MANAGEMENT OF TYPE 2 DIABETES MELLITUS AT PRIMARY HEALTH CARE LEVEL IN LITHUANIA

Background: Lassa fever is endemic in Nigeria and health care workers are at a high risk of contracting and transmitting the infection. This study compares Lassa fever prevention practices among health care providers in public and private Primary Health Care facilities in Jos.Methods: The study used a comparative cross-sectional design to study health care workers in 29 Primary Health Care facilities selected using a two-stage sampling technique. All health care workers who attended to patients were interviewed using a semistructured interviewer-administered questionnaire. Data were analysed using Statistical Package for Social Sciences version 23 and a p-value of ≤ 0.5 was considered statistically significant.Results: Majority of the respondents had neither received on-the-job training on Lassa fever prevention (91.9%) nor Universal Standard Precautions (88.7%). Private Primary Health Care facilities had better supplies and equipment for Lassa fever prevention compared to their public counterparts. Majority (65.8%) of respondents had poor Lassa fever prevention practices and this was worse in the private (75.4%) than the public (55.6%) facilities. No facility met all the requirements for Lassa fever prevention. Training had a statistically significant association with good practice among public Primary Health Care facilities. Conclusion: Noncompliance with Lassa fever prevention practice is still common in Primary Health Care facilities. This is worse in private facilities. Continuous training and improved supplies of materials and equipment are necessary for effective Lassa fever prevention among these health care providers.

BackgroundThe South African government is striving for universal access to HIV counselling and testing (HCT), a fundamental component of HIV care and prevention. In the Cape Town district, Western Cape Province of South Africa, HCT is provided free of charge at publically funded primary health care (PHC) facilities and through non-governmental organizations (NGOs). This study investigated the availability and accessibility of HCT services; comparing health seeking behaviour and client experiences of HCT across public PHC facilities (fixed sites) and NGO mobile services.MethodsThis qualitative study used semi-structured interviews. Systematic sampling was used to select 16 participants who accessed HCT in either a PHC facility (8) or a NGO mobile service (8). Interviews, conducted between March and June 2011, were digitally recorded, transcribed and where required, translated into English. Constant comparative and thematic analysis was used to identify common and divergent responses and themes in relation to the key questions (reasons for testing, choice of service provider and experience of HCT).ResultsThe sample consisted of 12 females and 4 males with an age range of 19–60 years (median age 28 years). Motivations for accessing health facilities and NGO services were similar; opportunity to test, being affected by HIV and a perceived personal risk for contracting HIV. Participants chose a particular service provider based on accessibility, familiarity with and acceptability of that service. Experiences of both services were largely positive, though instances of poor staff attitude and long waiting times were reported at PHC facilities. Those attending NGO services reported shorter waiting times and overall positive testing experiences. Concerns about lack of adequate privacy and associated stigma were expressed about both services.ConclusionsRealised access to HCT is dependent on availability and acceptability of HCT services. Those who utilised either a NGO mobile service or a public PHC facility perceived both service types as available and acceptable. Mobile NGO services provided an accessible opportunity for those who would otherwise not have tested at that time. Policy makers should consider the perceptions and experiences of those accessing HCT services when increasing access to HCT.

At the current stage of the development of health care systems, it is believed that local governments should be included in any reform plans. The World Health Organisation emphasizes the important role of local governments in reforming primary care while maintaining the primary responsibility for building national central government health systems. The purpose of the study is to characterize the relations of primary health care facilities with local governments by the heads in the context of reforming the health care system in Ukraine and identifying problem areas in them that require improvement. Materials and methods. The study was carried out in two stages: focusing interviewing heads of primary health care facilities with a high level of competence to determine the set of characteristics that form the relationship between of the local governments and primary health care facilities; a survey of 100 heads of primary care facilities using a questionnaire drawn up based on the results of the first stage of the study. Statistical analysis was carried out using descriptive and analytical statistics. Results and discussion. Comprehensive reform of local self-government and primary health care in Ukraine faces certain difficulties and requires coordination of relations between the local governments and primary health care facilities. Twelve main characteristics of the relationship between local governments and primary health care system of the community were identified. Of the total number of respondents, 72% did not give a satisfactory assessment of the competence of the representatives of local governments in the organization of medical services; 36% – the attitude of local governments to primary care facilities; 32% – response of local governments to the needs of primary health care facilities; 78% – understanding by the owner of the contribution of the primary health care to the prosperity of the community; 52% – priority of health development for community; 12% of the respondents noted that their facilities did not receive additional funding from local budgets for the development of the institution and improvement of the quality of medical care. In general, 68% of the surveyed primary health care managers assessed positively the relationship with the owner; 19% – negatively. Conclusion. The study identified problems in the relationship between the local governments and primary care facilities during the reform of the health care system, which need to be addressed. It was revealed that the main problem is the lack of awareness of the local governments of the importance of primary health care for the community, which is primarily due to the low competence of representatives of local authorities on health issues

To assess knowledge and practice of primary eye care among primary healthcare workers known as community health extension workers in Funtua district of Nigeria. Cross-sectional mixed method study among health workers employed in government-owned primary healthcare facilities. Quantitative data were obtained using self-administered questionnaires and checklists, while qualitative data by modified Delphi technique, role plays and observation. A score of 1 was given for each correct answer, while a total score of ≥60% was considered 'good'. Eighty three of 88 health workers participated (94%) in the questionnaire survey; while 16 of them were selected for the qualitative survey. Good scores regarding the knowledge of common eye diseases were obtained by 68.7%, but only 26.4% of them could identify their most important features. Participants could undertake 3 of 5 steps in visual acuity testing. Skills in recognising common eye diseases and their management were weak; while practice was often not according to the guidelines. Community health extension workers displayed good knowledge of common eye diseases. Areas of weakness are recognition and interpretation of eye signs, and practice rarely follows the guidelines. Preventive medicine was neglected; community health extension workers require practical retraining and supervision to achieve integration of primary eye care into primary healthcare services.

To assess the quality of child health services in primary health care (PHC) facilities in Calabar, south-east Nigeria. Cross-sectional, descriptive design. Key informant interviews, structured observation, self-administered questionnaire and focus group discussion. Calabar, south-east Nigeria. Participants All 10 PHC facilities in Calabar, 252 PHC workers serving in the facilities, and 76 mothers whose children received care in the facilities. Adequacy of structure (equipment and personnel); process (diagnosis, training and knowledge, use of national case-management algorithm, and supervision), and output (clients' satisfaction). PHC facilities were adequately equipped to the extent of providing immunization services and management of diarrhoea but not for other aspects of care expected of a PHC centre, including management of acute respiratory infections (ARI), a common problem in children in the region. Supply of essential drugs was inadequate in all centres and facilities for emergency care were lacking. Many of the health care workers (68.3%) had adequate training in immunization, and their knowledge scores on immunization issues (62%) was higher than in other aspect of PHC. Use of the national case management algorithm was low among PHC workers. Results of the focus group discussions with mothers showed that a few perceived quality of care to be poor. The main concerns were long waiting time, lack of essential drugs, and attitude of the health workers. Inadequacy in the quality of child health services in PHC facilities is a product of failures in a range of quality measures -- structural (lack of equipment and essential drugs), process failings (non-use of the national case management algorithm and lack of a protocol of systematic supervision of health workers). Efforts to improve the quality of child health services provided by PHC workers in the study setting and similar locales in less developed countries should focus not only on resource-intensive structural improvements, but also on cheap, cost-effective measures that address actual delivery of services (process), especially the proper use of national guidelines for case management, and meaningful supervision.

BackgroundDuring the coronavirus disease 2019 (COVID-19) containment, primary health care (PHC) facilities inChina played an important role in providing both healthcare and public care services to community populations. The tasks of COVID-19 containment facilitated by PHC facilities were different among different regions and during different periods of COVID-19 pandemic. We sought to investigate the gaps on task participation, explore existing problems and provide corresponding solutions.MethodsSemi-structured face-to-face interviews with COVID-19 prevention and control management teams of PHC facilities were conducted. Purposive stratified sampling was used and 32 team members of 22 PHC facilities were selected from Wuhan (as high-risk city), Shanghai (as medium-risk city) and Zunyi (as low-risk city). Framework analysis was employed to analyze the transcribed recordings.ResultsThe main tasks of PHC facilities during the early period of the pandemic included assisting in contact tracing and epidemiological investigation, screening of populations at high-risk at travel centers/internals, house-by-house, or pre-examination/triage within PHC facilities; at-home/ centralized quarantine management; the work of fever sentinel clinics.Further analyses revealed the existing problems and suggestions for improvement or resolutions. Regular medical supply reserves were recommended because of the medical supply shortage during the pre-outbreak period. Temporarily converted quarantine wards and centralized quarantine centers could be used to deal with pressures on patients’ treatment and management of the febrile patients. Only after strict evaluation of nucleic acid testing (NAT) results and housing conditions, decision on quarantine at-home or centralized quarantine centers could be made. Settings of fever sentinel clinics at PHC facilities allowed fever patients with no COVID-19 infection risks for treatment without being transferred to fever clinics of the designed secondary hospitals. Psychological intervention was sometimes in need and really helped in addressing individuals’ mental pressures.ConclusionsDuring the COVID-19 containment, PHC facilities in China were responsible for different tasks and several problems were encountered in the working process. Accordingly, specific and feasible suggestions were put forward for different problems. Our findings are highly beneficial for healthcare teams and governments in handling similar situations.

BackgroundLittle is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Given the current maternal and child mortality in Bangladesh and the challenges to addressing health-related Millennium Development Goal (MDG) targets the financial sustainability of such facilities is crucial.MethodsThe study was designed as a case study covering a single facility. The methodology was based on the 'ingredient approach' using the allocation techniques by inpatient and outpatient services. Cost recovery of the facility was estimated from the provider's perspective. The value of capital items was annualized using 5% discount rate and its market price of 2004 (replacement value). Sensitivity analysis was done using 3% discount rate.ResultsThe cost recovery ratio of the BRAC primary care facility was 59%, and if excluding all capital costs, it increased to 72%. Of the total costs, 32% was for personnel while drugs absorbed 18%. Capital items were17% of total costs while operational cost absorbed 12%. Three-quarters of the total cost was variable costs. Inpatient services contributed 74% of total revenue in exchange of 10% of total utilization. An average cost per patient was US$ 10 while it was US$ 67 for inpatient and US$ 4 for outpatient.ConclusionThe cost recovery of this NGO primary care facility is important for increasing its financial sustainability and decreasing donor dependency, and achieving universal health coverage in a developing country setting. However, for improving the cost recovery of the health facility, it needs to increase utilization, efficient planning, resource allocation and their optimum use. It also requires controlling variable costs and preventing any wastage of resources.

Background Globally, 422 million adults have type 2 diabetes mellitus (T2DM), causing 1.5 million deaths per year. Kuwait has one of the highest T2DM prevalence in the world and determining the proportion of patients and relatives who have pre-diabetes (PDM), insulin resistance (IR) and T2DM is crucial to inform preventive activities and curative services. Study objectives: The study describes the prevalence and risk factors of PDM, IR and T2DM, in adult patients attending a primary health care facility in Kuwait and the prevalence and risk factors of the same conditions among the patients’ first-degree relatives. The study also describes the degree of glycaemic control achieved by patients with T2DM and risk factors for poor glycaemic control. Finally, we assessed the agreement of a point of care (POC) device to measure glycated haemoglobin (HbA1c) to monitor T2DM control. Methods We conducted cross-sectional surveys of patients and first-degree relatives attending Nuzha health care facility in Kuwait and case-control studies of participants attending Nuzha’s diabetic clinic. Diabetic participants were consecutively tested by the Quo-test (POC) device to compare its agreement with a reference test. Results The prevalence of T2DM, IR and PDM among patients attending the clinics were 29.6% (95% CI: 25.1%-34.1%), 34.6% (95% CI: 29.1%-40.2%) and 26.0% (95% CI: 21.6%-30.4%), respectively. The proportion of patients with T2DM increased with age (AOR=5.4), with the highest prevalence occurring at 60-69 years of age. T2DM was associated with hypertension (AOR=1.95) and being a widow (AOR=6.11). IR was associated with low HDL (AOR=1.96), overweight (OR=8.25), obesity (OR=18.33) and increased waist circumference (OR= 5.5). Sugar-sweetened beverages were associated with IR. The prevalence of T2DM, IR and PDM among first-degree relatives of T2DM patients were 29.1% (95%CI: 23.7%-34.5%), 32.8% (95%CI: 26.2%-39.4%), 20.4% (95%CI: 15.6%-25.2%). The risk factors for T2DM were similar among patients and first-degree relatives, but IR was associated with manual labour occupations (AOR=3.6). Only 30% of T2DM patients achieved good glycaemic. Poor control was associated with high triglycerides (AOR=2.2), smoking (AOR=4.1) and the number of years since diagnosis (AOR=4). The Quo-Test had comparable performance to the reference test, with a Coefficient of Variation of 2.1% (r2 = 935, Kappa 90% and 87% at HbA1c cut-offs of 7.0 and 9.0% respectively). The POC and the reference tests performed poorly in patients with haemoglobinopathies. Conclusion This study demonstrates that a high proportion of patients and first-degree relatives attending one of the main primary health care centres in Kuwait have T2DM. Many patients and relatives were unaware of their condition. There was also a very high prevalence of IR and PDM suggesting the burden of T2DM will increase further in the future. Major efforts are needed to upscale detection, and preventive programmes for IR, PDM and T2DM and the quality of T2DM management needs to improve. The POC device tested could provide timely information for the management of T2DM.

PHP26 - Assessment of Prescribing Indicators in Public and Private Primary Health Care Facilities in Indonesia

ABSTRACTBackground: Missed opportunities for vaccination (MOV) have been identified as an important contributor to low childhood immunization coverage. In this study, we explore the reasons for MOV from the perspective of caregivers of children aged 0–23 months attending primary health care (PHC) facilities in Nassarawa Local Government Area (LGA) of Kano State, Nigeria. This was to inform the implementation of a quality improvement program to reduce MOV.Methodology: An exploratory qualitative research was conducted using focus group discussions (FGD) with caregivers of children aged 0–23 months that visited PHC facilities. The study was conducted in three purposively selected PHC facilities in Nassarawa, Kano. The caregivers were purposively selected from the three PHC facilities and were homogenous in terms of their place of residence. Each FGD was conducted face-to-face in a private room within the health facility. During the discussion, participants maintained a circular sitting arrangement. The FGD were audio-recorded, transcribed verbatim, and analyzed using template analysis approach through the lens of the theoretical domains framework (TDF) and the capability, opportunity, motivation – behavior (COM-B) model. The researchers that conducted this study are epidemiologists and implementation scientists with experience in immunization programs. They are multilingual, and some are fluent in both English and Hausa language. Although four of them are medical doctors, however, they do not have any affiliations or provide health services in any of the PHC facilities where this study was conducted.Result: Five FGD with 30 caregivers was conducted. The caregivers were aged between 19 and 32 years and lived within the LGA. Based on their lived experiences, several factors that are responsible for MOV were identified and categorized into three constructs based on the COM-B model. Capability encompassed caregiver’s inadequate knowledge of the vaccines that children need. The opportunity included contextual factors such as non-screening of home-based records, health worker’s refusal to offer immunization services, and husband’s refusal due to socio-cultural beliefs. Finally, motivation included fear of the side effects of vaccination.Conclusion: This study identified a useful framework that aided deeper insights into caregiver-related factors responsible for MOV in Nassarawa, Kano. Some of the findings from this study can be used to inform change ideas in a quality improvement program and should be explored.

The study aimed to explore potential challenges that hamper utilization of adolescent friendly health services (AFHS) in primary healthcare (PHC) facilities in Armenia. A qualitative study using in-depth interviews and focus group discussions was conducted with experts in adolescent health, PHC providers and facility managers from public PHC facilities and adolescents from thetwo largest cities in Armenia. We also collected data through observations in PHC facilities. We utilized a directed content analysis approach for data analysis. The study identified various factors negatively influencing utilization of AFHS in Armenia. These factors included adolescents' poor health literacy and awareness of health services, lack of PHPs' professional competencies, and breaches of confidentiality. Several facility-level barriers such as lack of privacy, inconvenient operating hours and long waiting times also contributed to insufficient service utilization by adolescents. The study findings shed light on different perspectives related to various challenges adolescents faced in PHC facilities in Armenia. Targeted interventions needed to improve adolescents' health literacy, to enhance the PHPs' competencies and to create a friendly and welcoming environment in PHC facilities.

A competitive advantage in health care institutions can be cultivated by marketing activities and value creation for patients with chronic diseases in primary health care. Type 2 diabetes mellitus (T2DM) is a major challenge in primary health care, as managing risk factors and managing patient knowledge can help to prevent a number of major of complications. This study reveals the expectations and attitudes of patients with T2DM regarding marketing mix elements in the management of their condition. To explore the perspectives of patients with T2DM on marketing mix elements in the primary health care institutions of Lithuania. The design of the national study was based on a survey of patients with T2DM that was conducted after consultation with a family physician in primary health care institutions in Lithuania. The survey was conducted from October 2017 to January 2018, and involved 510 patients with T2DM. Data analysis included factor analysis and linear logistic regression. A hypothetical model was built, defining the relationships between marketing mix elements and both perceived value (emotional, functional, and social) and satisfaction with primary health care services. The marketing mix element of 'Service' is statistically significantly dependent on the gender of the respondents, and is expressed more frequently by women (rcr = 0.118, P = 0.007). The occupation of respondents with T2DM (rcr = 0.151, P = 0.009) and affiliation to primary health care institution (rcr = 0.091, P = 0.040) statistically positively affect the marketing mix element of 'Price'. The marketing mix elements of 'Promotion' and 'People' do not statistically significantly depend on the sociodemographic characteristics of the respondents. Only a weak correlation between the sociodemographic characteristics of the respondents and the marketing element of 'Place' was found. The 'Process' element is statistically significantly more relevant to patients with an average monthly income of €350 (rcr = 0.104, P = 0.019). The element of 'Physical evidence' is more statistically significantly related to respondents with an average monthly income of €350 (rcr = 0.092, P = 0.038). Marketing mix analysis provides information about patients' expectations of primary health care services and identifies areas of improvement for the health services provided by primary health care institutions. The competitiveness of primary health care services is strengthened by enhancing value for patients, by using elements of the health care marketing, and by increasing patient satisfaction.

BackgroundChina set out the vision to establishing a hierarchical medical system, with primary health care (PHC) facilities serving health care users’ first contact. Common ailments were listed, supported by a...

To assess the availability, accessibility, appropriateness and quality of adolescent sexual and reproductive health (ASRH) services in primary health care (PHC) facilities in Plateau State, Nigeria, a cross-sectional study was conducted in 230 PHC facilities across the three senatorial zones of Plateau state. Primary data were obtained through face-to-face interviews with heads of facilities from December 2018 to May 2019. An adapted questionnaire from the World Health Organization (WHO) was used, covering five domains, to ascertain the extent that ASRH services were available and provided. Very few PHC facilities in the state had space (1.3%) and equipment (12.2%) for ASRH services. The proportion of PHC facilities offering counselling on sexuality was 11.3%, counselling on safe sex was 17%, counselling on contraception was 11.3% and management of gender-based violence was 3%. Most facilities were not operating at convenient times for adolescents. Only 2.6% PHC facilities had posters targeted at ASRH and just 7% of the PHCs had staff trained on ASRH. These findings underscore that the majority of PHC facilities surveyed in Plateau State, Nigeria, lacked dedicated space, basic equipment, and essential sexual and reproductive health care services for ASRH, which in turn negatively affect general public health and specifically, maternal health indices in Nigeria. Structural changes, including implementation of policy and adequate additional training of healthcare workers, are necessary to effectively promote ASRH.

Background In low- and middle-income countries, there is scarcity of validated and reliable measurement tools for health facility management, and many interventions to improve primary health care (PHC) facilities are designed without adequate evidence base on what management practices are critical. Objective This article developed and validated a scorecard to measure management practices at primary health care facilities under the performance-based financing (PBF) scheme in Nigeria. Methods Relevant management practice domains and indicators for PHC facilities were determined based on literature review and a prior qualitative study conducted in Nigeria. The domains and indicators were tested for face validity via experts review and organized into an interviewer-administered scorecard. A stratified random sampling of PHC facilities in three States in Nigeria was conducted to assess the reliability and construct validity of the scorecard. Inter-rater reliability using inter-class correlation (ICC) (1, k) was assessed with one-way ANOVA. Exploratory factor analysis (EFA) was conducted to assess the construct validity, and an updated factor structure were developed. Results 32 indicators and 6 management practice domains were initially described. Ordinal responses were derived for each indicator. Data on the scorecard were obtained from 111 PHC facilities. The ICC of mean ratings for each team of judges was 0.94. The EFA identified 6 domains (Stakeholder engagement and communication; Community-level activities; Update of plan and target; Performance management; Staff attention to planning, target, and performance; and Drugs and financial management) and reduced the number of indicators to 17. The average communality of selected items was 0.45, and item per factor ratio was 17:6. Conclusions Despite a few areas for further refinement, this paper presents a reliable and valid scorecard for measuring management practices in PHC facilities. The scorecard can be applied for routine supervisory visits to PHC facilities, and can help accumulate knowledge on facility management, how it affects performance, and how it may be strengthened.