Government Primary Health Care Research Articles

Prevalence and Risk Factors of Postpartum Depression in Palestinian Women in the Hebron Governorate, Palestine

Background Despite the increased interest from researchers in Postpartum depression (PPD) globally, related studies are limited in Palestine and do not provide a comprehensive understanding of PPD. Objective We examined the factors that determine post-partum depression among Palestinian mothers in Hebron governorate. Methods A cross-sectional study was conducted in 122 governmental primary healthcare clinics in Hebron Governorate. A convenient sampling method was used to collect data from 435 using a self-administered questionnaire using the Edinburg Postnatal Depression Scale. Results The mean EPDS scale score was 10.56 (SD 5.273), and 36.1% had a score of ≥13, indicating moderate-to-severe depression symptoms. The study results revealed that psychosocial factors were significantly associated with PPDS and play a crucial role in the development of PPD, such as the history of depression, being exposed to domestic violence before and during pregnancy, poor husband support, unplanned pregnancy, fear of infant’s gender, and in addition to anemia than other factors. Conclusion A high prevalence of PPD was found among Palestinian women in this study. The study proposes screening women for trauma or domestic violence and assessing their social support, inquiring about pregnancy intention, and discussing family planning. Delivering iron supplements to pregnant or postpartum anemic women is important. Women who have a history of depression, domestic abuse, or lack social support should receive psychological and medical treatment. Mental health services must be included in the after-birth care protocol to train primary health clinic staff to recognize and treat PPD.

Patient Satisfaction with Private Community Pharmacies versus Pharmacies in Primary Health Care Centers in Saudi Arabia

IntroductionSaudi Arabia has begun reforming its government-run health care system to increase efficiency and reduce costs. One effort is the adoption of an electronic prescribing system (Wasfaty) and outsourcing pharmaceutical services from government-run clinics to community pharmacies (CP). This study aims to compare satisfaction with pharmaceutical services offered in the two systems. Materials and methodsThis cross-sectional observational study used existing survey data collected from patients (≥15 years of age) visiting government primary health care centers from January 2022 to June 2022. Satisfaction with three pharmaceutical services (availability of medications, pharmacist’s explanation of the prescription, and waiting time to get medications) were the main outcomes. ResultsThe study comprised 91,317 participants, 74.06 % of them were CP/Wasfaty users. CP/Wasfaty patients had lower odds of satisfaction with the three pharmaceutical services: availability of medications (OR = 0.49, 95 % CI = 0.47–0.51), pharmacists’ explanation of prescription (OR = 0.55, 95 % CI = 0.53–0.58), and waiting time to get medications (OR = 0.81, 95 % CI = 0.75–0.88). Additional findings showed variations in satisfaction levels based on demographic factors and clinic types. ConclusionsThe significant differences observed in satisfaction levels based on demographic characteristics and type of clinics visited emphasize the importance of tailoring pharmaceutical services to meet the specific needs and expectations of different patient populations.

The COVID-19 pandemic and cases of domestic violence: perceptions of primary healthcare professionals in the context of social isolation

Objective: to analyze the perceptions of primary health care professionals in Paranaguá/PR about the relationship between the COVID-19 pandemic and cases of domestic violence in their assigned territories, identifying challenges in the approach, impacts on families and case management. Methodology: qualitative research was conducted using semi-structured interviews and focus groups with 36 professionals from two primary health care units in Paranaguá, on the Paraná coast. Results: Primary health care professionals unanimously reported an increase in the number of domestic violence cases in those communities, affecting women, children, and adolescents, with the closure of schools identified as an aggravating factor. The main challenges highlighted were the disruption of primary health care services during the peak of the pandemic due to the reallocation of professionals and resources; misinformation about referral processes for domestic violence cases within the intersectoral network; fear among professionals regarding the pandemic and reporting domestic violence cases; and high staff turnover. Conclusion: The period of social isolation caused by the pandemic intensified domestic violence cases, according to the perceptions of primary health care professionals in Paranaguá. The dismantling of the intersectoral network further compromised the care of individuals in situations of vulnerability and/or violence. The absence of national guidelines from the federal government left municipalities and primary health care professionals on their own to deal with the issue. Submission: 03/30/23| Review: 06/14/23| Approval: 10/04/23

Delay in Care Seeking for Menstrual Regulation

In Bangladesh menstrual regulation (MR) services are available at all major government and private hospitals, and even at government primary health care facilities. In spite of wide availability, women who do not use menstrual regulation services from proper facilities may resort to induce unsafe abortion by non-medical or untrained health workers in unhygienic condition. Worldwide, nearly 1 in 10 pregnancies end in unsafe abortion and World Health Organization (WHO) estimates that 18 out of 20 unsafe abortions takes place in developing countries. Induced abortion leading to complication such as bleeding, infection injuries and even death, these deaths could be prevented if women had an access to safe abortion facilities. This cross sectional study was carried out among fifty two women from family planning unit of Institute of Child and Mother Health (ICMH), Dhaka from December 2009 to May 2010. The purpose of this study was to identify the factors for delay in care seeking of menstrual regulation (MR). The data were collected by using the pretested questionnaires and cases were selected from the women who came for seeking care of MR after 10 weeks of amenorrhoea. Duration of amenorrhoea was confirmed by taking history and in some cases by ultrasonography. After incorporation of the socio-demographic data; factors or reasons of delay in MR were found due to personal, social, service and family related events. The mean age of respondents was 22.14 years. About 75% of the respondents were housewives and 79% were illiterate. The mean age of marriage 19.5 years. Regarding husband’s educational level of the respondent, more than one-third (37%) was class I – V, others one-third (33%) was above the primary level rest of the husbands were higher secondary and above. More than two-third (70%) of the respondents delivered 1 to 3 live children and used oral contraceptive pills. Most of the (87%) of women gave right answer about MR and most of them (85%) had knowledge about adverse effect of MR. Nearly two-third (65%) came to know about MR form relatives/neighbors, where one-fourth (25%) from health workers and rest them from mass media/ others. Most of the (87%) respondents answered correctly about advantages of MR, however, 60% did not know about the proper time of performing MR after cessation of menstruation. Most of the respondents (85%) knew about the side effects of MR; among them more than one-third (37%) told excessive bleeding was adverse effects of MR, however 33%, 8%, 6% and rest 4% told pain, sterility, perforation and infection respectively were the adverse effects of MR. Three-fifth (60%) of the patients didn't know about the right time of pursue care for MR and 63% of them were unaware about legal aspects of MR that they have right to seek MR. More than half of the respondents (56%) stated the reasons for the delay due to their personal problem where, 19%, 15% and 10% of them were specified the reasons as social factor, service related reason and family conflict respectively. Among the respondents of personal reason for delaying MR, more than half of them (52%) took oral tablets for abortion at home, 41% failed to understand their amenorrhoea and only 7% were unaware about service facility for MR. Regarding familial reasons for delay of MR, 60% pointed out the security problem and remaining 40% told about resistance by husband/others or absence of husband in the houses. The main (70%) social reasons of delaying MR was due to spiritual bindings and 30% was due to public disgrace. Service facility related reasons for delaying MR were treatment cost (62%), distance of facility (25%) and substandard services (13%). The study findings suggested that women had good knowledge about MR even they made delay due to unawareness of their legal rights, personal issues, social and service related causes. Strengthening of reproductive health services through community clinic at community level with available awareness building program on MR may minimize the delay for care seeking of MR among women. Bangladesh Med J. 2022 May; 51(2): 37-44

Delphi Plus: A novel methodology for identifying evidence-based data standards for health service decision-making.

The underlying tenet of evidence-based decision-making in health services is assessing all the relevant evidence. Using the traditional qualitative and quantitative approaches to identifying evidence may not capture the full spectrum of factors that need to be addressed. A selective mixed-method approach may provide a comprehensive assessment of the relevant knowledge. This paper adds to the methodological literature by outlining a novel sequential, mixed-method, exploratory process for identifying evidence-based data standards that may be used for health service decision-making. The three-phase process, entitled Delphi Plus, engages peer-nominated topic-specific experts to assess all publicly available and practice-based items and, through a series of reviews, reach an evidence-based consensus on standards for decision-making. Each process phase is outlined in-depth and supplemented by practical learnings gained through its implementation. The Delphi Plus methodology provides the first comprehensive process for combining the published and practised data to develop evidence-based data standards. The routine use of Delphi Plus would provide a framework for benchmarking in health services, enabling greater monitoring and evaluation of client outcomes and improving quality care. This manuscript describes the process of implementing Delphi Plus and provides an example of data standards generated from its use, which directly inform the Australian Government's Primary Health Care 10 Year Plan.

Characteristics and Outcomes of Conditions Encountered in Primary Care During FIFA World Cup 2022 in Qatar - A Cross-Sectional Study

The FIFA World Cup, a massive football event, presents significant challenges to healthcare systems. Primary healthcare plays a crucial role in patient-provider interactions and serves as a cornerstone of the system. This study aimed to assess the frequency, characteristics, and outcomes of conditions treated in primary care facilities during the FIFA World Cup Qatar 2022. A cross-sectional study was conducted from November 15 to December 20, 2022. All patients visiting the 29 governmental primary healthcare facilities in Qatar were included. Anonymous patient data, including age, sex, nationality, diagnosis, treatments, visit date, consultation type, and outcomes, were extracted from electronic medical records. A total of 401,962 patients were seen in primary care, with an average age of 34.50 ±19.3 years. Less than 1% held Hayya Visa (n=3120, 0.8%), and roughly 2% were referred to secondary care (8494, 2.1%). The most prevalent diagnoses were Type 2 diabetes mellitus (n=59670, 7.7%) and upper respiratory tract infection (n=47364, 6.2%). Paracetamol was the most frequently prescribed medication (n=69,960, 11.9%). Elderly patients (OR=1.23), non-Qatari patients (OR=1.25), and male patients (OR=1.17) were more likely to be referred to secondary care. Hayya cardholders were about twice as likely to be transferred (OR=2.40). Primary healthcare services operated efficiently during the FIFA World Cup 2022 in Qatar. The majority of cases involved managing chronic diseases and minor respiratory infections. Football enthusiasts and non-Qatari individuals were more often referred to secondary healthcare. These findings can guide policymakers in enhancing primary healthcare services for future mass gatherings.

Space Based Application For The Inventory, Distribution And Analysis Of Healthcare Facilities In Nasarawa State, Nigeria

The study aimed at carrying out the inventory, distribution and analysis of healthcare facilities in Nasarawa state using remote sensing and geographic information system (GIS) techniques. Field mapping was conducted and coordinates with attributes of these healthcare facilities were recorded. GIS analysis using multiple ring buffer and cluster extension of the spatial analysis tool in ArcGIS 10.8 version was used. Result revealed a total of 1,119 healthcare facilities distributed across the state. Out of which 807 are government primary healthcare, while 227 are private primary and 24 government secondary whereas 60 are private secondary and one tertiary healthcare facility. Result also revealed significant disparities in the distribution of government tertiary healthcare facilities across the local government areas with only having such facility in the whole of Nasarawa State. This indicates limited access to specialized healthcare services. The general trend of health facilities in Nasarawa state is towards clustering because these facilities are intended to reside close to settlements and thus will present some degree of clustering though the level may differ between different types of facilities. The buffer analysis in secondary healthcare showed a wide number of settlements by local government that need more present of secondary healthcare facility in Nasarawa state showing good accessibility of health care facility to the settlement within 1 km and 10 km radius. The government own primary healthcare facilities record a z-score of -17.52725 and 0.677488 nearest neighbour ratio suggesting a very strong trend towards clustering, and from the analysis, there is a less than 1% chance of randomness or dispersion. This indicates that there is a lot needs to be done to ensure a more dispersed and competitive distribution of these facilities. The private primary healthcare facilities have a z-score of -18.527370 and nearest neighbour ratio of 0.357209, which shows very significant clustering alongside an identical 1% probability of random distribution. This clearly indicates that there is need for strategic planning and resource allocation to the health sector to ensure an equitable, dispersed and competitive distribution of these facilities. The findings from this study have implications for the actualization of the United Nations’ health-related Sustainable Development Goal (SDG-3) and also to achieve the Universal health coverage.

The costs and financing needs of delivering Kenya's primary health care service package.

For many Kenyans, high-quality primary health care (PHC) services remain unavailable, inaccessible, or unaffordable. To address these challenges, the Government of Kenya has committed to strengthening the country's PHC system by introducing a comprehensive package of PHC services and promoting the efficient use of existing resources through its primary care network approach. Our study estimated the costs of delivering PHC services in public sector facilities in seven sub-counties, comparing actual costs to normative costs of delivering Kenya's PHC package and determining the corresponding financial resource gap to achieving universal coverage. We collected primary data from a sample of 71 facilities, including dispensaries, health centers, and sub-county hospitals. Data on facility-level recurrent costs were collected retrospectively for 1 year (2018-2019) to estimate economic costs from the public sector perspective. Total actual costs from the sampled facilities were extrapolated using service utilization data from the Kenya Health Information System for the universe of facilities to obtain sub-county and national PHC cost estimates. Normative costs were estimated based on standard treatment protocols and the populations in need of PHC in each sub-county. The average actual PHC cost per capita ranged from US$ 9.3 in Ganze sub-county to US$ 47.2 in Mukurweini while the normative cost per capita ranged from US$ 31.8 in Ganze to US$ 42.4 in Kibwezi West. With the exception of Mukurweini (where there was no financial resource gap), closing the resource gap would require significant increases in PHC expenditures and/or improvements to increase the efficiency of PHC service delivery such as improved staff distribution, increased demand for services and patient loads per clinical staff, and reduced bypass to higher level facilities. This study offers valuable evidence on sub-national cost variations and resource requirements to guide the implementation of the government's PHC reforms and resource mobilization efforts.

Knowledge and Perception of Healthcare Workers about Safe Water Supplies and Antibiotic-Resistant Bacteria at Primary Health Care Facilities in Gaza, Palestine

Background: While concerns about the spread of Antimicrobial resistance (AMR) in HCF have long been identified, the links with environmental issues - such as water, sanitation, and hygiene (WASH) - are much less well understood. Indeed, misperceptions of links between WASH and AMR are identified as one of the hindrances of infection control programs. This study assessed the gap in knowledge in healthcare facilities (HCFs), by analyzing the perceptions of healthcare workers. Methods: A cross-sectional survey was conducted in governmental primary healthcare facilities in Gaza, Palestine between April and August 2022. Out of 1802 workers, 322 were randomly recruited to fill out a self-administer questionnaire. The workers were representing both genders (50.3% females) and aged between (19- 60 years). Data was analyzed using Statistical Package for Social Sciences (SPSS) software, version 23. Results: About half of the respondents (52.5%) did not know what the “WASH” term stands for, and nearly a quarter (22.7%) were unable to define AMR bacteria correctly. The perception of water safety was higher for domestic (66.1%) than for drinking water (54.7%) with a lower perception among females (p value=0.005) and medical staff (p value=0.000). At HCFs, only 40.7% of respondents had the perception that regular water safety monitoring occurs and 30.4% declared that water pollution was reported at their facilities. Only 20.0% of health workers think that they play a role in monitoring water safety and 24.8% think that they play a role in preventing and controlling AMR bacteria. Conclusion: Hybrid educational and awareness programs about water safety and prevention of AMR bacteria need to be implemented within the context of the One Health approach. The investment in WASH infrastructure at HCFs requires parallel investment in capacity building and raising awareness of workers.

Caregivers’ Perception on Adolescents’ Access on, Use of, and Support Required to Prevent Unwanted Pregnancies in Lesotho

Background: Usage of hormonal or barrier contraception by adolescents is challenging for most adolescents. The study revealed new evidence of caregivers’ support to adolescents on access and effective contraception use to prevent unwanted pregnancies in k.w. There is a need for adolescents’ user-friendly services, supportive supervision, accommodative cultural and religious practices, and the promotion of independent decisions. Objectives: To explore and describe caregivers’ perceptions of access (1) and the use of (2) contraception for adolescents in Lesotho and to explore and describe caregivers’ perception of types of support needed for adolescents to prevent unwanted pregnancies in Lesotho (3). Methods: A qualitative explorative, descriptive, and contextual design. Purposive sampling caregivers of adolescents in a government primary health care facility with the highest outpatient number in Maseru district, Lesotho. Five focus groups with six participants each, which included (N=30) participants, were conducted using an interview schedule. Data were analysed using Creswell’s six steps of data analysis with the assistance of a co-coder. Results: Three categories emerged, namely (1) access to contraception by adolescents, (2) use of contraception by adolescents, (3) and support to prevent unwanted pregnancies with respective themes and sub-themes emerged. Conclusion: Contraception use among adolescents is challenging. Adolescents’ caregivers disclosed being unskilled to discuss sexuality due to their cultural and religious background. Basic sexuality education has been included in the school curriculum. Service providers’ attitudes and rigid health services contribute to the limited access to contraception for adolescents.

Utilisation of rural primary health centers for outpatient services - a study based on Rajasthan, India

IntroductionOutpatient services are crucial for strengthening primary healthcare and reducing out-of-pocket spending, which has been one of the major causes of impoverishment. So it is also critical to comprehend the people’s preferences in accessing primary healthcare facilities, as government primary healthcare facilities in India are underutilized. The current paper explores the factors that construct the individual’s decision to seek outpatient care in primary healthcare facilities in India’s largest state Rajasthan.MethodsIt was a cross-sectional survey conducted in 72 primary sample units of 24 primary health centers in 11 districts of Rajasthan, India, from November 2019 to January 2020. The study selected 368 households through purposive sampling. Out of 368 households, 460 people reported any illness and 326 reported outpatient visit to any health facility in the last 30 days from the date of the survey.AnalysisThe focus was on analyzing the data in the context of public and private health facilities to understand the factors influencing people’s choice to access outpatient services. The principal component analysis is used to understand the relationship between facility preparedness and OPD uptake. Also, multivariate logistic regression is applied to assess the significant predictors in using primary health facility services.ResultExcept for the 29% of patients who received no care, the proportion of patients attended public health facilities was 35%, and the rest were utilizing private health facilities. Those who sought care at PHCs were mostly over 45 years age, non-literate, and from the lowest wealth quintile. Logistic regression suggests that people belong to upper wealth quintile (OR = 0.298; 95% 0.118–0.753) are less likely to visit PHCs for treatment. Also, increase in distance of PHC (OR = 0.203; 95% CI 0.076–0.539) reduces the likelihood of their visit outpatient care. People are 9.7 times (OR = 9.740; 95% CI 2.856–33.217) more likely to visit a PHCs that are better equipped in terms of human resources, equipment, and medicine.ConclusionThe uptake of PHCs depends on several factors, which should be considered to ensure that all segments of society have equitable access to them. Through improved accessibility and quality of service, PHCs can be made more appealing to the larger population.

A New Strategy for Rejuvenating Primary Healthcare: The Government-Society Partnership Model.

Primary healthcare systems worldwide are under stress as increased demands during pandemic surges have exposed deficiencies in the system. Primary healthcare centers have significant responsibilities but are often underfunded and understaffed. Recent events, including the COVID-19 pandemic, have highlighted the importance of a strong primary health center network to promote community health and save lives. Most governments have multiple competing financial needs for scarce resources, ultimately limiting the advancement of government primary healthcare systems. Hence, various models involving collaboration and outsourcing have been evaluated and employed to improve primary health services. We propose and describe a sustainable and scalable government-society partnership model to bridge the gulf and rejuvenate primary healthcare with a focus on the Indian healthcare system. The involvement of key stakeholders, including society, non-government organizations, and corporate sponsors, is essential to rebuild the network.

Prevalence and determinants of medications non-adherence among patients with uncontrolled hypertension in primary care setting in Sarawak, Malaysia: A cross-sectional study.

Non-adherence to antihypertensive medications is a leading cause of uncontrolled hypertension and its complications. However, data on the factors associated with non-adherence to antihypertensive medications in the communities of Sarawak, Malaysia, are limited. This study aimed to examine the prevalence and determinants of medication non-adherence among patients with uncontrolled hypertension. A cross-sectional study was conducted using the systematic sampling method in four government primary healthcare clinics in Sarawak. A self-administered questionnaire was used to obtain socio-demographic data and evaluate non-adherence. Blood pressure was measured, and relevant clinical variables were collected from medical records. Multivariate logistic regression was used to determine the determinants of medication non-adherence. A total of 488 patients with uncontrolled hypertension were enrolled in this study. The prevalence of medication non-adherence was 39.3%. There were four predictors of medication non-adherence among the patients with uncontrolled hypertension: tertiary educational level (odds ratio [OR]=4.21, 95% confidence interval [CI] = 1.67-10.61, P=0.010), complementary alternative medication (0R=2.03, 95% CI=1.12-3.69, P=0.020), non-usage of calcium channel blockers (0R=1.57, 95% CI=1.02-2.41, P=0.039) and 1 mmHg increase in the systolic blood pressure (0R=1.03, 95% CI=1.00-1.05, P=0.006). Because of the high prevalence of medication non-adherence among patients with uncontrolled hypertension, primary care physicians should be more vigilant in identifying those at risk of being non-adherent. Early intervention should be conducted to address non-adherence for blood pressure control.

Factors influencing the practice of Smoking Cessation Assessment and Management among Primary Care Doctors (SCAAM-DOC) in three districts of Malaysia.

Smoking prevalence remains high in Malaysia. Primary care doctors have a good opportunity to motivate the smokers to quit smoking in view of the accessibility of primary healthcare clinics to the public. The objective of this study was to determine the practice of smoking cessation management among primary care doctors and its associated factors. A cross-sectional online survey was carried out among 383 medical officers and interns in all government primary healthcare clinics in the district of Petaling, Klang and Hulu Langat from June to August 2020. All doctors were involved in the care of patients for smoking cessation. The knowledge, attitude and practice of smoking cessation management were assessed using a 17-items validated questionnaire which covered the components of 5As (Ask, advise, assess, assist, arrange) and 5Rs (Relevance, risk, reward, roadblocks, repetition). The management of pre-contemplation phase included the components of ask, advise, assess and 5Rs. The management of the contemplation phase included the components of assist and arrange. The majority of the respondents had poor score of knowledge (62.4%); attitude (58%) and practice (pre-contemplation management:50.9%; contemplation management:75.7%). Using multivariate logistic regression analysis, the significant factors associated with the poor practice of smoking cessation management in the pre-contemplation phase were poor (OR = 2.14, 95% CI 1.11-4.12, p <0.01) or moderate knowledge (OR = 2.50, 95% CI 1.19-5.26, p<0.01), poor attitude (OR = 2.16, 95% CI 1.39-3.37, p<0.01), lacks smoking cessation banners, brochures and leaflets in the clinic (OR = 2.01, 95%CI 1.26-3.19, p<0.01) and lack of nicotine replacement medications (OR = 2.27. 95%CI 1.27-4.06, p<0.01). No significant factors were shown associated with the practice of the contemplation phase. The majority of primary care doctors had poor knowledge, attitude and practice of smoking cessation management. Factors that had increased the odds of the poor practice of smoking management at the pre-contemplation phase were poor knowledge, poor attitude, and insufficient organizational support for health promotion materials and nicotine replacement medication.

A public-private partnership based model for regulating out-of-pocket expenditures to strengthen primary care system.

In developing countries like India, the cost of health care is largely borne by patient out-of-pocket payments. Recent studies have reported that patients skip public-funded clinics providing free consultation for distant private care providers. Some of the reasons identified for such behaviour include longer waiting times, perception regarding quality of care, etc. Therefore, optimal allocation of existing and new capacity is critical for a greater public interest. This article presents a decision-making framework towards this intent for strengthening the existing government primary healthcare network. In this article, a mixed-integer linear programing (MILP) model is developed for optimal reconfiguration of the existing government primary healthcare network to minimise patient out-of-pocket expenditures (OOPE). The model involves three types of facilities: Primary Health Centre (PHC), Community Health Centre (CHC), and Private OPD (outpatient department). Implementation of the proposed model can help in reducing out-of-pocket expenditures. The optimization model proposed in the article is unique as it incorporates for the first time, patient out-of-pocket expenditure, capacity reconfiguration, and public-private partnership decisions in the primary healthcare system. A solution algorithm is also proposed for the optimization model. The model would be useful for theory development and also in policy-making.

Organizational safety climate and workplace violence among primary healthcare workers in Malaysia

Workplace violence (WPV) has become a global safety and health concern in recent times particularly in the healthcare sector. In addition, low levels of organisational safety climate (OSC) have been associated with higher occurrence of occupational related health outcomes. Hence, the objective of this study was to determine the association between organisational safety climate and workplace violence among government primary healthcare workers. A cross-sectional study among a stratified random sample of 838 primary healthcare workers (HCW) from the nine district health offices under the Selangor state health department. Two standardized self-administered questionnaires were used to obtain data on WPV and OSC. Logistic regression models used to estimate the association between OSC and WPV. Prevalence of WPV was 68.5% whereby verbal abuse was the most common type (65%) followed by bullying (27%), physical violence (6%) and sexual harassment (2%). Nurses (29.7%) were the most affected by WPV. The main perpetrators were relatives of patients (38%). Low level of OSC was also associated with WPV (OR=3.04, 95% CI=1.45-6.41). The results of this study confirmed that safety climate is associated with WPV. Hence, interventions and efforts to prevent WPV among HCW should also include improving organizational safety factors.

Preparedness for paediatric cardiopulmonary resuscitation amongst medical doctors working in primary health care facilities in Cape Town, South Africa.

BackgroundCardiopulmonary resuscitation (CPR) is the principal medical intervention used to reduce the high mortality associated with the cardiorespiratory arrest. There is a paucity of literature on the preparedness for paediatric cardiopulmonary resuscitation (pCPR) amongst doctors in Cape Town. This study aimed to assess the preparedness for pCPR of doctors working in Western Cape Provincial Government primary health care facilities (PHCFs) in Cape Town with regard to knowledge, confidence and doctors’ knowledge of equipment availability.MethodsA cross-sectional study using a questionnaire to collect quantitative data from a sample of 206 doctors working in Cape Town PHCFs.ResultsThe questionnaire was completed by 173 doctors (84% response rate). The majority (81.8%) had not undergone pCPR training (Paediatric Advanced Life Support or Advanced Paediatric Life Support). Basic life support was done by 88.3%: 28% greater than two years ago. The average pCPR knowledge score was 61% (standard deviation [s.d.]: 20.3, range: 8.3% – 100%). Doctors in their community service and internship years had significantly higher knowledge scores compared to grade 3 Medical officers (p = 0.001 and p = 0.010, respectively). Eleven per cent had performed pCPR > 10 times in the past year; 20% had never performed pCPR and 35% did not feel confident performing pCPR. More than 35% of doctors were uncertain about the availability of equipment in their facility.ConclusionDoctors working in Cape Town PHCFs have poor knowledge, have low confidence levels and are poorly prepared to perform pCPR. Urgent attention needs to be given to ensuring formal pCPR training and acquaintance with equipment availability and location in Cape Town PHCFs.

Evaluating scope of mobile technology for bridging health care gaps in impoverished population in LMICs.

Background:mHealth has potential to improve health care delivery but little is known about its effectiveness on health amongst marginalized communities. This study was carried out to determine the scope and usefulness of mHealth implementation in underprivileged slum population.Material and Methods:A cross-sectional study was carried out in an urban slum of Northern India where the government primary health care facility was digitized and mHealth component was integrated into the system to improve the health care service delivery. The survey was conducted using a pre-tested questionnaire among 921 persons who were sent SMSs within the last 2 months prior to survey to assess the reach and acceptability of mHealth in the underprivileged slum populations, and the role it can play to improve the healthcare services provided through primary health care facility.Results:In the surveyed population majority (59.8%) were young (18–30 years), females (79.3%), Hindu (94%) belonged to Scheduled caste (77.8%) and a significant percentage of them were illiterates (30%). Mobile phones were available with 87% of the surveyed population and more than 50% had smartphones. Though, only 59.5% of individuals confirmed the receipt of SMS, a very high proportion of survey population (98.3%) were willing to receive health-related SMS. About 72% individuals received SMSs and remembered the content of the message. Adherence to health advise sent through SMS was significantly higher among females (OR = 2.4 (95% CI: 1.2,5.1), P = 0.01), those who read messages themselves (OR = 1.9 (95% CI: 1.0, 3.3), P = 0.03), and who received SMS more than once in a month (OR = 2.2 (95% CI: 1.2, 4.2), P = 0.01). Majority of those who received SMS (83%) expressed that the health-related SMS were beneficial to them.Conclusion:mHealth has high potential to improve reach and increase accessibility of health care services for marginalized communities.

Assessment of Active Case Search of COVID-19 in Healthcare Facilities during the Third Wave of the Pandemic in Ekiti State, Nigeria

Early case detection and isolation of patients infected with highly infectious diseases through active case search (ACS) are important for early commencement of treatment and control of the disease within a population. This study aimed to assess the ACS of COVID-19 in healthcare facilities during the third wave of the pandemic in Ekiti State, Nigeria. This cross-sectional study was conducted in all healthcare facilities in Ekiti State. All cadres of local government primary healthcare workers were trained to carry out the ACS using semi-structured interviewer-administered questionnaire uploaded on android phone software open data kit (ODK). ACS was conducted between June and September (epidemiological week 23 to 36), 2021 and the collected data were analyzed using IBM SPSS version 23.0. P-value < 0.05 was taken as significant. The number of ACS visits for COVID-19 increases with epidemiological week progression, but the highest was in week 32 (9.9%). Cases of suspected COVID-19 in the healthcare facilities in the last one week were reported in more than half (58%) of the visits and 57.8% of those reported, documented between 1 - 4 cases. Also, out of those that were reported, 42% of them missed (not line listed) at least one suspected case of COVID-19. The private health facilities missed more cases of COVID-19 (54.3%) than other categories of health facilities (p < 0.001). The health educators and local government immunization officers (LIO) than other cadre of healthcare workers found most missed cases (57.1% and 51.4% respectively) in their visits (p < 0.001). The health educator as well as the LIO detected the highest proportion of missed suspected cases which shows that disease surveillance officers alone may not be adequate for ACS, there is a need to involve other local government team member.

What brings people to government urban primary care facilities? A community-based study from Delhi, India

Introduction: Mohalla or Community Clinics of Delhi, India, provides free primary care services to the general population, with special focus on the underserved and marginalized. This study was conducted to analyze the perception and experience of target beneficiaries and to understand and document the determinants of people visiting these clinics. Material and Methods: A community-based study was conducted from October 2019 to April 2020. A semi-structured questionnaire was used for data collection. Correlation and comparative analysis were used. Thirty-seven Mohalla Clinics and their catchment areas were visited. A total of 391 respondents (including 35 health staff and 356 community members) were included. Results: Proximity of clinics, waiting times, age, perceived quality of treatment, and cleanliness at facilities were the factors that influenced the usage of clinics. Lack of first-aid facilities and long waiting time (at a few facilities) were identified challenges. There is a need for wider publicity and awareness about the clinics and regular analysis of data to determine an appropriate mid-course action to further increase utilization. Conclusion: Community Clinics of Delhi, India, have brought people back to government primary healthcare (PHC) facilities. The popularity of these clinics has encouraged a number of Indian states to set up similar facilities. The factors behind their success need to be studied in detail to derive lessons for making urban PHC accessible in other low- and middle-income countries.