Community Health Centers Research Articles

On the pathway to health equity: Creating a harm reduction strategy for a large academic acute care hospital.

An urban centre in southwestern Ontario continues to be faced with the extensive impacts of high rates of substance use. To more effectively meet the quintuple aim, in a way that authentically considers patients who use substances, the need for a cohesive, comprehensive organizational harm reduction strategy at the large academic acute care hospital providing community and regional healthcare services was clear. Community-based harm reduction expertise was leveraged to support the development work. Information gathered through literature review and interviews with patients, internal staff and leaders, partner healthcare agencies, and Canadian hospitals leading in harm reduction work provided key insights and supported the formulation of emerging recommendations that will be used to shape the acute care hospital's formal organizational harm reduction strategy.

Public Health Challenges and Responses to the Growing Ageing Populations

ABSTRACTBackgroundHuman populations are rapidly ageing worldwide due to declining birth rates and rising life expectancies. This profound demographic shift presents complex public health challenges. Synthesizing evidence on key public health issues impacting ageing populations and policy strategies is required to address these needs.MethodsThe study employs narrative literature review based on the PubMed database. Data have been extracted on public health challenges to ageing populations and its recommended policy solutions.ResultsThe key public health challenges identified include rising chronic disease burden, risks for preventable multi‐morbidities and co‐morbidities, disability and dependencies, mental health issues, caregiving gaps, long‐term care system deficiencies, health inequities, healthcare access barriers, end‐of‐life care needs, financial instability, ageism/elder abuse, adverse built environments, climate/disaster threats, and social isolation. Evidence‐based policy responses span interventions in healthcare, social services, urban planning, emergency preparedness, economics, technology, anti‐ageism advocacy and so on.ConclusionsProactively addressing the array of public health challenges faced by rapidly growing ageing populations globally requires implementing collaborative, multisectoral policy solutions focused on promoting healthy, equitable, and socially engaged ageing. Healthcare systems, communities, and policies must be optimized to meet the needs of elderly people and tap into their strengths.

Faktor Resiko Umur >35 Tahun dan Anemia Ringan

Based on data obtained from the Pangkah Health Center, Tegal Regency in 2022, the number of maternal mortality rates (MMR) was 2 cases caused by amniotic fluid bleeding and embolism, whereas in 2023 it was zero or non-existent (Recap of PWS KIA data from Pangkah Community Health Center 2023). The aim of this study was to examine obstetric cases with high risk aged >35 years and mild anemia. This research uses a case study approach. The research subject was pregnant mother Mrs. A is 36 years old with high risk, aged >35 years and mild anemia. Data was taken from October to November 2023. Data was taken using interviews, observation and documentation, the results during pregnancy, the subjects accepted to have their Hb checked because at visit 2 the Hb was low and the results were the same as at visit 3-4 the Hb was high and normal. Pregnant women aged >35 years are still often found or are more at risk because the mother's health has declined, as a result pregnant women at that age have a high probability of preeclampsia, bleeding, preterm labor and others. Suggestion: if a similar case is found, collaboration with a doctor is necessary. during pregnancy until postpartum, apart from that it is necessary to involve the family, especially the child during pregnancy and after the baby is born.

Presentasi Bokong dan Kek

The Maternal Mortality Rate (MMR) in Tegal Regency in 2022 reached a high number, namely 27 cases, 13 of which occurred during the postpartum period, 10 cases during pregnancy, 4 cases during childbirth. Based on data obtained from the Lebaksiu Community Health Center from September to October 2023, there were no maternal and infant deaths. The number of pregnant women at high risk was 115 cases. These include pregnant women with breech presentation, Chronic Energy Deficiency (CED), age < 20 years, age > 35 years, child spacing < 2, history of CS, TB < 145 cm, HBSAg (+), HIV (+), anemia, history asthma, grand multipara, history of abortion, history of PEB and syphilis (+). The aim of this study was to examine obstetric cases with breech presentation and CED. This research uses a case study approach. The research subject was pregnant mother Mrs. S is 24 years old with breech presentation and CED. Data was taken from September to November 2023. Data was taken using interviews, observation and documentation, the results during the subject's pregnancy were successful in making the pregnancy normal. However, during labor, fetal hypoxia was experienced, so collaboration was carried out with the doctor, after management was carried out according to the doctor's advice, the fetal condition was normal and a SC delivery was carried out. During the postpartum period and the newborn is in normal and healthy condition. Suggestion: it is hoped that if a similar case is found there needs to be collaboration with doctors during pregnancy until postpartum, apart from that it is necessary to involve the family during pregnancy until postpartum.

The "E-UKGM" Model as an Effort to Improve the Quality ofRecording and Reporting Community Oral Health Efforts (UKGM) in Community Health Centers

UKGM is a dental health service activity carried out by the community through guidance from the health center. The obstacle to the implementation of UKGM is that the recording and reporting applied so far at the Community Health Centers is still manual. In the Bulukumba Regency area, recording and reporting of UKGM activities is still carried out manually, reports on UKGM activities are combined with other health reports, and there is no data on ongoing actions from the results of examinations on UKGM activities. Efforts are needed to improve the quality of recording and reporting of UKGM at Community Health Centers based on information systems. Objective: To prove that the E- UKGM model is effective as an effort to improve the quality of UKGM recording and reporting atCommunity Health Centers. Methods: Research and Development with Pre-experiment one Group Pretest-Posttest Design research design. The research sample was TGM working at the health center totaling 20 people who were given the E- UKGM model . Data collection techniques are interviews and questionnaires. Data were processed with non- parametric tests. Results: The expert validation test of the E-UKGM model obtained an average of 82% with a very feasible category and r> 0.726. The recording and reporting mechanism, and the quality of data and information improved after being given the E-UKGM model compared to the previous p-value of 0.000 (p<0.05). Conclusion: The application of the E-UKGM model is effective in improving the quality of recording and reporting UKGM at the Community Health Centers.

Towards zero new HIV infections in Amsterdam in 2026; building bridges between community organizations, undocumented migrants and sexual healthcare providers.

In the four largest cities in the Netherlands, an estimated 400 people live with undiagnosed HIV, including 170 in Amsterdam. Amsterdam targets having zero new HIV infections in 2026. Undocumented migrants are disproportionately affected by HIV and often contract HIV after migration. Moreover, they often experience difficulties accessing healthcare. The aim of this study was to analyze the outcomes of an HIV/STI testing program for undocumented migrants through community based testing. Between May 2021 and January 2022 data for this cross sectional study was collected during outreach testing activities of the Amsterdam Center for Sexual Health (CSH) of the Public Health Service, and the NGO Doctors of the World. Activities were organized in collaboration with migrant partner organizations. Participants were tested free-of-charge for HIV, syphilis, gonorrhea, chlamydia and if indicated for Hepatitis B and C. Prior to testing, a healthcare provider-administered questionnaire was filled out. 126 people from 22 countries were tested for HIV during 28 outreach activities. Mean age was 37 (IQR 32-43). Forty-nine people (39%) were additionally tested, (through self-sampling) for chlamydia, gonorrhea and syphilis, 42 (33%) for Hepatitis B and 14 (11%) for Hepatitis C. We found zero new HIV infections and 5 positive chlamydia cases.Reaching 52 HIV first time testers and 19 first time testers since migration shows the importance of these activities. The number of participants tested were lower than initially expected due to lower attendance per testing day for various reasons. To increase the likelihood of reaching undocumented migrants for HIV/STI testing and linkage to care, focus should be on on-site provider-initiated testing, e.g. during outreach healthcare activities, and on easy access to centers for sexual health. Collaboration between healthcare providers and community stakeholders is essential.

Exploring Healthcare Providers' Difficulties and Strategies when Caring for Community-Dwelling People With Dementia Who are at Risk of Getting Lost.

Caring for patients with dementia at risk of getting lost is challenging for community healthcare providers. Through semi-structured interviews with 25 participants, we examined the challenges faced by these providers and the strategies they employed. We identified the following themes of challenging parts: (a) the disturbance caused by behavioral and psychological symptoms in dementia; (b) difficulty in helping older family caregivers to keep the patient from going out; (c) difficulty in changing the attitudes of the family members; families' unawareness of the risk of getting lost. We also identified the following strategies to mitigate these themes: (a) detecting the risk of getting lost through early assessment; (b) encouraging the family to use resources or devices to prevent the patient from getting lost; (c) educating the family to manage behavior and psychological symptoms of dementia; (d) strengthening the patient's crisis awareness.

The Effect of Infusing Soursop Leaves (Annona muricata L.) on Vaginal Discharge in Women of Childbearing Age: A Randomized Clinical Trial at the Lolo Community Health Center, Kerinci Regency, Jambi, Indonesia

Introduction: Vaginal discharge (leukorrhea) is a common gynecological complaint among women of childbearing age. While physiological discharge is normal, pathological discharge can be indicative of underlying infections or conditions. This study aimed to investigate the efficacy of soursop leaf infusion (Annona muricata L.) as a complementary treatment for vaginal discharge in women of childbearing age. Methods: A randomized controlled trial was conducted at the Lolo Community Health Center, Kerinci Regency, Jambi, Indonesia. Women aged 15-49 years presenting with vaginal discharge were randomly assigned to either the intervention group (soursop leaf infusion) or the control group (standard care). The intervention group received soursop leaf infusion twice daily for seven days, while the control group received standard care as per the health center's protocol. The primary outcome was the reduction in vaginal discharge symptoms (amount, color, odor, and associated discomfort) after seven days. Secondary outcomes included changes in vaginal pH and microbiological assessment. Results: A total of 130 women participated in the study (65 in each group). After seven days, the intervention group showed a significantly greater reduction in vaginal discharge symptoms compared to the control group (p < 0.05). The amount, color, and odor of discharge improved significantly in the intervention group, along with a reduction in associated discomfort such as itching and irritation. Vaginal pH was also normalized in the intervention group, and microbiological assessment revealed a decrease in pathogenic microorganisms. Conclusion: Soursop leaf infusion (Annona muricata L) appears to be a safe and effective complementary treatment for vaginal discharge in women of childbearing age. Its antimicrobial and anti-inflammatory properties may contribute to its beneficial effects. Further research is warranted to explore its long-term efficacy and potential use in combination with conventional therapies.

Determinants of birth weight and length: an analysis of the 2020 mothers' cohort register data

A woman's nutritional status significantly impacts the qualities of the baby she delivers, as assessed by the baby's weight and length at birth. This study aimed to identify factors influencing birth weight and length using a retrospective case-control design with secondary data collected from the mothers' cohort register at the Community Health Center in 2020-2021. The study included 100 samples, comprising 25 cases and 75 controls. Several determinants of birth weight and length were examined: the mother's age (OR=4.1, 95% CI 1.41-12.0), weight gain during pregnancy (OR=3.6, 95% CI 1.051-12.553), mid-upper arm circumference (OR=2.9, 95% CI 1.061-8.220), hemoglobin level (OR=4.711, 95% CI 1.57-14.11), and iron supplement intake (OR=1.837, 95% CI 0.600-5.624), with hemoglobin level identified as the most influential factor on birth qualities. Mothers with less than normal hemoglobin levels have a 4.7 times higher risk of delivering babies of lower weight and length than mothers with normal hemoglobin levels. The impact of low hemoglobin in pregnant women includes reduced oxygen supply for both the mother and fetus, resulting in low birth weight, child anemia, premature birth, and child mortality. Given these significant effects, it is crucial to establish standards for health services in Indonesia, ensuring that pregnant women with low hemoglobin receive comprehensive care aligned with Indonesia's Sustainable Development Goals (SDGs) standards.

Street Medicine as Service Learning: Lessons from a Needs Assessment Conducted by Medical Students

Background The homeless population is growing across the United States, particularly in urban areas. Oftentimes, there is a disconnect between existing community services and actual needs of individuals experiencing homelessness. These services gaps are frequently identified by needs assessments and utilized by community agencies to inform outreach efforts and program development. Community outreach by medical students through participation in community-based service learning projects is critically important for the preparation of future physicians to care for underserved and vulnerable populations. This study describes the stepwise approach taken by medical students to design and administer a needs assessment for the purpose of informing the development of a new street medicine program. This study is intended to serve as a guide to students who aspire to launch a new street medicine program but is generalizable to other student-led service learning outreaches. Methods We conducted a needs assessment from April-June 2018 of 144 unsheltered homeless individuals in metro Phoenix, Arizona. The 16-question survey investigated perceptions of priority needs, sources of medical care, health literacy, and health status. Survey results were analyzed using Wilcoxon Rank Sum Test, chi-squared analysis, and multivariable logistic regression. Results Most respondents (91.6%) identified food as a top need. The majority (64.1%) utilized Emergency Departments as their primary source of care, and 40.1% reported suboptimal health. Suboptimal health was more likely to be reported in those who expressed transportation (OR 3.03, 95% CI: 1.30-7.07) as a top priority need. Health illiteracy (OR 3.68, 95% CI: 0.76-17.9) was associated with suboptimal health, as was obtaining care at an Emergency Department (OR 2.05, 95% CI: 0.81-5.25). Conclusions Pairing health care with meals and other primary needs may be an effective strategy to increase service utilization by this population. Needs assessments provide an opportunity for health professional students to learn about social needs and more effectively connect patients with services from community agencies and health care organizations.

Performance Analysis of the Regional Public Service Agency (BLUD) of the Tanara Health Center, Serang Regency using the Balance Scorecard Approach

This study aims to analyze the performance of the Regional Public Service Agency (BLUD) at the Tanara Community Health Center in Serang Regency using the Balance Scorecard approach. The Balance Scorecard emphasizes the importance of balancing various aspects such as financial and non-financial, short-term and long-term, as well as internal and external factors. The performance analysis of the BLUD is viewed from four perspectives: growth and learning, internal processes, customer satisfaction, and financial perspectives. This research adopts a quantitative approach. Data collection is conducted through surveys to gather insights into the growth and learning perspective, the internal process perspective, and the customer satisfaction perspective. Secondary data is used to analyze the BLUD's performance from the financial perspective. The results of this study indicate that the health center has not yet met the target scores set by the government. Although some indikators have been achieved, there is still a need for improvement, particularly in internal processes and customer satisfaction. To enhance the performance of the BLUD at this health center, integrated efforts are required, such as improving services and internal processes as well as fostering innovation.

PENGARUH PERLAKUAN METODE BIRTHING BALL TERHADAP PENURUNAN INTENSITAS NYERI KALA 1 FASE AKTIF

Childbirth is a natural thing and will definitely be experienced by every woman who has a partner. However, the fact that cannot be denied is that many women feel anxious before giving birth, which can be influenced by various factors. The aim of providing Endorphine Massage with lavender aromatherapy is to reduce the anxiety level of mothers in the first stage of labor at the Sekar Community Health Center, Bojonegoro Regency. The design provides instillation, massage, Endorphine Massage with lavender aromatherapy to reduce the anxiety level of mothers in the first stage of labor at the Sekar Community Health Center, Bojonegoro Regency. The results of the instillation, giving Endorphine Massage pills with lavender aromatherapy which has no side effects in reducing the anxiety level of mothers giving birth at the Sekar Community Health Center, Bojonegoro Regency, so that mothers can apply endorphine massage with lavender aromatherapy to reduce the level of anxiety in labor without causing side effects in reducing Anxiety level

Community perception and experience of health services in the midst of an earthquake and COVID-19 pandemic: A phenomenological study

Indonesia is located on the Pacific Ring of Fire with various disasters occurring frequently and causing tremendous impacts. Recently, Mamuju Regency in West Sulawesi was hit by an earthquake during the COVID-19 pandemic, making primary health care (PHC) a major community health care provider facing several issues. This study aims to explore the challenges and supporting factors of the recovery of PHC after the earthquake during the COVID-19 pandemic using a descriptive phenomenology grounded in Edmund Husserl's philosophy. The Bamboo PHC (Puskesmas Bambu) was selected as the only PHC in Mamuju which was most affected by the earthquake. A focus group discussion method was conducted by involving 15 participants selected using purposive sampling and divided into three groups (health workers, health cadres, and community members). As a result, the community members acknowledged that the Bamboo PHC services programs in general were favorable before the pandemic, there were several basic and superior health service programs that the community felt were valuable. Yet, the COVID-19 pandemic worsened the situation and the use of healthcare facilities decreased. Coupled with the occurrence of natural disasters in vulnerable areas, it is increasingly causing fatalities. Therefore, disaster preparedness and community empowerment are the key to successful disaster management.

The Oral Cavity-Another Reservoir of Antimicrobial-Resistant Staphylococcus aureus?

Staphylococcus aureus is one of the most common potentially pathogenic bacteria that may asymptomatically colonize many sites of healthy carriers. Non-nasal carriage, especially in the oral cavity, and its role in transmitting antimicrobial-resistant S. aureus strains in the healthcare community, is poorly understood. This study aimed to assess the prevalence and antimicrobial susceptibility of S. aureus in both oral and nasal cavities among preclinical dentistry students. A total of 264 oral and nasal swabs were taken from 132 participants, and all specimens were cultured using standard diagnostic procedures and antimicrobial susceptibility testing (EUCAST). The prevalence of S. aureus exclusively in the nasal (11.4%) or oral (9.1%) cavity was comparable, while concurrent oral and nasal carriage was present in 27.3% of participants. Although antibiotic resistance rates observed in both oral and nasal isolates were similar (ranging from 2.7% to 95.5%), 16.7% of carriers exhibited distinct antibiotic resistance profiles between oral and nasal isolates. Three (2.7%) methicillin-resistant S. aureus (MRSA) were isolated from the mouth and nose but multidrug resistance (27.3%) was more frequent in the oral than in the nasal isolates: 34% and 21.1%, respectively. This study demonstrated that preclinical dentistry students have a similar rate of oral S. aureus carriage as the nasal carriage rate, and that the oral cavity can be colonized by antimicrobial-resistant strains that do not originate from the nose. Consequently, the oral cavity seems to be an unjustly overlooked body site in screening for S. aureus carriage.

Hubungan Tingkat Pengetahuan, Sikap dan Dukungan Tenaga Kesehatan pada Calon Pengantin (Catin) Tentang Penyakit Sifilis di Wilayah Kerja Puskesmas Kotabaru Kecamatan Keritang Kabupaten Inhil Riau Tahun 2023

Syfillis cases in Southeast Asia in 2015 amounted to 3 million. The areas that have the highest rates of syphilis transmission are Sub-Saharan Africa, the United States and Southeast Asia. Studies conducted in Africa show that there are 30% positive antenatal syphilis cases and 50% result in infant death in congenital syphilis. This research is a type of quantitative research with an analytical observational research design with a cross sectional study approach. The population in this study were all prospective brides and grooms in Keritang District, the working area of the Kotabaru Community Health Center in 2023, as of January, as many as 36 people who had bridal injections (catin) at the Community Health Center. The sampling technique used in the research was accidental sampling. Data was collected using a questionnaire and data processing using the SPSS program. Data analysis in this study was univariate and bivariate analysis using the chi-square test formula with a confidence level of 95% (0.05). The results of the study revealed that the level of knowledge of the prospective bride and groom (catin), the attitude of the prospective bride and groom (catin) and the support of health workers had a value of each variable less than 0.05 or a significance value of p<0.05, which indicated that there was a significant relationship of these three variables in prospective brides (catin) regarding syphilis in the working area of the Kotabaru health center, Keritang District, Inhil Regency, Riau in 2023.

Determinan Kejadian Penyakit Infeksi Saluran Pernapasan Akut pada Balita di Wilayah Kerja Puskesmas 7 Ulu Palembang

Currently, ISPA disease in Palembang City is still one of the highest causes of death among children under five. Risk factors associated with the incidence of ARI are extrinsic and intrinsic factors. The aim of this research was to determine the relationship between exclusive breastfeeding, maternal knowledge, smoking habits, nutritional status and the incidence of ISPA in toddlers in the working area of the 7 Ulu Palembang Community Health Center. This research is analytical with a cross sectional design. The population in this study were mothers with toddlers aged 24 - 59 months with a sample size of 66 people. The sampling technique in this research is purposive sampling. The results of the research show that there is a relationship between exclusive breastfeeding, maternal knowledge, smoking habits, nutritional status and the incidence of ARI in toddlers in the working area of the 7 Ulu Palembang Community Health Center. It is hoped that the end of this research will be an illustration for the community health center to be able to further improve health services and be more active in providing counseling and education regarding ISPA in toddlers.

Healthcare Seeking Behavior and Disease Perception Toward Cholera and Acute Diarrhea Among Populations Living in Cholera High-Priority Hotspots in Shashemene, Ethiopia.

Healthcare seeking behavior (HSB) and community perception on cholera can influence its management. We conducted a cross-sectional survey to generate evidence on cholera associated HSB and disease perception in populations living in cholera hotspots in Ethiopia. A total of 870 randomly selected households (HHs) in Shashemene Town (ST) and Shashemene Woreda (SW) participated in our survey in January 2022. Predominant HHs (91.0%; 792/870) responded "primary health center" as the nearest healthcare facility (HCF). Around 57.4% (247/430) of ST HHs traveled <30 minutes to the nearest HCF. In SW, 60.2% (265/440) of HHs travelled over 30 minutes and 25.9% (114/440) over 4 km. Two-thirds of all HHs paid <USD1 travel cost; SW residents had slightly higher cost burden. When cholera symptoms occur, 68.0% (83/122), 75.5% (114/151), 100.0% (52/52), and 100.0% (426/426) of 0-4, 5-14, 15-17, and ≥18 years, respectively, in ST sought healthcare at our sentinel-HCFs. In SW, younger children visited our sentinel-HCFs slightly more (82.6%, 86.7% in 1-4, 5-14 years, respectively) than older age groups (74.4%, 75.6% in 15-17, ≥ 18 years, respectively). Relatively more adults in ST (12.0%; 51/426) sought over-the-counter drugs at pharmacies than those in SW (2.5%; 11/435). Around 73.8% (642/870) of HHs were aware of cholera disease and 66.7% (428/642) of HHs considered eating unclean food as main causes of cholera. Variations in cholera prevention practices between rural and urban residents were shown. Addressing differences in HSB per age groups is needed for community engagement for early case detection and case management; critical in reducing cholera deaths and transmission.

Retrospective Analysis of Cholera/Acute Watery Diarrhea Outbreaks in Ethiopia From 2001 To 2023: Incidence, Case Fatality Rate, and Seasonal and Multiyear Epidemic Patterns.

The Ethiopian government has developed the multisectoral cholera elimination plan (NCP) with an aim of reducing cholera incidence and case fatality rate (CFR). To better understand and monitor the progress of this plan, a comprehensive review of national cholera epidemiology is needed. Reported data on cholera/acute watery diarrhea (AWD) cases in the past 20 years were extracted from the Ethiopian Public Health Institute and World Health Organization databases. Descriptive statistics, Pearson χ2, and logistic regression analyses were conducted. From January 2001 to November 2023, a total of 215 205 cholera/AWD cases, 2355 deaths with a cumulative CFR of 1.10% (95% confidence interval [CI], 1.092-1.095), and a mean annual incidence rate of 8.9/100 000 (95% CI, 6.5-11.3) were reported. Two major upsurges of cholera epidemics were found in the last two decades with mean attack rate (AR) of 20.57/100 000 in 2006-2010 and 14.83/100 000 in 2016-2020. Another resurgence of outbreaks occured in 2021-2023 (mean AR, 8.63/100 000). In 2015-2023, 54.0% (53 990/99 945) of cases were aged 15-44 years. National cholera CFR (3.13% [95% CI: 2.1-4.5]) was the highest in 2022. The 2015-2023 cumulative cholera CFR was different across regions: Benishangul Gumuz (6.07%), Gambela (1.89%), Sidama (1.42%), Southern Nation, Nationalities, and Peoples' (1.34%), Oromia (1.10%), and Amhara (1.09%). Cholera/AWD patients in older adults (≥45 years), severe dehydration, peak rainy season (June-August), and outpatients were associated with higher risk of death. Cholera has been a public health problem in Ethiopia with case fatalities still above the global target. Case management needs to be improved particularly in outpatients and older populations. Outbreak preparedness should be rolled out well in advance of the typical rainy seasons. Significant investments are essential to advance the cholera surveillance system at healthcare setting and community level. Underlying factors of cholera deaths per areas should be further investigated to guide appropriate interventions to meet the NCP target by 2028.

W65 - Trends in Buprenorphine Prescribing in a National Network of Community Health Centers

W65 - Trends in Buprenorphine Prescribing in a National Network of Community Health Centers

T155 - Changes in Prevalence of Substance Use Among Patients of Community Health Centers in Los Angeles Over Time: Comparative Analysis From 2013 to 2022

T155 - Changes in Prevalence of Substance Use Among Patients of Community Health Centers in Los Angeles Over Time: Comparative Analysis From 2013 to 2022