diseases. In other words, the health agency has protection
activities that include complaint investigations, health
regulation enforcement, and licensing, permitting and
inspections for various facilities such as body art facilities, jails
or prisons, and hotels. Finally, home and community services
include home health care and life care services. They are put in
place to ensure everyone is comfortable in their home
environment.
Generally speaking, the Alabama Department of Public Health
was established to focus on a number of health related issues
such as emergency preparedness and emergency medical
services. It also focuses on disease prevention, home and
community health, healthcare access, family health and
regulation and licensure. Also, the health agency is responsible
for publishing health-related pamphlets that are readily
available to the residents of Alabama. The topics in the
pamphlets usually vary as they range from environmental
health, nutrition and physical activity to injury prevention. So, I
think that the department has done a good job so far in keeping
the residents of Alabama safe.
Reason being, when you look at their mission and vision
statement, you’ll notice that the department is doing all it can to
provide a comfortable environment for the state’s residents.
According to their website, the health agency’s mission states
that it aims to protect, promote and improve the health of
individuals and communities of Alabama. On the other hand, its
vision statement stipulates that the department wants to lead the
state in assuring the health of Alabamians by promoting
healthy, safe, prepared and informed communities. When you
combine all of that with the agency’s core values, you’ll see
why I am saying the facility has done a good job so far.
Now, my marketing plan is designed to promote nutrition among
teens especially in middle schools. Reason being, these teens
form the economically active population and make the most
nutritional mistakes leading to the high cases of obesity in the

country. My product strategy (in this case “promoting
nutrition”) involves the positive impact that breakfast has on
Continuous Assessment Tests scores and classroom behaviors.
My pricing strategy, on the other hand, involves costs and
recommendations that will be helpful in lowering the barriers of
implementing a Grab-N-Go breakfast. For instance, in case of
student rejection, the school faculty can offer a variety of foods
each day and they can present foods in a manner that students
find more attractive. The placement strategy is put in place to
guide the location that breakfast is sold and consumed in middle
schools. The sales will minimize the amount of time needed to
purchase while the consumption allows students to eat breakfast
where they can interact with other students.
Finally, my promotional strategy involves recommendations for
promoting the program to various teens around the state. I think
that we can use older teens and other high school students to
promote regular breakfast consumption. Also, in promoting the
program, parents or teachers can use word of mouth, school
websites and even signs placed in front of schools to reach out
to students who are having trouble grasping the importance of
the program. Furthermore, with the aid of the Alabama
Department of Public Health, my plan can be successfully
implemented.
The main aim will be to reduce unhealthy snacking and enhance
nutrition education in various middle schools. With the
department’s mission and vision, we can get state of the art
nutrition materials that can be helpful in supporting the
curriculum adopted by the schools. Also, we can adopt the
environmental services provided by the department to create a
cafeteria environment that will help improve merchandising or
presentation of milk, fruits and vegetables to increase
consumption among teens in the school. Reason being, nutrition
during childhood and adolescence is essential for growth and
development, health and well-being (Story et al., 2002). So, I
think that both my marketing plan and the health agency’s
resources will come in handy during the implementation of

nutrition programs in schools.
In conclusion, I believe that my marketing plan is designed to
help promote proper nutritional values to teens around the state
and with the help of the health agency, it can be successfully
implemented. All we have to do is acquire state of the art
resources and create a cafeteria environment that all teens can
access in the school environment. Furthermore, the health
agency’s mission and statement are simple and straight to the
point, and they can help in implementing the said marketing
plan. So, all tees should be open to change and hope that all
things will turn out for the better in future.
References
"Alabama Department of Public Health - ADPH -
healthfinder.gov". healthfinder.gov.
Story, M., Holt, K., & Sofka, D. (2002). Bright futures in
practice. National Center for Education in Maternal and Child
Health.
Running head: SOCIAL MEDIA TOOLS FOR HEALTHCARE
SERVICES 1
SOCIAL MEDIA TOOLS FOR HEALTHCARE SERVICES
4
Social Media Tools for Healthcare Services
Introduction
Technology, especially the coming of various social media
platforms, have changed methods of marketing. The health
sector today can use social media tools to advance preventive
and curative healthcare services to a wide population. Social
media tools, when properly used, facilitate instantaneous
feedback, creation of a networked community and enhance the
dissemination of information. Today, most Americans suffer
from obesity or overweight. Various indicators show that poor
nutrition plays a significant role in the phenomenon. It makes

sense to target youths with nutrition matters as they form the
economically active population and make the most nutritional
mistakes leading to the high cases of obesity in the country.
Twitter, Facebook, and Instagram give enough platform to
inform and educate the youths on better nutritional choices.
Hashtags and use of social backers make the marketing of
healthcare programs efficient and effective.
Obesity and overweight remain one of the top public health
issue affecting most Americans. The world health organization
has reported that the USA numbers remain the highest in the
world. Obese people spend more on medical expenses annually
as compared to the non-obese people. The government of the
USA also spend more on providing medical services because of
high cases of obesity. Statistics show that 39.8 % of USA adults
above 20 years suffer obesity (Ogden et al., 2015). On the same
age bracket, an additional 31.8 % suffer from overweight (Hales
et al., 2017). Considering the past decades, obesity rates in the
USA tend to keep rising. Many research studies claim that
problems of obesity and overweight emanate from poor nutrition
and physical inactivity. Due to the increasing medical expenses,
increasing cases of overweight and various diseases affecting
obese people, the time has come to device a public health
program. The aim of the program will be sensitize and
disseminate information on nutrition and its role in curbing
obesity to young adults. In marketing the plan on a need to keep
a nutritional check, public health sector intends to use social
media tools to reach out to as many people as possible as well
as getting immediate feedback.
Most Americans use social media to check on trends, events,
and continuous communication. The penetration of social media
in the country remains high at 70%, and 79% of the population
has a social media profile in one of the platforms (Hales et al.,
2017). Healthcare providers have to use multiple platforms, for
instance, snap chat, twitter, and Facebook to reach the target
audience (Young adults of 20 years plus). Social media
marketers need to use tools such as Hashtags and social backers

to ensure online presence, immediate feedback, and continuous
engagement on the nutritional change health program. When
putting the message across on the need to change nutrition,
healthcare campaign needs to reach a broad audience, deliver
the message convincingly, and monitor the reaction from the
youths on the same program. The use of Hashtag and social
backer tools will provide efficient and effective program
marketing to the target population.
Conclusion
Hashtags help in increasing social media outreach. It attracts a
real audience, grow conversation participates, and resonates
well with the youth (target audience). By using
HashtagsForLikes, its algorithms help in coming up with the
best Hashtag for a given program and facilitate its social media
spread. Hashtags help in attracting target niche followers and
unit audience interested in the program. The tool enhances both
twitter and Instagram marketing. Social backers enable social
media marketers to use AI (artificial intelligence) to understand
audience behavior. It personalizes content when engaging
customers but helps in the growing fan base. It also helps in
managing different social media accounts whereby one content
is seamlessly posted across all platforms. When marketing the
importance of nutritional change to youths, healthcare providers
should use hashtags to make the topic trendy and grow the
audience for the same. Social backers will help in content
creation, customization, and engaging fan base on the program.

Reference
Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L.
(2017). Prevalence of obesity among adults and youth: the
United States, 2015–2016. Retrieved from
https://www.cdc.gov/nchs/data/databriefs/db288.pdf
Ogden, C. L., Carroll, M. D., Fryar, C. D., & Flegal, K. M.
(2015). Prevalence of obesity among adults and youth: the
United States, 2011–2014. Retrieved from
https://www.cdc.gov/nchs/data/databriefs/db219.pdf
1
Management and Control of Nematode Parasites of Small
Ruminants
in the Face of Total Anthelmintic Failure
P. J. Waller
Department of Parasitology (SWEPAR), National Veterinary
Institute
SE- 751 89 Uppsala, Sweden

Email: [email protected]
Abstract
Total failure of modern broad spectrum anthelmintics to control
nematode parasites of
sheep and goats is a reality, of rapidly increasing dimension, on
many farms in the
tropical / subtropical regions of the world. This is primarily
associated with the highly
pathogenic, blood sucking parasite, Haemonchus contortus, and
where it now cannot
be controlled by chemotherapy, annual mortalities exceeding
20% of the flock can be
expected. Thus sheep and goat enterprises become totally
unsustainable, unless major
changes in management are effected. These must include a
change away from reliance
on suppressive anthelmintic treatment and to include several
non-chemotherapeutic
management options. In situations where livestock numbers
need to be preserved and
there is no opportunity to increase the grazing area available,
then zero grazing with
cut-and-carry herbage from uncontaminated pasturelands is the

only option. In other
circumstances stocking rates need to be substantially reduced,
so that short-term
rotational grazing can be effectively practiced. This strategy is
improved if it is
combined with the biological control of the free- living stages
of the parasites, using
the microfungus Duddingtonia flagrans. Monitoring the
parasitological status of the
animals by faecal sampling sentinel sub-flocks for nematode
faecal egg counts, or the
use of the FAMACHA procedure, are also valuable tools.
Improving overall nutrition of
the flock is an important adjunct to control. As a long-term
priority, attempts to
change the genotype of the flocks to those breeds that have been
shown to possess
natural resistance to H. contortus are worthwhile.
2

INTRODUCTION
Recently, an exhaustive review was commissioned to prioritise
animal health
research for poverty reduction in the Developing World, by an
international donor
consortium consisting of the WHO, OIE, FAO. This report
concluded that gastro
intestinal parasitism had the highest global index as an animal
health constraint to the
poor. The highly pathogenic nematode parasite of small
ruminants, Haemonchus
contortus, was singled out as being of overwhelming importance
(Perry et al. 2002).
This blood-sucking parasite is responsible for acute outbreaks
with mortalities,
particularly in young animals. In Kenya alone, it has been
estimated that it causes
losses in the order of US$ 26 million each year (Anon. 1999). It
is probably the only
nematode parasite of sheep and goats that can be accurately
diagnosed without the aid
of laboratory testing. Signs of acute anaemia are obvious, past
history (particularly
weather conditions) and discounting other less common

conditions that cause anaemia
(eg. fasciolosis, theileriosis etc.), will strongly suggest clinical
haemonchosis. This
parasite has very high biotic potential (egg production by
female parasites) and at
times when transmission of this parasite is favoured (warm and
wet), losses can occur
in all classes of animals. On a “worm- for-worm” basis, H.
contortus is generally
considered the most pathogenic parasite of small ruminants
(Soulsby, 1986).
Although it occurs in mixed infections with other nematode
parasites, it invariably
dominates the faecal worm egg counts and often approaches
90% of worm egg
contamination on pastures under prevailing conditions of high
temperature and
humidity, which are the norm in the humid tropics / sub tropics.
However it is now apparent that H. contortus is becoming more
important in
the temperate regions of the world, with the apparent change in
weather conditions
that favour this parasite (Waller et al. 2004). Thus much of the
problems associated

with parasite infections in small ruminants, problems in their
control and problems of
anthelmintic resistance, relate specifically to this single species
of nematode parasite.
Detailed economic evaluations repeatedly show that the major
losses due to parasites
are on animal production, rather than on mortality (Anon. 1991;
McLeod 1995). In
many instances, these costs exceed the costs of losses due to the
major “killer”
diseases due to viruses and bacteria (Anon. 1991). Recent
estimates of the annual
costs of parasites to the sheep industry in Uruguay and South
Africa were US$ 41.8
million (Nari et al. 1997) and US$ 45 million (I. K. Horak),
respectively.
3
WORM CONTROL: PRINCIPLES AND PRACTICES
The severity of nematode parasitic disease is dictated by the
degree of larval

pickup, or challenge, from pasture. This is principally
determined by the prevailing
weather conditions, namely temperature and rainfall. If either of
these environmental
variables is unfavourable (ie. temperature and/or humidity is too
low) then
discontinuities in the translation process from egg hatch to
infective larval availability
on pasture, can occur (Levine 1963). Thus, both temperature
and rainfall are
important parameters controlling this process in the temperate
regions of the world,
whereas in the tropics / subtropics, rainfall is the only limiting
environmental variable
because temperatures are always high enough to facilitate this
process. Consequently,
in the humid tropics / subtropics, the environmental conditions
on pasture are
favourable, more-or- less continuously. Whereas in the
temperate regions there are
often times when “bottlenecks” occur in the larval translation
process, which not only
reduce larval pickup, but also can be exploited in parasite
control programmes

(Waller et al. 1995).
In contrast to the livestock systems of the temperate regions,
where varying
degrees of winter housing and /or zero grazing are practiced,
ruminant livestock
production in the tropics / sub tropics is characterised by all
year round grazing on
pasture. Thus larval pickup from pasture is more-or- less
continuous and all livestock
are likely to be infected. Whilst livestock owners in many
countries of the tropic s /
subtropics, lack the financial resources, knowledge, or the will,
to treat their animals
with drugs, there are also many countries in this region where
quite the opposite is the
case. In many regions in the tropics / subtropics communal
grazing is the norm. Thus
there is little, or no, opportunity of individual farmers to
practice any form of parasite
control, unless there is widespread compliance to the same
practices by the whole
community.
Anthelmintics: failure and the future?

For livestock produc ers that can afford it, control of nematode
parasites has
been based on the use of anthelmintic drugs. However, since the
early 1960’s there
have been only three major classes of broad-spectrum
anthelmintics commercially
released for the control of nematode parasites of ruminant
livestock, namely: the
benzimidazoles / probenzimidazoles (BZs), the
tetrahydropyrimidines /
4
imidazothiazoles (most important drug being levamisole: LEV),
and the macrocyclic
lactones (MLs), or avermectins /mylbemycins. Although the re
are novel classes of
anthelmintic drugs that have been discovered (eg
parahequamide,
cyclooctadepsipeptides), possibly the greatest constraint in their
commercial
development are the enormous costs involved (Waller 1997).
The international
pharmaceutical industry is undergoing unprecedented re-

structuring with resultant
company mergers and the reorganisation of product portfolios.
Apart from the
lucrative companion animal and horse market, it is evident that
veterinary drugs have
been a victim of these “down- sizing” activities. Simply it is a
matter of economics.
There is more money to be made in human pharmaceuticals –
even the cosmetic
industry – than providing new drugs for the grazing livestock
industries. Therefore, it
seems to me to be unlikely tha t a new anthelmintic drug (class)
for use against
nematode parasites of food producing domestic livestock will be
released onto the
market place in the foreseeable future.
Because of the clinical importance of H. contortus, and the very
high
efficiency of the broad spectrum anthelmintics against this
parasite (at least in
initially), the concept of suppressive drenching of sheep and
goats became firmly
entrenched in many countries of the tropics / subtropics where
this parasite is

endemic. Frequent (every 4 – 6 weeks), and often haphazard
treatment became
commonplace. This has become much more the case since patent
protection of all the
currently available broad-spectrum anthelmintics has lapsed,
resulting in a burgeoning
in the marketing of generic anthelmintic products. Quality
assurance was an absolute
pre-requisite for the parent companies, but now they have to
compete on the
deregulated market against companies with these “look alike”
products. On the face
of it, this outcome for the farmers seems to be favourable, with
not only a greater
range, but also much cheaper products, becoming available.
However, many instances
of poorly manufactured, or counterfeit, generic products have
been reported. This is
particularly so in the developing countries, which cannot
provide the resources to
monitor product quality and to prosecute offenders (Wanyangu
et al. 1994; Waller et
al. 1996). Also, as a result of this unfair competition, there are
instances of highly

reputable companies marketing substandard products in this
region of the world (van
Wyk et al. 1995). Thus in most instances, freeing-up the
anthelmintic market in the
tropics / subtropics has not been in the farmers best interests.
As poor quality products
assume a significant market share, then not only do the farmers
waste their money, by
5
failing to control parasites in their animals, but they hasten the
selection process for
anthelmintic resistance.
Recently, the World Organisation for Animal Health (Office
International des
Epizooties: OIE) commissioned a survey to determine the status
of parasiticide
resistance in pests of livestock worldwide (Nari and Hansen
1999). Of the 151
member countries, responses were obtained from 77 (55%
response). The parasites
considered to be of greatest importance to the livestock in each
country were in rank

order – worms (73% of respondent countries), ticks, mange
mites, flies and lice.
Control of these pests was almost entirely by the use of
chemicals. Resistance had
been diagnosed in 55% of the responding countries. Of these,
86% had diagnosed
anthelmintic resistance, 50% ixodicide resistance and 31%
insecticide resistance. An
important note was that these estimates were considered
conservative, as 27% of
countries mentioned a lack of capabilities, infrastructure, and/or
interest in assessing
the significance of these problems.
The examples of anthelmintic resistance in nematode parasites
of ruminant
production systems would form, more-or-less, a uniform
gradation along the spectrum
from no problem to total failure, which is continuously
changing for the worse. The
first reports of total chemotherapeutic failure across the entire
range of broad-
spectrum anthelmintics, was made in 1983 (pre - marketing of
MLs) on goat farms in

north coastal NSW, Australia, which experienced high levels of
summer rainfall
(Anon. 1983). Subsequently, van Wyk (1990) cited a number of
instances in the high
rainfall, or irrigated areas, of South Africa where farmers had
to abandon sheep
farming because of failure to control worms using chemothe
rapy. Total failure of the
BZs and LEV, plus 70% resistance to ivermectin (IVM), the
first of the MLs, was
reported in a survey of anthelmintic resistance of sheep farms in
the humid Oriental
region of Paraguay (Maciel et al. 1996). Most recently it has
been found that total
chemotherapeutic failure to all the three broad-spectrum
anthelmintic groups (also to
the narrow spectrum, salicylanilide drugs) exist on all the large
government managed
small ruminant breeding farms in the eastern Malaysian state of
Sabah
(Chandrawathani et al. 2004). Coupled with a similar result on a
large government
breeding farm on Peninsula Malaysia (Chandrawathani et al.
2003b), it seems as

though Malaysia has the dubious distinction of being able to
declare itself the first
country where virtually total anthelmintic failure to control
internal parasites of small
ruminants is present – at least in the large breeding farms,
whose main purpose is to
6
supply sheep and goats to small- holder farmers. Thus in the
space of approximately
20 years, the situation of virtually total anthelmintic failure has
moved from the
individual farm, to district, to region, to state and finally to a
country problem.
All the above situations share three important features. Namely,
they are all
located in the humid tropics / subtropics, where conditions are
more-or-less
continuously wet throughout the entire year, secondly the major
nematode pathogen,
H. contortus, completely dominates the parasite profile, and
thirdly sheep and goat
raising was/is attempte d to be the sole production system. The
experience on Sabah,

where total anthelmintic failure has likely to have been present
for some years, is that
annual mortalities exceeding 20% of the flock can be expected
(Chandrawathani et al.
2004) – totally unsustainable livestock systems by any
assessment!
SOLUTIONS IN THE FACE OF FAILURE
However abandonment of enterprises cited above, is not
necessarily the only
course of action. I believe that even under such environmental
conditions where H.
contortus flourishes, there are a number of options that could be
taken to restore a
reasonable measure of small ruminant production and if strictly
adhered to, should
prove to be sustainable.
Immediate strategies
• Most farms where these problems have been reported have
very heavy
stocking rates. A reduction of the carrying capacity would
provide more ease
and flexibility to undertake the following measures.

• Attempt to remove resident worm infections. On the face of it,
this maybe a
difficult task. However other older classes of drugs with known
good efficacy
against H. contortus, which have not been used should be tried,
such as the
organo-phosphate anthelmintics (napthalophos: NAP), or
phenothiazine
(PTZ). These drugs, particularly the former, now play an
important role in the
management of multiple, high level resistance in nematode
parasites of sheep
in Australia (Dobson et al. 2001)
• In those areas where night housing of stock is a feature and
sufficient labour is
available, break the infection cycle by preventing grazing of
pastures for two
months by implementing cut-and- carry for shed feeding of all
animals. The
pastures selected for cutting should be from a location that has
been ungrazed
7

(thus uncontaminated) by small ruminants for the last two
months. Ecological
studies in the wet tropics have shown that survival of the free-
living stages of
H. contortus is very short, with the majority of infective larvae
disappearing
from pasture within 4-6 weeks (Banks et al. 1990; Sani and
Chandrawathani
1996).
Short term strategie s
• Implement and strictly adhere to the short-term rotational
grazing strategy, as
developed for parasite control in small ruminants in the wet
tropics (Barger et
al. 1994; Sani and Chandrawathani 1996). This requires the
subdivision of
available pastures into small plots. Animals are then moved
around these
pastures in quick succession (3 - 4 days grazing only on each
plot), returning
to their original plot after approximately 30 - 40 days.
• Monitor faecal egg counts on a regular (initially every 4-6
weeks) basis in a

sentinel group of young sheep.
• Utilise the FAMACHA system of monitoring presence of
anaemia (indirect
measurement of H. contortus infections) and treat accordingly
(Malan and van
Wyk, 1992)
• Introduce molasses/mineral feed blocks to improve the general
nutrition of the
animals. Trial the use of medicated (fenbendazole: FBZ) blocks
for one
grazing cycle (4 weeks) every 6 months. Previous work has
shown that by
using a benzimidazole anthelmintic to which resistance has
developed, from
non-persistent (oral drench) to persistent (daily administration
in a feed block)
use, can restore anthelmintic efficiency (Knox 1996).
• Consider using biological control with the micro-fungus
Duddingtonia
flagrans. This has been shown to be a useful adjunct to worm
control of sheep
and goat parasites on Peninsula Malaysia (Chandrawathani et al.
2002;

2003a).
Longer term strategies
• Where appropriate and as a long-term priority, attempt to
change the genotype
of the sheep to those which have been shown to have natural
resistance to H.
contortus infections, such as the Red Maasai, Barbados Black
Belly, St. Croix,
Florida native sheep (for review Baker 1996).
8
CONCLUSION
This review focuses on the possible ways forward for owners, or
managers, of
small ruminant production systems where chemotherapeutic
options to control
nematode parasites have been exhausted. Whether they abandon
such farming
enterprises, or attempt to ameliorate the problem, one thing is
certain they cannot

persist - simply for economic reasons. There are instances
where the former option
has been taken. In such cases, consigning all animals to the
slaughterhouse should
occur. This represents a “dead end” for the both the hosts and
their parasites. However
what often happens is that these animals are sold to other
farmers, who unsuspectingly
import multiply resistant parasites onto their farm. Such is the
case also where
government farms pass sheep and goats on to small-holder
farmers. It is very
important that veterinary advisers are made aware to the proble
m of anthelmintic
resistance in the tropics sub/tropics and aim to prevent this from
occurring. Correct
diagnosis is important, based clinical signs, history and
particularly on faecal
nematode egg counts, both pre and post-anthelmintic treatment.
In many cases when
animals are suffering with “ill thrift”, or diarrhoea, nutritional
inadequacies rather
than internal parasites is the problem.
However there are alternative solutions to restore parasite

control in what
appears to be a disastrous situation, but these are not simple or
straightforward. They
depend on a combination of strategies, none of which will be
fully effective if solely
relied upon. Such integrated approaches to nematode parasite
control in small
ruminant livestock are the only way to ensure that reasonable
levels of control will
occur for the foreseeable future.
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