Comprehensive Health Care Center Research Articles

#2624 Point of care creatinine for early detection of community acquired acute kidney injury in a primary health care centre in Nigeria

Abstract Background and Aims Community acquired Acute kidney injury (AKI) and leads to poor outcomes in low and middle-income countries due to delayed diagnosis however its epidemiology is poorly studied due to lack of biochemical diagnosis. Supported by the International Society of Nephrology, we evaluated the accuracy of point of care creatinine (POC Cr) technology using capillary samples [1] and its use implementing a clinical algorithm to select patients at risk of AKI for POC Cr testing in the Hospital Emergency Department in Port Harcourt in Nigeria. In this phase of the project POC Cr was used in a large primary care health centre for early detection and management of community acquired AKI. Method The study is conducted in Ozuoba Model Comprehensive Primary Health Care Centre. The centre has 4148 patient attendances per month (20.3% medical, 18.8% obstetrics and 60.8% paediatrics) with 11.1% considered acute requiring short admission at the centre usually for intravenous fluids. Historically, decision making is based largely on clinical judgement and renal function tests when requested from external laboratories are reported in > 48 hours. During this project POC Cr was offered on high-risk patients based on the clinical algorithm from the previous stage (Fig. 1) and patients with detected AKI were offered short admission for intravenous fluids and antibiotics. Results To date 54 patients have been screened with POC Cr. Median age is 25.5 years, minimum 2 months, maximum 85 years, interquartile range (48-10), 62% are females, 57% presented with malaria diagnosis and 9% with gastroenteritis. Mean (standard deviation) of POC Cr was 105 (54) µmol/L. There were 5 cases (9%) of AKI (Cr >150 µmol) detected in patients aged 5 months, 13 months, 7 years, 19 years and 31 years. All were treated with short admission and intravenous fluids and were discharged after clinical improvement. Knowledge of the presence of AKI altered management in all patients prompting short admission. Conclusion Community acquired AKI is common in young patients with malaria and early biochemical diagnosis can improve outcomes. The study continues to recruit and aims to investigate the characteristics of community acquired AKI in Africa and to contribute to the design of optimal and sustainable pathway for early detection and management of AKI.

Knowledge, attitudes, and practices toward Patient Safety among nurses in health centers

ObjectiveTo assess knowledge, attitudes, and practices (KAPs) toward patient safety among nurses working at primary and comprehensive health care centers in Jordan; to identify factors that predict KAPs among nurses.MethodsA descriptive cross-sectional design was conducted using a convenience sample of 307 primary health care nurses in Jordan. A self-reported questionnaire (KAPs) toward patient safety was distributed to the nurses between August 2022 and October 2022.ResultsThe results revealed that the mean score of knowledge was 9.51 out of 11 (SD = 1.35), the mean score of attitudes was 57.66 out of 75 (SD = 9.17), and the mean score of practices was 5.64 out of 8 (SD = 1.72). Where 59% of participants reported good knowledge about patient safety. 61% of participants reported positive attitudes toward patient safety. A significant regression equation was found (R² = 0.073, F= (2.94), p = 0 0.003). Age and having information on patient safety during continuing education were significant predictors of the attitude score (p ≤ 0.05).ConclusionIt is necessary to implement patient safety education programs and training.

Acceptance of Information and Communication Technology and Its Related Factors among Older Adults; a Cross-Sectional Study in Iran

Introduction: Given the increasing elderly population and the decreasing role of families in elderly care, the use of up-to-date technologies by older adults will become increasingly important in helping them live healthier and better lives. This study aimed to determine the acceptance of information and communication technology (ICT) by older adults and related factors in Yazd city, Iran.
 
 Methods: This cross-sectional study was conducted in 2022 with the participation of 360 older adults aged over 60 years from comprehensive health care centers in Yazd city, Iran. Participants were selected using a multi-stage random sampling method. Data were collected using a demographic information questionnaire and an Information and Communication Technology Acceptance Questionnaire completed by interview. Data were analyzed using descriptive indices, independent two-sample t-tests, one-way analysis of variance, and regression by SPSS.
 
 Results: The ICT acceptance rate among older adults was 22.5%. The highest mean score was related to the dimension of perceived usefulness (15.37). The most significant barriers to ICT acceptance were lack of interest (48.6%), lack of sufficient skills (46.4%), and lack of perceived need (45.3%). The regression results showed that age, level of education, smartphone use, and time spent on technology tools were predictors of ICT acceptance by older adults, accounting for 82% of the variance in ICT acceptance.
 
 Conclusion: Given the low level of technology acceptance among older adults in Yazd city and the need to learn and use ICT to meet their individual, social, health, and medical needs, as well as to live a more independent life and save time and costs, providing older adults with the opportunity to become familiar with technology is essential.

Psychometric evaluation of the Persian version of the European Health Literacy Instrument (P-HLS-EU-Q47).

Health literacy is one of the most critical determinants of health for effectively improving health services and reducing health inequalities. The importance of accurate measurement cannot be overstated. The European 47-item Health Literacy Questionnaire (HLS-EU-Q47) can provide precise measurements of health literacy. Therefore, this study aimed to evaluate the psychometric properties of the European Health Literacy Instrument in Iranian society (HLS-PV-Q47) for its Persian version. This cross-sectional study was conducted using a convenient sampling of 560 people referred to comprehensive healthcare centers. The construct validity was assessed by exploratory (280 people) and confirmatory factor (with 280 people). The internal consistency was calculated using Cronbach's alpha coefficients. Based on the exploratory factor analysis, three factors of healthcare, disease prevention, and health promotion explained 48.9% of the total variance of health literacy. Cronbach's alpha was 0.96 for the whole instrument. The Persian version of the European Health Literacy Instrument (P-HLS-EU-Q47) had good validity and reliability, which can be used in future studies due to its good psychometric properties.

Effects of Social Support and Self-regulation on Changes in Exercise Behavior Among Infertile Women: A Cross-sectional Study for Comparison of External and Internal Factors

Background: Exercise behavior (EB) has a significant impact on infertility, but the magnitude of the effect is not easily determined. This study aimed to assess the effect of social support and self-regulation, as external and internal factors, on changes in EB among infertile women. Methods: This cross-sectional study was conducted on 483 infertile women in Sanandaj (Iran) in 2020. Samples were recruited from 35 comprehensive healthcare centers by convenience sampling. Standardized face-to-face interviews were conducted using valid and reliable instruments for the assessment of EB, social support, and self-regulation. The association between EB, social support, and self-regulation was evaluated by logistic regression models. Results: The majority of the participants (56.7%) had secondary infertility, while 70.8% of them did not perform any exercise. Self-regulation and social support were significantly higher in women with secondary infertility than in those with primary infertility (P<0.01). Self-regulation was significantly lower in women whose height was below 160 centimeters (P<0.05). Social support was significantly higher among participants aged≥35 years and weighing≥60 kg (P<0.01). The odds of EB adoption increased with self-regulation and social support (odds ratio [OR]=1.05, 95% CI=1.02-1.09, P<0.01; OR=1.06, 95% CI=1.02-1.11, P<0.01). Conclusion: Social support and self-regulation almost equally influenced EB in infertile women. In future research, designing support and consultation programs can be considered to encourage infertile women to exercise.

Evaluation of the Short-Time Empowerment Intervention Package of the Ministry of Health and Medical Education of Iran to Reduce Domestic Violence

Background: Domestic violence is any act to gain authority and control over a spouse, intimate partner, girlfriend/boyfriend, or close family member. Domestic violence against women or intimate partner violence (IPV) is prevalent in many parts of the world, ranging from 15% to 75%, depending on the definition and perception of violence. Objectives: This study aimed to evaluate the effectiveness of the short-time empowerment intervention package for women with domestic violence developed at the Ministry of Health and Medical Education in Tehran. Methods: The method of this study was a historical cohort. The researcher-made tool consisted of 30 questions based on the materials contained in the short-time empowerment intervention package. It was provided to 200 women referred to comprehensive healthcare centers who had previously been screened for domestic violence. Of these, 100 people in the experimental group received telephone intervention from a psychologist, and 100 people in the control group received telephone intervention without receiving the intervention. They were asked questions about the tool. Results: The results showed that there were no significant differences between the two groups of women with intervention and women without intervention in 5 areas of safety capabilities, recognizing high-risk situations, designing strategies to deal with high-risk situations, skills to deal with spouse anger, reduce anxiety and stress for themselves and their children (P > 0.05). Conclusions: The findings indicate that the short-time empowerment intervention package for women with domestic violence could not empower women to prevent the recurrence of violence and needs revision.

Preventive Behaviors, Psychological Distress, and their Associated Factors in Iranians during the SARS-CoV-2 Delta Variant Outbreak

Background: Up to now, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected and killed millions of people across the globe. In these conditions, Iran was experiencing the fifth wave of the Coronavirus disease 2019 (COVID-19) pandemic, accrued by the Delta variant, over the course of the present study. Objectives: The present study aimed to reflect on preventive behaviors, psychological distress, and their associated factors in Iranians during the SARS-CoV-2 Delta variant outbreak. Methods: Utilizing a descriptive-analytical cross-sectional research design, this study was performed on 1,015 Iranian individuals referred to the comprehensive healthcare centers in Kashan, central Iran, selected via simple random sampling. Data collection tools included the sociodemographic information questionnaire, the Preventive Behaviors against COVID-19 Questionnaire (PBCQ), and the 12-item General Health Questionnaire (GHQ-12). Results: The study results revealed that the mean±standard deviation (SD) of PBCQ was 17.20±4.18 (12-36). In addition, involvement in preventive behaviors against COVID-19 was at higher levels in male (P=0.007), younger (P≤0.001), and self-employed (P=0.016) participants with a fair family economic status (P=0.007), as compared to other cases. Those receiving no vaccines (P=0.023), together with the subjects recently contracting COVID-19, also adhered to only some preventive behaviors (P≤0.001). The GHQ-12 mean±SD was equal to 2.15±2.41 (0-12). Moreover, the study results indicated that female (P=0.021) younger (P=0.017), married (P=0.024), self-employed (P=0.003) subjects with a fair or poor family economic status (P=0.001) and recent infection with COVID-19 (P=0.010) were more susceptible to psychological distress, as compared to others. Conclusion: The present study demonstrated that engagement in preventive behaviors against COVID-19 significantly dwindled, and the incidence rate of psychological distress augmented in the course of the fifth wave of the pandemic in Iranians. These findings could provide healthcare planners and policymakers with valuable information.

Incidence of malaria and typhoid fever co-infection among patients attending Rimingado Comprehensive Healthcare Centre, Kano State, Nigeria.

The research was carried out to determine the incidence of malaria-typhoid co-infection among patients attending Rimingado comprehensive healthcare centre, Kano state, Nigeria. Patients’ bio- data were obtained through structured questionnaire and diagnosis was done using venous blood sample obtained from the participants. Rapid diagnostic test was used for analysis of malaria parasites while widal test was used for the analysis of enteric fever. Of the 150 patients enrolled for the study (85 females and 65 males), 60 (40.0%) had malaria and typhoid fever co-infection (P<0.05). The incidence of malaria-typhoid co-infection was highest among those in the age group range between 11-20 years (12.0%). However, with regard to the marital status, those that were single had the highest incidence of coinfection (27.3%) than the married. Poor sanitary habits, poverty and ignorance are the predisposing factors for the development of malaria and typhoid infections.

Evaluation of errors related to surgical pathology specimens of different hospital departments with a patient safety approach: a case study in Iran

BackgroundMost surgical specimen errors occur in the pre-analysis stage, which can be prevented. This study aims to identify errors related to surgical pathology specimens in one of the most comprehensive healthcare centers in Northeast Iran.MethodsThe present study is descriptive and analytical research conducted cross-sectionally in 2021 at Ghaem healthcare center in the Mashhad University of Medical Sciences on the basis of a census sampling. We used a standard checklist to collect information. Professors and pathologists evaluated the validity and reliability of the checklist using Cronbach’s alpha calculation method of 0.89. We analyzed the results using statistical indices, SPSS 21 software, and the chi-square test.ResultsOut of 5617 pathology specimens studied, we detected 646 errors. The highest number of errors is the mismatch of the specimen with the label (219 cases; 3.9%) and the non-compliance of the patient’s profile in the specimen sent with the label (129 cases; 2.3%), and the lowest errors are the inappropriate volume of the fixator(24 cases; 0.4%), and they accounted for insufficient sample size (25 cases; 0.4%). Based on Fisher’s exact test results, there was a significant difference between the proportion of errors in different departments and months.ConclusionConsidering the frequency of labeling errors in the stage before the analysis in the pathology department, the use of barcode imprinted in specimen containers, the removal of the paper request for pathology, the use of radio frequency chip technology, the use of the rechecking system and improving communication in different departments can be effective in reducing these errors.

Knowledge and Attitudes of Women toward the Influenza Vaccination during Pregnancy in Amman, Jordan

Objectives: The study aimed to assess the level of knowledge and attitudes of Jordanian women regarding influenza and its vaccine during pregnancy.
 Methods: A cross-sectional study was conducted on 384 Jordanian women who had had a full-term delivery during the last 12 months. Data were collected with an interviewer-administrated questionnaire at five governmental comprehensive healthcare centers in Amman governorate.
 Results: Most participants had moderate knowledge (78.1%) (average score of 6.08 ± 1.38 out of 10). Women were either positive (51.0%) or neutral (47.9%) towards the influenza vaccination during pregnancy (average score of 52.43 ± 6.29 out of 75). Further, the vaccination rate during the women’s latest pregnancy was 2.1%. A significant positive relationship was found between the knowledge and attitudes of participants (p=0.001).
 Conclusion: The vaccination rate was low among women during pregnancy. The study’s results suggest that a greater awareness of the flu vaccine would help build positive attitudes towards its uptake during pregnancy. In this sense, antenatal care healthcare providers, such as gynecologists and midwives, should communicate strong health education messages about the flu vaccine as a preventative measure against influenza complications during pregnancy.

The Intention of Waterpipe Tobacco Smoking by Women in the COVID-19 Pandemic and its Contributing Factors: a Nonparametric Path Analysis.

People with waterpipe tobacco smoking (WTS) seem to be more at risk for the serious complications of coronavirus disease 2019 (COVID-19). This study aimed at assessing the behavioral intention (BI) of WTS by women in the COVID-19 pandemic and its contributing factors. This cross-sectional descriptive-correlational study was conducted in 2020 (ie, during the COVID-19 pandemic). Participants were 300 women randomly selected through multistage sampling from comprehensive healthcare centers in Khorramabad, Iran. Data collection instrument was a 42-item questionnaire with 4 main subscales, namely knowledge, attitude, differential association, and BI. Data were collected through both online and phone-based methods and were analyzed using non-parametirc path analysis. The prevalence of WTS among women was 13% (95% CI, 11.06-14.94) and the mean scores of attitude, differential association, and behavioral intention among participants with WTS were significantly higher than participants without WTS (P < 0.001). Moreover, 46.12% (95% CI, 38.12-54.08) of participants with WTS reported intention to quit WTS due to the COVID-19 pandemic and 43.6% (95% CI, 35.66-51.54) of women with WTS and 16.5% (95% CI, 14.20-18.80) of women without WTS believed in the protective effects of WTS against COVID-19. The path analysis model showed that the BI of WTS had a significant inverse relationship with knowledge and a significant direct relationship with attitude and differential association. This study suggests the need for quality educational and counseling interventions for the general public to correct popular misconceptions about the protective effects of WTS against COVID-19.

The effect of Coronavirus disease pandemic on maternal and neonatal health: A cohort study from Isfahan, Iran.

The Coronavirus disease-2019 (COVID-19) pandemic may profoundly impact on maternal and neonatal health worldwide. However, a few studies have investigated this topic. This study aimed to investigate the impact of the COVID-19 pandemic on maternal and neonatal health. This retrospective cohort study analyzed collected data from March to May 2020, and the same period in 2019, involving 5711 pregnant women referring to comprehensive healthcare centers in Isfahan province health facilities, Iran. Pregnant women and neonates were followed-up until 40 days after the delivery. Demographic characteristics, pre-pregnancy, antenatal care, and post-pregnancy variables were collected. A total of 5711 pregnant women were studied, of whom 3477 (61%) were referred in 2019 (before the COVID-19 pandemic as nonexposed) and 2234 (39%) during the COVID-19 pandemic (as exposed group) in 2020. For those living in cities with a population of 20,000, the number of antenatal care were lower about 2% compared to nonexposed group (p = 0.01). The number of mothers with a history of the underlying disease who referred to a comprehensive healthcare center during the COVID-19 pandemic (47%) was lower about 6% compared to nonexposed group (41%) (p 0.001). During the COVID-19 pandemic, the prevalence of hypertension and gestational diabetes mellitus was 5% (n = 109) and 20% (n = 445), which were higher about 2% and 4%, respectively, compared to nonexposed group. The COVID-19 pandemic had no other significant effect on mothers' and neonates' other characteristics than nonexposed group. The COVID-19 pandemic imposes no significant effect on mothers' and neonates' health compared to nonexposed group.

The Effect of a Non-Pharmacological Multicomponent Pain Management Program on Pain Intensity and Quality of Life in Community-Dwelling Elderly Men With Chronic Musculoskeletal Pain

Background and AimImproving the level of care for the elderly with musculoskeletal pain requires pharmacological and non-pharmacological pain control methods. This study aimed to investigate the effect of a non-pharmacological pain management intervention on pain intensity and quality of life in community-dwelling older men with musculoskeletal pain who were referred to comprehensive healthcare centers in the city of Ilam, Iran. Materials and MethodsA quasi-experimental study with pre and post-test design was performed on 65 older men with chronic musculoskeletal pain. The samples were selected regarding inclusion criteria as available and randomly assigned to either the control (usual care) or the experimental group (educational intervention plus physical exercises). Baseline characteristics of participants, the Visual Analogue Scale, and the CASP-19 Quality of Life were used to collect data. Data were analyzed by SPSS software using the ANCOVA, independent and paired t-test, and chi-square test at the statistically significant level of 5 %. ResultsAccording to the findings, there was a significant difference between the experimental and control groups in terms of quality of life (p < .05) and pain intensity (p < .05) after the intervention. No relevant differences were found between groups regarding demographic characteristics at baseline. ConclusionsA six-week physical activity and education program for community-dwelling older men with chronic musculoskeletal pain could improve quality of life and decrease pain intensity after a one-month follow-up compared with usual care. Therefore, it seems necessary to consider pain management programs in the elderly care program and familiarize health care professionals with these pain control methods.

Reproductive Health Literacy and its Related Factors in Women of Reproductive Age Referring to Comprehensive Healthcare Centers in Chabahar in 2021

Background: Reproductive health literacy plays a vital role in the health of women as one of the vulnerable groups in the community. Therefore, the present study aimed to investigate reproductive health literacy and its related factors in women of reproductive age referring to comprehensive healthcare centers in Chabahar in 2021. Methods: This cross-sectional study was conducted on women of reproductive age referring to comprehensive urban and rural healthcare centers in Chabahar. The participants were 220 women who were selected using convenience sampling. The data were collected using the Reproductive Health Literacy Scale and analyzed via SPSS software (version 22). Results: The mean score of reproductive health literacy was significantly lower in the women aged 15-24 years, those with lower education, women in rural areas, and housewives. The mean score of reproductive health literacy was significantly different among the women in terms of socioeconomic status (P=0.12). The results of multiple linear regression analysis indicated that the age group and education could significantly predict the women’s overall reproductive health literacy. Conclusion: Following the findings of this study, effective interventions need to be incorporated into national women’s health programs to improve reproductive health literacy in women with lower age and primary education, women living in villages, and housewives

Association between Placenta Malaria Parasites and Preeclampsia/Eclampsia among Parturient Mothers in Alex Ekwueme Federal University Teaching Hospital Abakaliki

In tropical countries, malaria and preeclampsia/eclampsia are common diseases of pregnancy; and placenta have been implicated in the pathophysiology of both disease processes. The two diseases have pathophysiologic similarities in the placenta such as placenta ischaemia, endothelial dysfunction and production of pro-inflammatory cytokine. Yet, there is paucity of studies on the association of these two disease processes. Determining the association between the two disease processes may help to unravel the pathogenesis of preeclampsia and also help in its prevention and patient management. Objective: Determined the association between placenta malaria parasitemia and preeclampsia/eclampsia among parturients at Alex Ekwueme Federal University Teaching Hospital Abakaliki. Materials and Methods: This was a case control study that was conducted in the Labour wards of department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA) and Mile 4 Missionary Hospital Abakaliki, a comprehensive health care centre in Abakaliki, Ebonyi state. It was conducted over a period of 6 months between 1st October 2021 and 31st March, 2022. The cases in this study were parturients that developed preeclampsia/eclampsia in the course of pregnancy, while the controls were parturient without preeclampsia/eclampsia. Interviewer-administered questionnaires were used to collect data on socio-demographic characteristics, obstetrics and medical histories. Histological examinations were conducted to isolate plasmodium falciparum parasites from placenta samples obtained from the maternal surface of the placenta. The data was processed using Epi Info software. Categorical variables were analyzed using Mc Nemar X2 test, with a p-value of 0.05 considered statistically significant. Logistic regression models were used to estimate the odds ratios (OR) and 95% CI of the association between placenta malaria parasites and preeclampsia/eclampsia was conducted. Relative risk with 95% CI was used to determine both fetal and maternal outcomes. Results: The prevalence of preeclampsia during the study period was 2.9%. Placenta malaria was positive in twenty one (21) of the 67 cases of preeclampsia/eclampsia analyzed, giving a prevalence of 31.3% and in eleven (11) out of 68 controls (normotensive) patients analyzed, giving a prevalence of 16.2%. The presence of placenta malaria significantly increased the odds of developing preeclampsia/eclampsia among parturients (OR = 2.4, 95% CI = 1.0 - 5.4, P value = 0.04). Presence of placenta malaria in mothers with preeclampsia/eclampsia was associated with adverse pregnancy outcomes such as cerebrovascular accident (RR = 19.2, 95% CI = 1.1 - 341.7, P value = 0.04), DIC (RR = 10.9, 95% CI = 1.4 - 88.0, P value = 0.02), abruptio placenta (RR = 2.4, 95% CI = 1.2 - 4.8, P value = 0.01), pulmonary edema (RR = 2.7, 95% CI = 1.1 - 25.9, P value = 0.03), IUGR (RR = 2.1, 95% CI = 1.1 - 4.5, P value = 0.03) and IUFD (RR = 3.8, 95% CI = 1.3 - 11.7, P value = 0.02). Presence of placenta malaria also increased the risk of NICU admission (RR = 2.6, 95% CI = 1.1 - 6.0, P value = 0.03), Low 1st minute APGAR score (RR = 2.7, 95% CI = 1.2 - 6.1, P value = 0.02) and Low 5th minute APGAR score (RR = 3.0, 95% CI = 1.0 - 8.6, P value = 0.04) among neonates delivered by mothers with preeclampsia/eclampsia. However, presence of placenta malaria did not significantly increase maternal and perinatal mortalities. Conclusion: There is a higher prevalence of placenta malaria among mothers with preeclampsia/eclampsia when compared with normotensive controls and this was associated with increased risk of certain maternal and perinatal morbidities. Placental malaria was not associated with increased risk of either maternal or perinatal mortality.

Evaluating Daily Cell-Phone Use in Elderly and its Effect on Lifestyle, Isfahan Comprehensive Health Care Centers.

The seniors' lifestyle is an important public-health issue. Hence, assessing the association of cell phone use as a rapidly spreading technology on older adults' lifestyle can be useful for planning prevention and health-promotion policies. This cross-sectional study was conducted from March 2020 to March 2021 in Isfahan Comprehensive Health Care Centers to investigate the impact of cell phone use on the lifestyle of the elderly. The Cell-Phone Over-Use Scale and the lifestyle checklist were the assessment tools employed for this purpose. Of the 300 participants with a mean age of 67.93 ± 5.14 years, 46% were male and 54% female. The average value of cell phone usage score was 47.88 ± 26.56, which was categorized into low 36%, moderate 41%, and overuse 23%. A positive and significant correlation was reported between the level of cell phone use in males (β =10.711, [0.95 confidence interval {CI} =4.262-17.160]) and people who have used a substance or opium in the past year (β =10.819, [0.95 CI = 3.677-17.961]). The present results found no significant association between cell phone use patterns and age, level of education, body mass index, television time, sports time, smoking in the past year, marital relationship, and living alone. In this study, we demonstrated a correlation between cell phone use and some demographic and lifestyle variables, namely sex and drug abuse.

Primary health care providers knowledge of dementia and cognitive assessment tools for elderly populations in Southeast Nigeria: A pilot survey.

Primary health care remains the widely available first point of medical care in Nigeria and in other low- and middle-income countries. Recognizing the rising prevalence of dementia in these settings, primary healthcare providers should be trained on cognitive assessment. However, little is known about the current Nigerian primary healthcare providers' knowledge of dementia, cognitive assessment tools, and use in elderly populations. The aim of this study was to evaluate primary healthcare providers' knowledge of dementia and cognitive assessment tools in Southeast Nigeria in preparation for the introduction of digital tablet-based assessment tool. This is a cross-sectional mixed method descriptive pilot survey carried out in a comprehensive healthcare center affiliated with Nnamdi Azikiwe University Teaching Hospital. Fifty healthcare workers participated. Convenience sampling was employed involving all consenting primary healthcare providers in comprehensive healthcare center-Nnamdi Azikiwe University Teaching Hospital. A structured questionnaire was distributed for generation of both qualitative and quantitative data. The mean age of the 50 primary healthcare providers was 36.6 years, with females constituting 80%. Mean practice duration was 10.8 years. Their response on the mean age at which patients may need a cognitive assessment was reported as 52.8 years. Primary healthcare providers reported that dementia is associated with memory loss and can be genetically inherited. None of the respondents were familiar with Montreal cognitive assessment, or any form of tablet-based cognitive assessment tool. Most (86%) knew about the mini mental state examination. Primary healthcare providers are deficient in knowledge of dementia Alzheimer's or cognitive assessment tools, and so they do not routinely carryout cognitive screening in elderly patients during clinic visits. It is important to train all cadres of primary healthcare staff on the use and benefit of cognitive assessment using culturally validated user-friendly tool to improve quality of care for the elderly population.

Using the RE-AIM framework to evaluate the implementation of scaling-up the Friendship Bench in Zimbabwe – a quantitative observational study

BackgroundThis study aimed to evaluate the real-world implementation of the Friendship Bench (FB) – an evidence-based brief psychological intervention delivered by community health workers (CHWs) – three years after its implementation in three city health departments in Zimbabwe. Implementation sites were evaluated according to their current performance using the RE-AIM framework making this one of the first evaluations of a scaled-up evidence-based psychological intervention in sub-Saharan Africa (SSA).MethodsUsing the RE-AIM guide (www.re-aim.org), the authors designed quantitative indicators based on existing FB implementation data. Thirty-six primary health care clinics (PHC) in Harare (n=28), Chitungwiza (n=4) and Gweru (n=4) were included. Among these clinics 20 were large comprehensive health care centers, 7 medium (mostly maternal and child healthcare) and 9 small clinics (basic medical care and acting as referral clinic). Existing data from these clinics, added to additionally collected data through interviews and field observations were used to investigate and compare the performance of the FB across clinics. The focus was on the RE-AIM domains of Reach, Adoption, and Implementation.ResultsSmall clinics achieved 34% reach, compared to large (15%) and medium clinics (9%). Adoption was high in all clinic types, ranging from 59% to 71%. Small clinics led the implementation domain with 53%, followed by medium sized clinics 43% and large clinics 40%. Small clinics performed better in all indicators and differences in performance between small and large clinics were significant. Program activity and data quality depends on ongoing support for delivering agents and buy-in from health authorities.ConclusionThe Friendship Bench program was implemented over three years transitioning from a research-based implementation program to one led locally. The Reach domain showed the largest gap across clinics where larger clinics performed poorly relative to smaller clinics and should be a target for future implementation improvements. Program data needs to be integrated into existing health information systems. Future studies should seek to optimize scale-up and sustainment strategies to maintain effective task-shared psychological interventions in SSA.

The effects of self-care education based on the health literacy index on self-care and quality of life among menopausal women: a randomized clinical trial

PurposeAging is associated with many different health-related challenges for women such as menopause and its associated problems. Self-care (SC) is a factor with potential effects on menopause and its consequences. SC education based on health literacy has the potential to improve menopausal women’s SC. The aim of this study was to evaluate the effects of SC education based on the health literacy index (HLI) on SC and quality of life (QOL) among menopausal women.MethodsThis randomized clinical trial was conducted in Iran. Participants were 100 menopausal women purposively recruited from five comprehensive healthcare centers in the south of Tehran. They were randomly allocated to a control and an intervention group through block randomization. Intervention was an HLI-based SC education program implemented in four 1.5–hour weekly sessions through the lecture, group discussion, and question and answer methods. Data were collected before and eight weeks after the intervention using a demographic questionnaire, the Health Literacy for Iranian Adults scale, the Menopause-Specific Quality of Life Questionnaire, and the Menopausal Self-Care Questionnaire. The SPSS software (v. 22.0) was used to analyze the data through the Chi-square, Fisher’s exact, paired-sample t, and the independent-sample t tests as well as the analysis of covariance at a significance level of less than 0.05.FindingsThere were no significant differences between the intervention and the control groups respecting the pretest mean scores of QOL (88.15 ± 32.36 vs. 79.6 ± 36.99) and SC (104.75 ± 12.31 vs. 103.32 ± 13.8) (P > 0.05). However, the posttest mean scores of QOL and SC in the intervention group significantly differed from the control group (66.44 ± 28.41vs. 81.3 ± 38.04 and 125.6 ± 11.23 vs. 102.6 ± 14.34) (P < 0.05).ConclusionHLI-based SC education is effective in significantly improving menopausal women’s QOL and SC and can be used to improve health-related outcomes among menopausal women.Clinical trial registration This research was registered (24/03/2020) in the www.thaiclinicaltrials.org with registration number: TCTR20200324002.

Knowledge, Anxiety, and Fear of the Unknown Among Pregnant Women During COVID-19 Pandemic

Background: This study aimed to determine pregnant women’s knowledge about COVID-19 and their anxiety and fear of the unknown. Methods: This online cross-sectional study was conducted in March and April 2020 on Iranian pregnant women visiting comprehensive healthcare centers affiliated with the Gonabad University of Medical Sciences. Participants were selected using a stratified random sampling strategy among pregnant women who agreed to participate, had a Telegram or WhatsApp account or phone number, and had no history of pregnancy complications. A demographic questionnaire, Spielberger’s state-trait anxiety inventory, fearing the unknown questionnaire, and an uncertainty scale was used to collect data. Data were analyzed using simple and multiple linear regression models using SPSS software, version 16. Results: A total of 190 pregnant women were included in the analysis. The Mean±SD for knowledge of COVID-19 was 8.82±1.72. The knowledge of 71.1% of participants was moderate. The Mean±SD for fearing the unknown was 36.2±9.1. The Mean±SD for the state anxiety about COVID-19 incidence in pregnant women was 47.6±10.2. The results showed that 65.3% of the participants had a moderate level of anxiety. Multiple regression analysis showed an increase of 0.16 (P=0.029) in the fearing the unknown score for each week of increase in the gestational age. Similarly, the anxiety increased by 0.56 (P&lt;0.001) for each unit of increase in fearing the unknown. Moreover, the results showed that the anxiety of people using Telegram or WhatsApp was 3.44 units more than others (P&lt;0.018) Conclusion: The findings showed that the pregnant women’s knowledge was moderate at the time of research. However, with increasing gestational age, fear of the unknown, and sources of knowledge were associated with anxiety. This points to the essentiality of increasing supportive programs and it is required to screen pregnant women to prevent the adverse effects of anxiety.