Primary Health Care Development Research Articles

The molecular genetic aspects of basal cell carcinoma from the position of population health preservation

The exploration of molecular genetic mechanisms that underlie carcinogenesis, hereditary factors of various oncological diseases, including basal cell carcinoma, the most common type of skin cancer is especially actual and significant for target strategies of public health. The diagnosis of basal cell carcinoma is based on complex clinical, radiologic and genetic examination data. The further research in the field of somatic or hereditary mutations in genes associated with basal cell carcinoma, including Patched 1 (PTCH1), Patched 2 (PTCH2), Smoothed (SMO) continue to be topical. The strategies of primary prevention of basal cell carcinoma, discussions of complex issues of decision-making concerning treatment at primary health care level, training courses and development of guidelines for general practitioners and interdisciplinary recommendations for effective early diagnosis and comprehensive care of basal cell carcinoma are to be suggested.

О современном состоянии и перспективах развития сельского здравоохранения.

The article discusses current trends in the development of primary health care in the Russian Federation. The reasons that caused in the 90s. of the last century, the destruction of rural health care, as well as the effectiveness of restorative measures. A comparative description of the main indicators of the health of rural and urban residents is given. The mortality rate for rural residents is much higher than for urban residents with a steady upward trend. There is a disproportion between the relatively low morbidity rates of the rural population with cardiovascular and oncological pathologies and mortality from the same diseases, which may be due to insufficiently effective detection of these categories of diseases. The concept of a geriatric contact center is proposed, aimed at eliminating the shortage of personnel and resource support for rural healthcare.

Health Benefits of Exclusive Breastfeeding on Children as Perceived by Pregnant Women in Ilorin South LGA, Kwara State, Nigeria

Breastfeeding aids general health growth and development in the infant. The study is designed to examine the impact of exclusive breastfeeding on the health of children as perceived by nursing mothers in Ilorin South LGA, Kwara State. The objective of the study was to examine if exclusive breastfeeding reduces infant mortality or promotes rapid growth and development in children as perceived by pregnant women in Ilorin South LGA, Kwara State, Nigeria. A descriptive research design of the survey type was adopted. A multistage sampling technique was used for the study. Four hundred (400) respondents were sampled for the study. A researcher-structured questionnaire which was validated and tested for reliability was adopted for the study. The instrument was administered by the researchers and supported by the research assistants. The data collected for the study analysed using the inferential statistics of chi-square was used to analyse the hypotheses postulated for this study at 0.05 alpha level. The findings revealed that exclusive breastfeeding reduced infant mortality as perceived by pregnant women with the calc. x2 value of 881.17 is > the critical value of 16.92 at the degree of freedom of 9 @ 0.05 alpha level. Exclusive breastfeeding promotes physical growth and development in infants as perceived by pregnant women with the calc. x2 value of 856.62 is > the critical value of 16.92 at the degree of freedom of 9 @ 0.05 alpha level. Based on the findings, it was concluded that exclusive breastfeeding reduced infant mortality and it promote physical growth and development. The researchers recommended among others that the Primary Health Care Development Agency in Ilorin South Local Government should create specific programmes aimed at educating pregnant women about the advantages of exclusive breastfeeding. This is to decrease the rate of infant mortality in the area under study.

Risk of Bias Mitigation for Vulnerable and Diverse Groups in Community-Based Primary Health Care Artificial Intelligence Models: Protocol for a Rapid Review.

The current literature identifies several potential benefits of artificial intelligence models for populations' health and health care systems' efficiency. However, there is a lack of understanding on how the risk of bias is considered in the development of primary health care and community health service artificial intelligence algorithms and to what extent they perpetuate or introduce potential biases toward groups that could be considered vulnerable in terms of their characteristics. To the best of our knowledge, no reviews are currently available to identify relevant methods to assess the risk of bias in these algorithms. The primary research question of this review is which strategies can assess the risk of bias in primary health care algorithms toward vulnerable or diverse groups? This review aims to identify relevant methods to assess the risk of bias toward vulnerable or diverse groups in the development or deployment of algorithms in community-based primary health care and mitigation interventions deployed to promote and increase equity, diversity, and inclusion. This review looks at what attempts to mitigate bias have been documented and which vulnerable or diverse groups have been considered. A rapid systematic review of the scientific literature will be conducted. In November 2022, an information specialist developed a specific search strategy based on the main concepts of our primary review question in 4 relevant databases in the last 5 years. We completed the search strategy in December 2022, and 1022 sources were identified. Since February 2023, two reviewers independently screened the titles and abstracts on the Covidence systematic review software. Conflicts are solved through consensus and discussion with a senior researcher. We include all studies on methods developed or tested to assess the risk of bias in algorithms that are relevant in community-based primary health care. In early May 2023, almost 47% (479/1022) of the titles and abstracts have been screened. We completed this first stage in May 2023. In June and July 2023, two reviewers will independently apply the same criteria to full texts, and all exclusion motives will be recorded. Data from selected studies will be extracted using a validated grid in August and analyzed in September 2023. Results will be presented using structured qualitative narrative summaries and submitted for publication by the end of 2023. The approach to identifying methods and target populations of this review is primarily qualitative. However, we will consider a meta-analysis if quantitative data and results are sufficient. This review will develop structured qualitative summaries of strategies to mitigate bias toward vulnerable populations and diverse groups in artificial intelligence models. This could be useful to researchers and other stakeholders to identify potential sources of bias in algorithms and try to reduce or eliminate them. OSF Registries qbph8; https://osf.io/qbph8. DERR1-10.2196/46684.

Association Between Alcohol Consumption and Cardiovascular Risk Based on Data from the Three Generations for Health Program in Hungary.

BACKGROUND Alcohol consumption has a significant effect on cardiovascular health, and risk factors, such as excessive alcohol use, should be avoided. Although alcohol consumption has decreased over the last decade in Hungary, it is still significantly higher than the average across the European Union. The objective of this study was to describe the patterns of alcohol use based on the Alcohol Use Disorders Identification Test (AUDIT), with a special focus on cardiovascular risk status (low, moderate, high, or very high). MATERIAL AND METHODS The Three Generations for Health program focuses on the development of primary health care in Hungary. One of the key elements of the program is the identification of risk factors of cardiovascular diseases. An ordinal multiple logistic regression analysis was performed with 10 categorical explanatory variables and the outcome was the categorical cardiovascular risk. RESULTS The database consisted of patients aged 40-65 years with a sample size of 11 348. A significant relationship was found between alcohol consumption and cardiovascular risk status; people with high-risk drinking patterns had higher a value of odds ratio (OR=1.306 [1.003-1.701]) for having a more serious cardiovascular status. According to multiple regression analysis, alcohol dependence was associated with cardiovascular risk. CONCLUSIONS From a public health perspective, the results highlight the importance of reducing alcohol consumption with the help of primary care and preventive services in countries with a high cardiovascular risk profile to reduce the cardiovascular disease-related burden.

Improving Program Outcomes Through Responsive Feedback: A Case Study of a Leadership Development Academy in Nigeria.

In 2018, the National Primary Health Care Development Agency (NPHCDA), under the Nigeria Federal Ministry of Health, recognized that inadequate personnel competencies limited its ability to provide technical assistance to state primary health care development boards (SPHCBs). In response, NPHCDA instituted a cohort-based leadership development academy (LDA) to develop its staff's leadership and management skills. A baseline assessment identified critical gaps in leadership and management competencies. Agency leaders and midlevel staff aligned on the gaps and approaches to bridge them. Participants in the LDA were selected across headquarters and zones to ensure equitable spread. The NPHCDA adopted a mix of capacity-building approaches that prioritized 6 core leadership and management skills with the application of the 70-20-10 learning philosophy to ensure participants learn and apply skills. Responsive feedback (RF) mechanisms were key in program design and implementation. NPHCDA collaborated with development partners through an iterative cocreation process to design and revise for implementation. The program embraced information and communication technology to collate qualitative and quantitative data across activities in real-time and used insights to drive continuous improvement. Incorporating feedback from the first cohort led to an increase in the proportion of trainees acquiring intermediate to advanced competencies in target skill areas from 41% to 57% in the second cohort. The trainees have taken on more challenging roles at NPHCDA, delivering technical assistance to SPHCBs and bolstering the agency's ability to independently execute activities such as the COVID-19 vaccine introduction. The agency continues to adopt RF mechanisms in the coordination and delivery of advanced technical training for staff and institution of a capacity-building and acculturation program for new hires. RF has demonstrated that identifying and engaging key stakeholders to participate in continuous learning and adaptation is critical to achieving program effectiveness and sustainability.

Organização da atenção e vigilância em saúde na atenção primária frente à COVID-19 em municípios do Nordeste brasileiro

Abstract The aim of this study was to analyze the organization and development of primary health care and surveillance, including normative frameworks and the implementation of local health actions. Qualitative descriptive multiple-case study involving three municipalities in the state of Bahia. We conducted 75 interviews and a document analysis. The results were categorized into the following two dimensions: approach to the organization of the pandemic response; and development of care and surveillance actions at local level. Municipality 1 was found to have a well-defined concept of the integration of health and surveillance with a view to organizing team work processes. However, the municipality did not strengthen the technical capacity of health districts to support surveillance actions. In M2 and M3, delays in defining PHC as the entry point for the health system and the prioritization of a central telemonitoring service run by the municipal health surveillance department compounded the fragmentation of actions and meant that PHC services played only a limited role in the pandemic response. Clear policy and technical guidelines and adequate structural conditions are vital to ensure the effective reorganization of work processes and foster the development of permanent arrangements that strengthen intersectoral collaboration.

Equity in maternal healthcare utilisation in Ghana: Do community-based primaryhealth care programmes matter?

Improving equity in the use of maternal health services in rural and remote communities is critical to meeting the Sustainable Development Goals targets on maternal and child health. This study examines the effect of a community-based primary healthcare strengthening programme on improving the utilisation of antenatal care (ANC4+), skilled delivery and health facility delivery. Baseline and endline survey data of women of reproductive age for intervention and comparison districts were used to examine the equity impact of the Ghana Essential Health Interventions Programme (GEHIP) on antenatal care visits, skilled delivery and health facility delivery. The Wagstaff extension of the concentration index and regression models are used to assess equity effects of the programme on the utilisation of these services by wealth index and educational attainment. Coverage rates increased for both intervention and comparison districts, but were generally higher in intervention districts than comparison districts at endline (90% vs. 88% for ANC4+, 88% vs. 84% for skilled delivery and 93% vs. 88% for health facility delivery). Only ANC4+ showed a statistically significant positive treatment effect of the intervention (Dif-in-Dif = 0.071, p-value = 0.010). Equity analysis showed a mixed picture with intervention districts achieving significant equity improvement for skilled delivery for both wealth index and maternal education but only education equity for health facility delivery, while comparison districts achieved both wealth and education equity improvements for two indicators (health facility delivery and skilled delivery). No significant equity/inequity effects were found for ANC4+. Efforts to improve community-based healthcare access have been associated with improved coverage of maternal health services; however, the effect on improving equity in service coverage is mixed. Results indicate a need to extend community-based primary health care development beyond general improvements in access to ensure equity in the coverage of maternal and child health services that such programmes provide.

The development of primary health care under the influence of the Alma-Ata and Astana declarations

The development of primary health care under the influence of the Alma-Ata and Astana declarations

On the issue of a general practitioner

In 2023, May 19 is marked as the World Family Doctor Day. The development of primary health care is represented by one of the main directions, the principles of which were developed and adopted at the International Conference under the auspices of the World Health Organization in Alma-Ata in 1978. The decisions of the Alma-Ata Declaration became a policy document for all WHO Member States. In the context of reforming primary health care, the main component is the transition to a system of a single responsible attending physician as a key figure, i.e. a general practitioner, and the team of registered nurses. Practically purposeful activity in the format of organizing primary medical care on the principle of a general practitioner (family doctor) has been carried out since 1992. The aspects of the formation and development of general medical practice constantly remain relevant.

A study of primary health care service efficiency and its spatial correlation in China

BackgroundChina’s primary health care system has undergone major changes since the new round of medical reform in 2009, but the current status of primary health care institution service efficiency is still unsatisfactory. The purpose of this study is to compare and evaluate the China’s primary health care institution service efficiency and provide a reference for improving the efficiency and promoting the development of primary health care institution.MethodsBased on panel data of 31 provinces (municipalities directly under the central government and autonomous regions) in mainland China from 2011 to 2020, using the super efficiency slack-based measure-data envelopment analysis model, to analyze the data from a static perspective, and the changes in the efficiency of primary health care services were analyzed from a dynamic perspective by using the Malmquist index method. Spatial autocorrelation analysis method was used to verify the spatial correlation of primary health care service efficiency among various regions.ResultsThe number of Primary health care institutions increased from 918,000 in 2011 to 970,000 in 2020. The average primary health care institution service efficiency in the northeastern region including Jilin (0.324), Heilongjiang (0.460), Liaoning (0.453) and northern regions such as Shaanxi (0.344) and Neimenggu (0.403) was at a low level, while the eastern coastal regions such as Guangdong (1.116), Zhejiang (1.211), Shanghai (1.402) have higher average service efficiency levels. The global Moran’s I showed the existence of spatial autocorrelation, and the local Moran’s I index suggested that the problem of uneven regional development was prominent, showing a contiguous regional distribution pattern. Among them, H–H (high-efficiency regions) were mainly concentrated in Jiangsu, Anhui and Shanghai, and L-L regions (low-efficiency regions) were mostly in northern and northeastern China.ConclusionThe service efficiency of primary health care institution in China showed a rising trend in general, but the overall average efficiency was still at a low level, and there were significant geographical differences, which showed a spatial distribution of “high in the east and low in the west, high in the south and low in the north”. The northwestern region, after receiving relevant support, has seen a rapid development of primary health care, and its efficiency was steadily improving and gradually reaching a high level. The average primary health care institution service efficiency in the northeastern region including the northern region of China was at a low level, while the average efficiency in the eastern coastal region and some economically developed regions was high, which also verifies the dependence and high symbiosis of primary health care institution service efficiency on regional economy.

Health Psychology Services for People in Disadvantaged Regions of Hungary: Experiences from the Primary Health Care Development Model Program.

The importance of community health psychology in providing complex bio-psycho-social care is well documented. We present a mixed-method outcome-monitoring study of health psychology services in the public-health-focused Primary Health Care Development Model Program (2012-2017) in four disadvantaged micro-regions in northeast Hungary. Study 1 assessed the availability of the services using a sample of 17,003 respondents. Study 2 applied a follow-up design to measure the mental health outcomes of the health psychology services on a sample of 132 clients. In Study 3, we conducted focus-group interviews to assess clients' lived experiences. More mental health issues and higher education predicted a higher probability of service use. Follow-up showed that individual and group-based psychological interventions resulted in less depression and (marginally) higher well-being. Thematic analysis of the focus-group interviews indicated that participants deemed topics such as psychoeducation, greater acceptance of psychological support, and heightened awareness of individual and community support important. The results of the monitoring study demonstrate the important role health psychology services can play in primary healthcare in disadvantaged regions in Hungary. Community health psychology can improve well-being, reduce inequality, raise the population's health awareness, and address unmet social needs in disadvantaged regions.

Ward Health System in Nigeria: Are Health Workers in the Local Government Areas Well Informed?

The Ward Health System was introduced in 2001 by the National Primary Health Care Development Agency to enhance community mobilization for health thereby revitalizing the Primary Health Care system. This move was in alignment with the recommendation of the World Health Organization in 1992 that boundaries of the health district should be the same as that of the electoral ward for effective and wholesome community mobilization and ultimately ownership. This study determined the knowledge of the health workers in the Local Government Areas on Ward Health System. A semi-structured questionnaire was administered to a total of 300 Primary Health Care facility workers in Anambra State. Approximately 46% of the health workers had ever heard of the term Ward Health System, while over 94% had no idea of the roles of the three tiers of government in the program. Over 76% of them could not correctly identify the functions of the village and ward development committees. Adequate and on-going education of health workers on Ward Health System is critically needed.

Improving the primary health care in Iran: a policy brief

Background: Primary healthcare (PHC) is the best method to provide primary healthcare for the people, and is the most efficient and effective way to achieve and improve a high level of health in any society. Failure to pay attention to PHC and low-quality health services can lead to an increase in various diseases, and consequently a higher number of death toll in any society, which would cause economic damages. PHC in Iran received a lot of attention after the revolution in 1979. In PHC, a healthcare network was established throughout the country. With the development of PHC in the Islamic Republic of Iran, the causes of death have decreased, and the death due to infectious diseases, pregnancy, and childbirth problems have also decreased. Despite the vast achievements of PHC in Iran, in recent years, enough attention has not been paid to its reconstruction and consecration. Lack of sufficient financial resources, non-implementation of family doctors in cities and executive problems in family doctors, lack of human resources, lack of attention to the education of students in the health sector, their lack of students’ interest in learning the activities of this field, and structural and administrative problems are some of the existing challenges. Results of the present study suggest that policymakers in Iran need to invest more in PHC in order to improve health indicators, reduce patient admissions to hospitals, and make more appropriate use of limited financial resources. Using the infrastructure that already exists in this sector and strengthening the network of PHC play an important role in reducing household expenses; also, the position of the family doctor and its functions can be properly implemented in the society.

Ключевые тенденции и проблемы существующих моделей первичной медико-санитарной помощи в современном мире

This article is devoted to the analysis of the current state and challenges facing the primary health care system in the modern world. The study includes a review of existing primary health care models, identification of key trends and challenges, and proposals to improve the availability, quality, and effectiveness of primary health services. The article addresses the introduction of technology, quality management, training of health personnel and the impact of socio-cultural aspects on the provision of primary health care. The analysis makes it possible to identify optimal strategies for the development of primary health care that contribute to maintaining the health of society and promoting the sustainable development of the health care system as a whole.

Tecnologia educacional sobre tuberculose: construção compartilhada com enfermeiros da Atenção Primária à Saúde

ABSTRACT Objective: to develop, in a participatory way, an educational technology to assist nurses in the management of tuberculosis cases in Primary Health Care. Methods: methodological research with a qualitative approach. Data were collected between June and October 2022, in 25 Basic Health Units, with 41 nurses interviewed individually. Thematic content analysis was carried out to guide technology elaboration. Results: three empirical categories were organized, demonstrating the facilities and difficulties in tuberculosis management, the conceptions about educational technology as a facilitator of the teaching-learning process in Primary Health Care and participatory development of technology. Nurses were in favor of constructing an instructional guide technology, and made suggestions to encourage its creation and use in daily service routine. Final considerations: the participatory process made it possible to create technology to assist nurses in the teaching-learning process in Primary Health Care about caring for people with tuberculosis.

Cause-Effect of Five Child-Killer Diseases on UnderFive Mortality in Adamawa State, Nigeria

This study investigated the Cause-Effect of Five Child-Killer Diseases on Under-Five Mortality (Deaths) in Adamawa State, Nigeria. The study used Ex post facto and quantitative design. A secondary data was obtained from Adamawa State Primary Health Care Development Agency (PHCDA), Yola across the study area for the period of 2001 to 2020.The study used Multiple Regression Analysis to determine the Cause-effect of the Five Childkiller Diseases on Under-Five Mortality in the study area. The study revealed that; Polio needs to be excluded from the Five Child-Killer Disease since there is no death associated with polio disease for the period under review in the study area. The results also revealed that the deaths due to diarrhoea have a significant causal relationship on Under-Five Mortality, while deaths due pneumonia, measles and tetanus has insignificant causal relationship on Under-Five Mortality in the study area. Based on the overall model, the Five Child-Killer Diseases have a Causeeffect of 64% on Under-Five Mortality in the study area. In view of the above, the study recommends that Adamawa State Primary Health Care Development Agency, Yola whose primary responsibility among orders is to curb and reduce the spread of Child-Killer Diseases among vulnerable children of ages; needs to review and strategies their action plans, since the Cause-effect is still high.

Methodological approaches for studying the level of primary health care development

Methodological approaches for studying the level of primary health care development

Using Digital Technologies to Strengthen Routine Immunization Data in Enugu, Nigeria: A Qualitative Study of Stakeholders’ Perceptions of Open Data Kit

ABSTRACT Background: Stakeholders have had a long-standing concern about the quality of Routine Immunisation (RI) data in Nigeria. Digital technology tools like Open Data Kit (ODK) can address this challenge by reducing errors and discrepancies in RI data. However, despite its use in various health promotion programs, ODK is yet to be implemented for RI data capture and transmission. Aim: The purpose of this study is to explore stakeholders’ views regarding the use of ODK for RI data capture and transmission. Methods: The study was conducted in Enugu State, using a qualitative research approach. Stakeholders in RI from Primary health facilities, local government quarters and Enugu state primary health care development agencies (ENS-PHCDA) were purposefully selected and interviewed. The analyses followed a thematic approach. Results: The study found that the current method of RI data capture is challenged by delays, incomplete and inaccurate reporting. Stakeholders had a positive reception of a switch to ODK for RI data capture and transmission because they think it can address the challenges associated with the current method, which is partly paper-based. The desire to switch to ODK was based on the belief that it guarantees data safety, timely submission, and reduced error or inaccurate data; these views were informed by previous experience with ODK in other health promotion programs. Stakeholders also perceived that to effectively implement ODK for RI data capture and transmission, training must be properly organized and resources put in place. Conclusion: The study provides new knowledge to pave the way for pilot implementation and integration of ODK for RI data capture and transmission in Enugu State, Nigeria.

GIS-Based Study of Dental Accessibility and Caries in 3-Year-Old Japanese Children

This study aimed to reveal the geographic accessibility of dental clinics for most municipalities in Japan in 2015 and to explore the association between dental accessibility and dental caries status in 3-year-old children. We computed the accessibility index and accessibility index rate for the population outside a 1-km radius of dental clinics using a geographic information system. We also used spatial autocorrelation analysis (Moran's I statistic) to examine the spatial clustering patterns of dental accessibility in Japanese municipalities. In addition, we adjusted the prevalence of dental caries for most municipalities using empirical Bayesian estimation. Finally, we applied multiple linear regression to scrutinise the associations between dental caries status, including the prevalence of dental caries and decayed and filled teeth (dft), and dental accessibility, with adjustments made for other sociodemographic variables. The distribution of dental accessibility in Japanese municipalities is relatively unequal. Dental accessibility is decent in the 3 metropolitan areas around Tokyo, Osaka, and Nagoya but poor in the Tohoku and Kyushu regions. In addition, dental accessibility is significantly related to the prevalence of dental caries and dft after adjusting for other sociodemographic variables (P < .005). This study suggests that dental accessibility is considerably connected to the dental caries status of 3-year-old children after excluding financial burden. Preschool children in areas with poor dental accessibility are likely to have poor dental caries status. We also verified the inequality of dental accessibility amongst Japanese municipalities. For the future development of primary oral health care, more attention should be paid to people with a disadvantage in terms of dental accessibility.