Government Primary Health Care Research Articles

Evaluation of the Cold Chain Expanded Program on Immunization at Governmental and Private Health Care Centers in Riyadh City, Saudi Arabia

Objective: Vaccine storage is essential to ensure optimal vaccine effectiveness. Cold chain is a series of storage and transport links, designed to keep the vaccine at the correct temperature till it reaches the user. To evaluate the Cold Chain Expanded Program on Immunization at Governmental and Private Health Care Centers in Riyadh city, Saudi Arabia.
 Methods: A cross-sectional study was conducted from March to May 2021 in government and private primary health care centers of Riyadh, Saudi Arabia were included. Data collection was carried out using standardized check list developed by Saudi Ministry of Health (MOH) and World Health Organization (WHO). Data were analysed using IBM SPSS Statistics 26 (C) and IBM SPSS 26 (IBM Inc.)
 Results: The results showed that the mean score of Room and Refrigerator Elements for governmental PHCs was 8.8(±0.82), while it was 8.3(±1.86) for private PHCs. The mean temperature monitoring device score for government PHCs was 4.0 (0.0), and the 3.65 (±0.92) for PHCs centers. The mean temperature chart (record keeping) score for governmental PHCs was 2.55(±0.5) and 1.8(±1.2) for private PHCs. The mean maintenance and operations score for governmental PHCs was 4.6 (±0.49), while it was 4.1 (±0.84) for private PHCs. The mean scores of all cold chain components differed significantly between government and private facilities (p=0.000).
 Conclusion: Our study highlights the cold chain management programs Saudi Arabia. More importantly governmental PHC centers in the current settings comply with the standards to the guidelines, provided by Saudi Ministry of Health and WHO, was observed, in comparison to private PHC centers.

A time series analysis of the short-term association between climatic variables and acute respiratory infections in Singapore.

Acute respiratory infections (ARIs) are among the most common human illnesses globally. Previous studies that examined the associations between climate variability and ARIs or ARI pathogens have reported inconsistent findings. Few studies have been conducted in Southeast Asia to date, and the impact of climatic factors are not well-understood. This study aimed to investigate the short-term associations between climate variability and ARIs in Singapore. We obtained reports of ARIs from all government primary healthcare services from 2005 to 2019 and analysed their dependence on mean ambient temperature, minimum temperature and maximum temperature using the distributed lag non-linear framework. Separate negative binomial regression models were used to estimate the association between each temperature (mean, minimum, maximum temperature) and ARIs, adjusted for seasonality and long-term trend, rainfall, relative humidity, public holidays and autocorrelations. For temperature variables and relative humidity we reported cumulative relative risks (RRs) at 10th and 90th percentiles compared to the reference value (centered at their medians) with corresponding 95% confidence intervals (CIs). For rainfall we reported RRs at 50th and 90th percentiles compared to 0mm with corresponding 95% CIs. Statistically significant inverse S-curve shaped associations were observed between all three temperature variables (mean, minimum, maximum) and ARIs. A decrease of 1.1°C from the median value of 27.8°C to 26.7°C (10th percentile) in the mean temperature was associated with a 6% increase (RR: 1.06, 95% CI: 1.03 to 1.09) in ARIs. ARIs also increased at 23.9°C (10th percentile)compared to 24.9°C of minimum temperature (RR: 1.11, 95% CI: 1.07 to 1.16). The effect of maximum temperature for the same comparison (30.5°C vs 31.7°C) was non-significant (RR: 1.02, 95% CI: 0.99 to 1.05). An increase in ambient temperature to 28.9 °C (90th percentile) was associated with an 18% decrease (RR: 0.82, 95% CI: 0.80 to 0.83) in ARIs. Similarly, ARIs decreased with the same increase to 90th percentile in minimum (RR: 0.84, 95% CI: 0.80 to 0.87) and maximum (RR: 0.89, 95% CI: 0.86 to 0.93) temperatures. Rainfall was inversely associated with ARIs and displayed similar shape in all three temperature models. Relative humidity, on the other hand, exhibited a U-shaped relationship with ARIs. Our findings suggest that lower temperatures increase the risk of ARIs. Anticipated extreme weather events that reduce ambient temperature can be used to inform increased healthcare resource allocation for ARIs.

HEALTH INFORMATION SYSTEM AS CORRELATE OF MONITORING AND EVALUATION OF PRIMARY HEALTH CARE SERVICES IN IFE CENTRAL LOCAL GOVERNMENT AREA, ILE-IFE, OSUN STATE, NIGERIA

This study examines “The relevance of Health Information System in Monitoring and Evaluation of Health Care Delivery Services Ife Central Local Government, Ile-Ife. The research design used in this study was descriptive survey to provide necessary database on the relevance of Health Information System in the monitoring and evaluation of health care delivery services in Local Government Primary Health Care System, the researcher uses Ife Central Local Government, Ile-Ife, Osun State. The target population consists of one hundred and twenty (120) respondents (Staff of Primary Health Care Department of Ife Central Local Government, Ile-Ife). Sampling technique adopted for this study is total enumeration, all the staffs of Health Information Management Department were used for the research because the researcher considers these respondents as a genuine unit where all important and detailed information could be obtained for this research work. In the course of data collection exercise, a total of one hundred and twenty questionnaires were administered. The questionnaires were administered at the various units of the Primary Health Care Department of Ife Central Local Government and one hundred and fourteen questionnaires were completed and returned questionnaire which denotes the response rate to be 95% which proved that there is sufficient information from the respondents. From the findings of the study, it was discovered that health information system is effective due to the opinion of majority of the respondents which denotes that health information system contributes to good service delivery in Primary Health Care settings. It was affirmed that there are factors hindering effective management of health information system by the respondents which was supported by 75.5% of them in their response to question 24 of the questionnaire. HIS has benefits on health care monitoring and evaluation which denotes it can be used in policy and decision making. It was also proved according to responses to question 21 of the questionnaire that the duties of the health information officers cannot be overruled and that they play their roles as expected for generation and utilization of health information. It was observed too that health information is being put into use regularly for monitoring and evaluation of health care service by the respondents in question number 20 of the questionnaire. This study reveals that Health Information System has great impact on healthcare service delivery, the system captures, transmits and stores information related to patient care and the activities of the health institution. It incorporates routine information system, disease surveillance system, laboratory information system, hospital patient administrative system which is used to process reports and create awareness in order to make policy action programmes effective for quality monitoring and evaluation activities and the recommendations that were made includes: The provision of sufficient and well trained staff, training and seminar, caution against paucity in information gathering, adequate funding, setting up supervisory committee and computerization of various sections.

Adapting an Evidence-Based, Early Childhood Parenting Programme for Integration into Government Primary Health Care Services in Rural Bangladesh.

This paper describes the process of adapting an early childhood development programme, with proven effectiveness in Bangladesh, for integration into government health services in rural Bangladesh. Through a three-stage process, we adapted an evidence-based, home-visiting, programme (Reach-Up and Learn) for delivery in government health clinics by government health staff as part of their regular duties. Stage one involved preparing an initial draft of two parenting interventions for use with: (1) pairs of mother/child dyads, and (2) small groups of mother/child dyads. In stage two, we piloted the adapted interventions in nine clinics with a total of twenty-seven health staff and 357 mother/child dyads. We used data from mothers' attendance, feedback from participating mothers and health staff and observations of parenting sessions by the research team to revise the interventions. Stage three involved piloting the revised interventions in six clinics with eighteen health staff and 162 mother/child dyads. We gathered additional data on mothers' attendance and used observations by the research team to finalize the interventions. Through this three-stage process, adaptations were made to the intervention content, process of delivery, materials, and engagement strategies used. The largest challenges were related to incorporating the parenting programme into health staff's existing workload and promoting mothers' engagement in the programme. We also simplified the content and structure of the curriculum to make it easier for health staff to deliver and to ensure mothers understood the activities introduced. This iterative piloting was used prior to implementing and evaluating the interventions through an effectiveness trial.

Prevalence and associated factors of stress among primary health care nurses in Saudi Arabia, a multi-center study.

Background:Nursing practice has been identified as one of the most stressful professions within the healthcare systems. The current study aimed to determine the prevalence of stress and its associated factors among primary healthcare nurses.Materials and Methods:This analytical cross-sectional study was conducted among 200 Saudi nurses in the government primary health care centers in Medina city, Saudi Arabia. Stress was measured by the stress subscale of the 21-Item Depression, Anxiety and Stress Scale. Sources of stress were assessed by 15 items.Results:The majority were females (68.0%) and aged less than 40 years (72.5%). Thirty percent had severe or very severe stress. Stress was associated significantly with the presence of chronic diseases (P = 0.037) and with working in night shifts (P = 0.042). All sources of stress in the workplace were associated significantly and positively with stress (P < 0.01).Conclusion:About one-third of the participants had stress. Improving work conditions and minimizing stress in the workplace should be a priority in the primary health care setting.

Reliability and Validity of the Malay Version of Edinburgh Postpartum Depression Scale (EPDS) When Administered to Postpartum Mothers at Two Points in Time

Introduction: Edinburgh Postpartum Depression Scale (EPDS) is a tool used to assess the risk of postpartum depression (PPD). In this study we determined the reliability and validity of the Malay version of EPDS when administered at two different time points in the postpartum period. Materials and Methods: This cross-sectional study design was carried out between May and September 2017 at three government primary healthcare clinics located in Batang Padang district, a suburban area of Perak state in Peninsular Malaysia. We recruited a total of 89 women; 41 women were in the early postpartum period (1-30 days) and 48 women were in the late postpartum period (31-120 days). Cronbach's alpha coefficient, inter-item correlation, and corrected item-total correlation were used to assess the internal consistency. The concurrent validity was assessed using Spearman’s correlation. The data were analyzed using SPSS version 20 and R 3.4.2. Results: The Cronbach’s alpha for the first and second group was 0.78 and 0.62, respectively, which indicated satisfactory reliability. At both time periods, removing Item 2 from the scale resulted in a significant increase in Cronbach’s alpha (to 0.847 and 0.709, respectively). As expected, the EPDS scores correlated moderately with the BDI-II scores (1−30 days: Spearman's rho = 0.65, p &lt; 0.01; 31−120 days: Spearman's rho = 0.73, p &lt; 0.01). Conclusion: The Malay version of the EPDS is a reliable screening instrument for detecting postpartum depression. It showed reasonability and feasibility and can be used in postpartum clinical settings or for assessing intervention effects in research studies. Furthermore, as our results indicated, removing Item 2 from the Malay version would increase the internal consistency of the EPDS.

Assessment of treatment satisfaction and adherence amongst diabetic patients in governmental primary care clinic of Ramallah, West-Bank

ABSTRACT Objective This study aimed to assess treatment satisfaction and its association with medication adherence among patients with diabetes. Methods Participants in this study were outpatients at the governmental Primary Healthcare Unit in Ramallah. Adherence was measured with the 4-item Morisky Green-Levine (MGL) questionnaire, and treatment satisfaction with the Treatment Satisfaction Questionnaire for Medication version 1.4. Glycemic control was measured as the last value of an HbA1c test, with HbA1c ≤7 considered good. Results Of the participants, 220 (57.9%) were classified as having high adherence to their medications, and 160 (42.1%) as having low adherence. Regarding glycemic control, 174 (45.7%) of patients had good control, while 206 (54.2%) had poor control. Satisfaction with treatment effectiveness showed a significant mean difference with adherence level (78.61 vs. 74.2; p = 0.04). Glycemic controlled patients had a higher and significant adherence mean in the global satisfaction domain (69.19 vs. 62.08; p = 0.01). However, glycemic control level had no significant differences in means of effectiveness, side effects, and convenience domains (P = 0.31, 0.49, 0.37) respectively. Conclusions Treatment satisfaction level is lower among low adherence and poor glycemic control. Addressing the specific needs of these patients might be effective in improving their satisfaction, thus having a positive influence on other clinical outcomes.

Health & Wellness Centers to Strengthen Primary Health Care in India: Concept, Progress and Ways Forward.

In February 2018, the Indian Government announced Ayushman Bharat Program (ABP) with two components of (a) Health and Wellness Centres (HWCs), to deliver comprehensive primary health care (PHC) services to the entire population and (b) Pradhan Mantri Jan Arogya Yojana (PMJAY) for improving access to hospitalization services at secondary and tertiary level health facilities for bottom 40% of total population. The HWC component of ABP aims to upgrade and make 150,000 existing Government Primary health care facilities functional by December 2022. The first HWC was launched on 14 April 2018 and by 31 March 2020, a total 38,595 AB-HWCs were operational across India. This article documents and analyses the key design aspects of HWCs, against core components of PHC & the health system functions. The article reviews the progress and analyses the potential of HWCs to strengthen PHC services and therefore, advance Universal Health Coverage in India. Challenges emerged from COVID-19 pandemic & learnings thus far has also been analyzed to guide the scale up of HWCs in India. It has been argued that effectiveness and success of HWCs will be dependent upon a rapid transition from policy to accelerated implementation stage; focus on both supply and demand side interventions, dedicated and increased funding by both union and state governments; appropriate use of information and communication technology; engagement of community and civil society and other stakeholders, focus on effective and functional referral linkages; attention on public health services & population health interventions; sustained political will & monitoring and evaluation for the mid-term corrections, amongst other. Experience from India may have lessons and learnings for other low and middle-income countries to strengthen primary healthcare in journey towards universal health coverage.

Prevalence of drugs with constipation-inducing potential and laxatives in community-dwelling older adults in Bahrain: therapeutic implications.

This study evaluated the prevalence of prescribing drugs with constipation-inducing potential and the prophylactic use of laxatives in community-dwelling older adults. An audit of outpatient prescriptions ordered for older adults aged ≥65years with one or more chronic morbidities in 24 governmental primary healthcare centres in Bahrain. The prescriptions were collected by pharmacist-in-charge of each health centre between December 2015 and June 2016. The proportion of prescriptions with constipation-inducing drugs and co-prescribed laxatives was determined. The overall prevalence of prescribing drugs with the potential to cause constipation was 30.5% (642/2106). Prescriptions with at least one anticholinergic/drug with anticholinergic potential (DAP) were 22.5% (473/2106): single medication in 16.6% (350/2106) and two or more combinations in 5.9% (124/2106). A combination of two or more anticholinergics/DAP accounted for 2.9% (61/2106) prescriptions. Constipation-inducing drugs other than anticholinergics such as multivalent cation preparations and non-dihydropyridine calcium channel blockers were prescribed in 8.0% (168/2106) of cases. Orphenadrine and first-generation antihistamines, both with high anticholinergic drug burden, were the frequently prescribed medications, either alone or combined. The rate of prescribed laxatives was 2.96% (19/642), mostly for those on constipation-inducing drug monotherapy. Approximately a third of prescriptions for older adults had constipation-inducing medications, typically a single DAP. Prescribing laxatives were uncommon and did not correlate with the prevalence of prescribing drugs with constipation potential. Physicians' awareness about anticholinergic drugs and their potential risks, and the prophylactic use of laxatives to mitigate iatrogenic constipation are to be included in continuing professional programmes.

Necessity and concerns about lipid-lowering medical treatments and risk factors for non-adherence: A cross-sectional study in Palestine.

Strong evidence indicates that drugs reduce blood lipids and improve cardiovascular end-points, leading to their wide usage. However, the success of these drugs can be affected by poor patient's adherence to prescribed medication. This study aimed to evaluate medication adherence in patients with dyslipidaemia in association with patient beliefs about medicines. The study was conducted from January 2019 to July 2019 at the middle governmental primary healthcare clinics in Ramallah and Bethlehem cities, and used a cross-sectional design. Adherence was determined using the 4-item Morisky medication adherence scale, while beliefs were determined using the Beliefs about Medicines Questionnaire. Of 220 patients, 185 agreed to participate in the study, resulting in a response rate of 84.1%. Of the participants, 106 (57.3%) were men, and almost half (88, 46.5%) were ≥56years. Medication non-adherence was high (47.6%), but a majority (65.5%) reported believing their treatment to be necessary for their continued good health. Accordingly, the mean necessity score (17.3, SD 3.7) significantly outweighed (P<.001) the mean concerns score (14.0, SD 3.5). Multivariate regression demonstrated four variables to be significantly correlated with non-adherence: illiterate (OR=2.52; CI: 0.9-4.3; P=.03), polypharmacy (OR=3.18; CI: 1.9-5.7; P=.007), having comorbidity (OR=3.10; CI: 2.2-4.6; P=.005) and having concerns about side effects (OR=2.89; CI: 1.1-4.6, P=.04). Non-adherence among patients taking lipid-lowering agents was high despite most holding positive beliefs regarding medication necessity. This may be due to concern also being high. Physicians should identify and target high-risk patients and individualise their treatment plans in order to achieve adequate control of dyslipidaemia.

Burnout and psychological distress among nurses working in primary health care clinics in West Bank-Palestine

Nurses and midwives are necessary at all aspects of primary health care; they need a lot of devotion with respect to patient administration and bringing care. The time and devotion spent by nurses and midwives in nursing duty may lead to burnout and psychological distress. There is a lack of study in Palestine that investigate the burnout syndrome and the level of psychological distress among nurses and midwives in primary health care clinics. Therefore, this study estimates the propagation of overwork and psychological distress among primary health care nurses and midwives working in the north of the West Bank. A quantitative, cross-sectional survey design was applied using a self-administered questionnaire pack. The questionnaire pack had Maslach Burnout Inventory (MBI) and the General Health Questionnaire (GHQ-28) to evaluate the level of burnout and psychological distress among 295 nurses and midwives working in the Palestinian governmental primary health care centers in the north of the West Bank. Data were analyzed using the SPSS system version 20. The prevalence of distress and burnout was 10.6% among 207 nurses and midwives who participated in this study. High levels of burnout were found in 36.7% of the respondents in the area of emotional exhaustion, 14% in the area of depersonalization, and 17.9% in the area of reduced personal accomplishment. However, 22.6% had a positive score in the GHQ-28 which proves the very existence of psychological distress amongst the respondents. The current study explained the relationship between nurses’ burnout syndrome and the level of psychological distress. It also indicates that this burnout and psychological distress are common among nurses working in PHC. This study concluded that PHC nurses in the north of the West Bank need more attention to deal with their psychological conditions. Nursing managers and others in the Palestinian ministry of health are in good position to support nurses, especially when nurses express different sources of stress. Nurses’ burnout and psychological distress levels have special characteristics relating to the unique structure of health care in Palestine.

Patients' Perception Towards Health Education Services Received at the Enhanced Primary Healthcare Facilities: A Qualitative Exploration.

Background:The present Malaysian healthcare system is burdened with increasing cases of non-communicable diseases (NCDs) and its risk factors. Health care providers (HCPs) have to provide both treatment and health education to ensure optimal outcome. Health education is a vital component in addressing and managing chronic diseases. This study intends to explore patient’s perspective on health education services received from HCPs, focusing at the secondary triage in government primary healthcare facilities.Methods:This qualitative exploratory study focused on the health education component derived from a complex enhanced primary health care intervention. Participants were purposively selected from patients who attended regular NCD treatment at 8 primary healthcare facilities in rural and urban areas of Johor and Selangor. Data collection was conducted between April 2017 and April 2018. Individual semi-structured interviews were conducted on 4 to 5 patients at each intervention clinic. Interviews were transcribed verbatim, coded and analyzed using a thematic analysis approach.Results:A total of 35 patients participated. Through thematic analysis, 2 main themes emerged; Perceived Suitability and Preferred HCPs. Under Perceived Suitability theme, increased waiting time and unsuitable location emerged as sub-themes. Under Preferred HCPs, emerging sub-themes were professional credibility, continuity of care, message fatigue, and interpersonal relationship. There are both positive and adverse acceptances toward health education delivered by HCPs. It should be noted that acceptance level for health information received from doctors are much more positively accepted compared to other HCPs.Conclusion:Patients are willing to engage with health educators when their needs are addressed. Revision of current location, process and policy of health education delivery is needed to capture patients’ attention and increase awareness of healthy living with NCDs. HCPs should continuously enhance knowledge and skills, which are essential to improve development and progressively becoming the expert educator in their respective specialized field.

Quality of Care for Maternal and Newborn Health in Health Facilities in Nepal

IntroductionNepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. This paper examines quality of delivery and newborn services in health facilities of Nepal.MethodsData were sourced from the Nepal Health Facility Survey 2015, which covered a national representative sample of health facilities. The datasets were analysed to assess service readiness, availability and quality of delivery and newborn care in a sample of 992 health facilities.ResultsOf the 992 facilities in the sample, 623 provided delivery and newborn care services. Of the 623 facilities offering delivery and newborn care services, 13.3% offered comprehensive emergency obstetric care (CEmONC), 19.6% provided basic emergency obstetric care (BEmONC) and 53.9% provided basic delivery and newborn service. The availability of essential equipment for delivery and newborn care was more than 80% in health facilities. Except for the coverage of vitamin K injection, the coverage of immediate newborn care was more than 85% in all health facilities. The coverage of use of chlorhexidine ointment to all newborns was more than 70% in government hospitals and primary health care centers (PHCCs) and only 32.3% in private hospitals.ConclusionsThese findings show gaps in equipment and drugs, especially in PHCCs and private health facilities. Improving readiness and availability of equipment and drugs in PHCCs and private health facility will help improve the quality of care to further reduce maternal and newborn mortality in Nepal.

The prevalence and risk factors of urinary incontinence amongst Palestinian women with type 2 diabetes mellitus: A cross-sectional study

ABSTRACTObjective: To determine the prevalence of urinary incontinence (UI) in women with type 2 diabetes mellitus (T2DM) in the North West Bank, Palestine, and to assess the role of potential risk factors including age and DM control.Patients and methods: Adult women with DM attending governmental primary healthcare centres in the North West Bank were interviewed using the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES) standardised UI questionnaire. The prevalence of UI was estimated and differences between groups were evaluated using the chi-square test. A multivariate logistic model was used to estimate the adjusted relationships and to control for confounders. The statistical significance level was set at P < 0.05. The study was approved by the Institutional Review Board at An-Najah National University.Results: The study included 381 women with T2DM, aged 30–83 years, of whom 43.2% (95% confidence interval [CI] = 37.9–47.8%) reported UI regardless of the type. About 40% reported that they were extremely bothered by the condition and 35.2% stated that their daily routine life was greatly affected. Amongst the women with UI, 133 (80.6%) and 128 (77.6%) were found to have urge and stress UI, respectively. UI was found to be significantly associated with a history of recurrent urinary tract infection (adjusted odds ratio [OR] 3.0, 95% CI 1.9–4.9; P < 0.001) and parity (adjusted OR 1.7, 95% CI 1.1–2.7; P = 0.04)Conclusions: The prevalence of UI amongst Palestinian women with T2DM regardless of the type is high. The findings highlight the importance of educating women with T2DM about UI. The medical team should focus on this problem as it is often neglected; physicians should be alert for UI as it is often underreported and therefore undertreated.Abbreviations: BMI: body mass index; (T2)DM: (type 2) diabetes mellitus; HbA1c: haemoglobin A1c; MoH: Ministry of Health; NHANES: National Health and Nutrition Examination Survey; OR: odds ratio; QoL: quality of life; (S)(U)UI: (stress) (urge) urinary incontinence.

Challenges faced by the patients in the management of risk factors of non-communicable diseases in a government primary health care setting of Puducherry

Background: India’s current approach for intervention in non-communicable diseases (NCDs) is more in terms of early diagnosis and treatment. The focus should also be on the management of risk factors in the diseased individuals. The objectives of the study are to measure the risk factors of NCDs, lifestyle modification followed by them and to assess the challenges in reducing the risk factors of NCDs faced by the study population.Methods: The study was conducted between March and June 2017 in 2 government primary health centres (PHCs) in Puducherry. Based on systematic random sampling, 200 patients enrolled in NCD clinic with diabetes mellitus, hypertension, Stroke and myocardial infarction were selected for the study. After obtaining written informed consent, data was collected.Results: Out of 200 participants, majority of them were in the age group of 51-70 years (60%), females (71%) and living in nuclear family (83%). Among 200 participants, 23.5% of them had diabetes mellitus, 42% had hypertension and 24% had diabetes with hypertension. The risk factors that many of the participants had were excessive salt and sugar intake, overweight and obesity, less vegetable and fruits intake and alcohol consumption. Out of 200 participants, the major challenges in reducing the salt and sugar intake were lack of awareness and no family support.Conclusions: Most of the participants were oldest females who had diabetes or hypertension. The most common NCD they were suffering from were diabetes and hypertension. The major challenge in the management of NCDs is lack of awareness.

Rural South African Community Perceptions of Antibiotic Access and Use: Qualitative Evidence from a Health and Demographic Surveillance System Site.

.Knowledge and practices of rural South African populations with regard to antibiotic access and use (ABACUS) remain understudied. By using the case of four villages in the north east of the country, our aim was to investigate popular notions and social practices related to antibiotics to inform patient-level social interventions for appropriate antibiotic use. To achieve this, we investigated where community members (village residents) were accessing and sourcing medication, and what they understood antibiotics and antibiotic resistance (ABR) to be. Embedded within the multicountry ABACUS project, this qualitative study uses interviews and focus group discussions. A sample of 60 community members was recruited from the Agincourt Health and Demographic Surveillance System, situated in Mpumalanga Province, from April to August, 2017. We used the five abilities of seek, reach, pay, perceive, and engage in access to healthcare as proposed by Levesque’s “Access to Healthcare” framework. Respondents reported accessing antibiotics prescribed from legal sources: by nurses at the government primary healthcare clinics or by private doctors dispensed by private pharmacists. No account of the illegal purchasing of antibiotics was described. There was a mix of people who finished their prescription according to the instructions and those who did not. Some people kept antibiotics for future episodes of infection. The concept of “ABR” was understood by some community members when translated into related Xitsonga words because of knowledge tuberculosis and HIV/AIDS treatment regimens. Our findings indicate that regulation around the sale of antibiotics is enforced. Safer use of antibiotics and why resistance is necessary to understand need to be instilled. Therefore, context-specific educational campaigns, drawing on people’s understandings of antibiotics and informed by the experiences of other diseases, may be an important and deployable means of promoting the safe use of antibiotics.

Prevalence and Factors Associated with Intimate Partner Violence among Postpartum Women Attending Government Primary Health Care Clinics in Malaysia

Intimate partner violence (IPV) is an important gender-based, social, and public health problem that affects women worldwide, including women who are pregnant or have recently given birth. Studies have shown that violence against women often increases during pregnancy and the postpartum period. This study aims to examine lifetime and past-year prevalence of IPV among postpartum women in Malaysia, and to determine the socio-demographic as well as husband’s/partner’s behavioral factors associated with IPV exposure. This is a nationwide, cross-sectional and clinic-based study involving a total of 5727 women at 6 to 16 weeks postpartum, who attended randomly selected government health clinics between July to November 2016. Face-to-face interviews were conducted by trained female enumerators based on a pre-validated structured questionnaire, using mobile devices as data collection tools. Chi-squared tests and multivariable logistic regressions were used to investigate selected factors associated with IPV exposure. The lifetime and past-year prevalence of any form of IPV among postpartum women were 4.94% (95% CI [3.81,6.39]) and 2.42% (95% CI [1.74,3.35]) respectively, with the highest prevalence being emotional violence, followed by physical and sexual violence. Multivariable analysis showed that husband’s/partner’s behaviors, such as frequent alcohol use, drug use, fighting habits and controlling behaviour were significantly associated with both lifetime and past-year IPV (all p < 0.001 for past-year IPV). These findings suggest that prevention and intervention strategies for IPV should consider the prevention of substance use and reducing controlling behaviors by husband/partner, as well as raising awareness to build healthy relationships through education.

Enablers and Barriers of Follow-Up Care: An Experience From an HPV DNA Detection–Based Cervical Cancer Screening Program in Rural India

Background: Success of a cervical cancer screening program is intrinsically linked with appropriate management of women detected positive on screening tests. While routine screening can be done in any setting, the follow-up care of screen positive women is linked with settings that are equipped with diagnostic and treatment facilities, and trained medical providers. In low resource settings, the major obstacles to deliver follow-up care are lack of adequate healthcare infrastructure and trained service providers at district or subdistrict levels. Aim: To assess feasibility of implementing community based interventions to increase uptake of follow-up care of screen positive women in a HPV detection based screening program conducted by Chittaranjan National Cancer Institute (CNCI), Kolkata. Strategy: A network of key stakeholders including government authorities and civil society organizations was developed to deliver continuum of care at the doorsteps of screen positive women. The infrastructure of government's primary health care delivery system was used to set up temporary clinics at district and subdistrict levels. The clinics were organized on prescheduled dates and times that were convenient to the women. Community health workers (CHWs) were trained in community mobilization strategies to increase uptake of follow-up services. All instruments, equipment and consumables required for providing follow-up services were carried to the clinics in a vehicle. Program: The CHWs played a key role in counseling and recalling the screen positive women. The temporary clinics were arranged in the government primary health centers. A team of trained doctors and paramedics provided the diagnostic and treatment services. Colposcopy was performed on all screen positive women using portable colposcopes and guided biopsies were taken as indicated. Women who were eligible for ablative treatment were counseled and treated in the same sitting. All women were advised yearly follow-up. Outcomes: A total of 43,325 women were screened by HC2 test during July 2010 to March 2015, and 2045 (4.7%) women were detected to be high-risk HPV positive. Compliance to first recall was good with 78.6% (1608/2045) of women undergoing diagnostic evaluation at field clinics. But overall compliance to at least one follow-up visit after 1 year was poor (23.2%). Follow-up compliance rate was higher in women who were diagnosed with CIN1 as compared with those with normal diagnosis ( P &lt; 0.001). What was learned: Diagnostic and treatment services could be effectively organized in the community in convergence with existing healthcare delivery system. High compliance to initial diagnostic evaluation and treatment was achieved by making the services available close to the doorsteps of the women. The reasons for low compliance to yearly follow-up were lack of understanding of future cancer risk, unwilling to undergo speculum examination again, and lack of cooperation of spouse/family.

Unplanned Pregnancy and Its Associated Factors

INTRODUCTION: Unplanned pregnancy is a major public health concern globally. Numerous studies found various factors that can predict or determine unplanned pregnancy. However, there were no studies that reported this problem in Malaysia. The objective of this study is to determine the prevalence of unplanned pregnancy in Malaysia and the associated factors.METHODS: This nationwide cross-sectional study targeted to women at postpartum period at government primary health care clinics throughout Malaysia. Structured questionnaire with face-to-face interview was used for data collection. The factors studied included mothers’ age, husband’s age, ethnicity, religion, marital status, education, occupation, household income, polygamous marriage, family support, contraception used, and disagreement of husband on contraception, smoking and alcohol consumption. History of emotional, physical and sexual intimate partner violence (IPV) were also studied.RESULTS: A total of 5727 Malaysian postpartum mothers were involved in this survey. The prevalence of unplanned pregnancy was 42.9% (95% CI: 38.6, 47.4). The multivariate logistic regression revealed that older mothers aged 45-49 years old (aOR: 8.010; 95%CI: 1.909, 33.013) and Muslim mothers (aOR: 2.465; 95%CI: 1.432-4.241) were significantly associated with unplanned pregnancy. In terms of household income, mothers with less than RM1000 per month were 1.712 (95% CI: 1.080, 2.713) times more likely to have unplanned pregnancy. The other significant associated factor was history of emotional intimate partner violence; aOR [1.720 (95% CI: 1.011, 2.925)].CONCLUSIONS: Unplanned pregnancies were observed to be higher among older Muslim women from low income family. A possibility of unmet need for family planning should be considered and appropriate intervention strategies planned for these at-risk population.

Work-related stress among nursing staff working in government hospitals and primary health care centres.

Work-related stress (WRS) in the nursing working environment is prevalent and significantly affects the performance of nurses and organizations. Poor nursing and administrative performance affects the delivery of safety and quality patient care. Thus, this study aims to compare the sources and factors of stress among nurses from hospitals and primary health care centres. A cross-sectional study was conducted in five government hospitals and four sectors of primary health care centres in Saudi Arabia. Through a survey, the Nursing Stress Scale was completed by 347 nurses from February to March 2016. Workload is perceived as the most common source of WRS, whereas inadequate preparation is regarded as the least. Other major sources are conflicts with physicians and nurses in primary centres and the lack of support and uncertainty concerning treatment in hospitals. The nurses' age, marital status, nationality, and job position are the significantly identified factors that contribute to stress. Overall, the sources and factors of WRS significantly vary with nurses' working environment. Hence, understanding the perception of nurses towards their working environment can be a strategic basis in modifying policies in occupational stress management.