Health Passport Research Articles

Umbrella review of hospital passports: Their use and improvements

AbstractBackgroundThe hospital or health passport is widely acknowledged as a central element in making reasonable adjustments for patients with intellectual disabilities. Historically, the health passport has been used exclusively for patients with intellectual disabilities; however, it has wider applications for any patient requiring additional support. Commonly, it documents past medical history, communication needs and a person's means of expressing pain. There are, however, significant barriers to their use, meaning patients are unable to access adjustments to improve their experiences in a healthcare system that already marginalises and discriminates against people with intellectual disabilities. This umbrella review aims to establish whether the passport is an effective reasonable adjustment, identify barriers to its use and make recommendations to alleviate these barriers.MethodsDatabase and citation searches informed a synthesis of international evidence to address these aims. Following the removal of duplicates and screening, nine review papers originating from the United Kingdom, Australia and Ireland were identified for inclusion. Seven focus on the use of passports for patients with intellectual disabilities, one on the use of passports for autistic people, and one exploring the use of passports for patients with dementia.FindingsThe results demonstrated that the passports are effective in improving care for patients with intellectual disabilities. However, there are barriers to its routine use. We identified three main issues with the current use of the hospital passport. First, there is a need for greater managerial support to implement reasonable adjustments. Second, standardisation of the passports at a national level will make them more accessible to healthcare professionals and will ensure that information is not ‘buried’; the development of a standardised passport must involve consultation of patients, carers and staff to meet the needs of all stakeholders. Finally, education for all healthcare staff to raise awareness of the passport and ensure it is utilised appropriately will ultimately pave the way for positive, long‐lasting change.ConclusionsPassports can be an effective means of communicating reasonable adjustments. Addressing a lack of awareness of its utility, ensuring managerial commitment to implementing reasonable adjustments and making the passport accessible through a standardised format will empower patients to engage with their own care.

Universal screening for developmental dysplasia of the hip in Austria: what have we learned?

Hip ultrasound, according to Graf, is a standardized sonographic method for the detection of developmental dysplasia of the hip (DDH) during the neonatal period. Graf established his method during the 1980s in his home country Austria. It was implemented in the Austrian Mother-Child Health Passport in 1992. Since then it served as a general screening method. The aim of this paper is to present the effects of general hip ultrasound screening in Austria by reviewing and analysing the literature of Austrian authors. This article described how the method was further developed and which prerequisites are currently required for a correct diagnosis. Moreover, it reports about the education in ultrasound screening according to Graf in Austria.

Developing comprehensive woman hand-held case notes to improve quality of antenatal care in low-income settings: participatory approach with maternal health stakeholders in Malawi

BackgroundIn the quest for quality antenatal care (ANC) and positive pregnancy experience, the value of comprehensive woman hand-held case notes cannot be emphasised enough. However, the woman’s health passport book in Malawi presents gaps which hinder provision of quality care, especially during pregnancy. We aimed to develop a compressive updated woman hand-held case notes tool (health passport book) which reflects WHO 2016 ANC guidelines in Malawi.MethodsFrom July 2022 to August 2022, we applied a co-creative participatory approach in 3 workshops with key stakeholders to compare the current ANC tool contents to the WHO 2016 ANC guidelines, decide on key elements to be changed to improve adherence and change in practice, and redesign the woman’s health passport tool to reflect the changes. Within-group discussions led to whole-group discussions and consensus, guided by a modified nominal group technique. Facilitators guided the discussions while ensuring autonomy of the group members in their deliberations. Discussions were recorded and transcribed. Data was analysed through thematic analysis, and reduction and summaries in affinity diagrams. The developed tool was endorsed for implementation within Malawi’s healthcare system by the national safe motherhood technical working group (TWG) in July 2023.ResultsFive themes were identified in the analysis. These were (i) critical components in the current tool missed, (ii) reimagining the current ANC tool, (iii) opportunity for ultrasound scanning conduct and documentation, (iv) anticipated barriers related to implementation of the newly developed tool and (v) cultivating successful implementation. Participants further recommended strengthening of already existing policies and investments in health, strengthening public private partnerships, and continued capacity building of healthcare providers to ensure that their skill sets are up to date.ConclusionAchieving goals of quality ANC and universality of healthcare are possible if tools in practice reflect the guidelines set out. Our efforts reflect a pioneering attempt in Malawi to improve women’s hand-held case notes, which we know help in enhancing quality of care and improve overall women’s satisfaction with their healthcare system.

Hospital admission and its common causes in children on antiretroviral therapy (ART) in Lilongwe Malawi between 2001 and 2016: a retrospective cross-sectional study

Background Paediatric HIV data shows a variable and sometimes catastrophic response in the initial stage of ART regimen administration. The burden of disease that affects children in their first year of treatment is not comprehensively available. Objective Objective of our study was to describe patterns of admission in children; before ART initiation, within the first six months, and post-six months of ART between 2001 and 2016. Methods Principal caregivers of 260 children (45.7% females 54.2% males, all <15 years) on ART for at least six months were interviewed about admissions of their children. Diagnoses were verified from the health passport books. Data on age, sex, date of ART initiation was obtained from the database of Baylor College of Medicine in Lilongwe. Data were analysed using Excel for descriptive analysis. Chi Square Test was used to test for significance. Results There were more admissions before starting ART 74% (95%CI 68.67–79.33%) vs. 42% (95%CI 36.00–48.00%), after starting ART (p = <0.001 at 5% significance level); after six months of ART 34% (95%CI 28.24–39.76) vs. 20% (95% CI 15.51–24.86%) (p = <0.001 at 5% significance level). The commonest causes of admission were pneumonia, malaria, tuberculosis, anaemia; no difference in causes of admission within the first and after six months of ART initiation. Conclusion ART significantly reduces admission in children living with HIV. The common causes of admission are HIV non-specific conditions. No difference between causes of admission within and after six months of ART.

Exploring and prioritising strategies for improving uptake of postnatal care services in Thyolo, Malawi: A qualitative study.

Although postnatal care services form a critical component of the cascade of care in maternal, newborn, and child health the uptake of these services has remained low worldwide. This study explored and prioritised the strategies for optimising the uptake of postnatal care (PNC) services in Malawi. A qualitative descriptive study followed by nominal group techniques was conducted at three health facilities in Malawi from July to December 2020 and in October 2021. We conducted focus group discussions among postnatal mothers, fathers, healthcare workers, elderly women, and grandmothers. We conducted in-depth interviews with midwives and key health managers. Nominal group techniques were used to prioritise the main strategies for the provision of PNC. The demand strategies include appointment date reminders, provision of free health passport books, community awareness campaigns, and involvement of men in the services. The supply strategies included training health providers, improving clinic operations: task-shifting and hours of operation, having infrastructure for the services, and linkage to other services. Having services delivered near end-user residences was a crosscutting strategy. Refresher training and improvement in the clinic operations especially on hours of operation, appointment date reminders, and linkage to care were the prioritised strategies. There is a need to use acceptable and contextualised strategies to optimise the uptake and delivery of postnatal care services. Educating the healthcare workers and the community on postnatal services is key to increasing the demand and supply of the services.

Epidemiological contemplation for a currently pragmatic COVID-19 health passport: a perspective.

The coronavirus disease 2019 (COVID-19) has caused a global pandemic that has wreaked havoc on the lives of millions of people around the world. Confinement measures aim to reduce the epidemic's spread and minimize the burden of morbidity and mortality. In response to the challenges caused by the pandemic, digital health passports have been developed exponentially. We highlight the latent epidemiological barriers to health passports to achieve standardized digital care platforms. This review paper not only highlights the epidemiological barriers but also articulates the possible infrastructure required to make the International Standard for a multi-factor authenticated and validated health passport.

Screening for iron deficiency among pregnant women

Iron deficiency (ID) and iron deficiency anemia (IDA) are extremely common in females in Saudi Arabia and are highly prevalent in pregnancy. The Saudi MOH Mother Health Passport recommends that pregnant women undergo testing for complete blood count and ferritin in every trimester. The purpose of this study was to describe practices of screening pregnant women for ID or IDA during pregnancy and to identify the prevalence of anemia and IDA. The inclusion criteria were all patients who had at least 2 antenatal visits in the same center and 336 women were included. It was noted that 591 (51.5%) hemoglobin tests were performed during pregnancy, a 50% gap in comparison with MOH recommendations of measuring Hb in every trimester. The overall prevalence of anemia was 28.6%, 12.2% in the first trimester, 37.2% in the second trimester, and 36.3% in the third trimester. Ferritin was measured in less than 5% of patients, and most women had ferritin levels below 15 ng/ml. Screening practices for IDA and ID among pregnant women are suboptimal, and the prevalence of both entities is substantial. The development of detailed national guidelines for screening and managing ID and IDA in pregnancy is recommended.

Does a school-based intervention increase girls’ sexual and reproductive health attitudes and intentions? Results from a mixed-methods cluster-randomized trial in Burkina Faso

Adolescent girls in Burkina Faso face unintended pregnancy risk due to a lack of contraceptive use. The (re)solve project was designed to address contraceptive misperceptions and increase girls’ perceptions of their pregnancy risk, primarily through a participatory game and a health passport aimed at easing health facility access. The intervention components were implemented for girls in private and public school in grades 4ème and 3ème (grades 9 and 10) in Ouagadougou and Bobo Dioulasso, Burkina Faso. We conducted an impact evaluation using a mixed-methods cluster randomized control trial design to evaluate (re)solve’s impact on girls’ intentions to use contraception, among other outcomes. Thirty-two schools were randomly allocated intervention or control. The evaluation included quantitative longitudinal surveys at baseline (N = 2,372) and endline (N = 2,072), qualitative in-depth interviews with girls in the intervention group at baseline (N = 41) and endline (N = 48) and with implementation staff (N = 35) and experts (N = 14) at endline. We used generalized estimating equations (GEE) analysis for the main analysis. Girls receiving the intervention had more positive attitudes related to contraception at endline compared to girls at control schools. (re)solve had a positive effect on girls’ intention to use contraception (aOR = 1.59, 95% CI 0.97–2.61), though this did not reach statistical significance. The impact was particularly large among girls who had never had sex, girls who attended public schools, and girls in 3ème. Qualitative findings suggest the intervention was well received and positively shifted attitudes and facility-seeking behaviors for many girls, but that myths and misconceptions related to contraceptive use persist in this mostly young, sexually naïve population. That the (re)solve intervention appears to have shifted adolescent girls’ attitudes toward using contraception, coupled with positive trends in intention to use contraception, indicates that interventions like (re)solve may ‘prime the pump’ for behavior change and increasing girls’ use of contraception. Trial registration number and date: https://www.isrctn.com/ISRCTN15387847 Registered on June 15th 2021.

Integrating machine learning in electronic health passport based on WHO study and healthcare resources

Healthcare's evolution amid rapid scientific progress demands the efficient management of extensive data. This has given rise to electronic health passports, which play a crucial role in modern healthcare by providing secure access to comprehensive medical histories. This study, exemplified by diabetes, addresses the mounting global prevalence of this disease, which saw cases soar from 108 million in 1980 to 422 million by 2014, resulting in a 5 % rise in diabetes-related premature mortality from 2000 to 2016. Disease prediction based on patient attributes holds potential to optimize healthcare resource allocation. The research aim is to identify new hidden dependencies and parameters in the diagnosis of diabetes, utilizing machine learning techniques. The first stage of this involves a thorough comparison and optimization of various modeling techniques, from Decision Trees (e.g., Random Forest, Adaboost) to advanced Deep Learning models like CNN, RNN, and LSTM networks, aiming to determine the most effective implementation method. Leveraging a subset of the MIMIC-III Critical Care Database, a comprehensive de-identified health-related dataset, this research provides insights into addressing the escalating diabetes challenge. The study revealed that the Gradient Boosting Machine was the most effective for making diagnoses. In the realm of deep learning, the Recurrent Neural Network (RNN) demonstrated the best results. This work aligns with the broader context of utilizing electronic health passports to enhance healthcare efficiency and decision-making in an era characterized by abundant health data. It is essential to emphasize that this work represents the initial phase of a broader research trajectory, and its continuation will be expounded upon in forthcoming publications. Datasethttps://doi.org/10.13026/C2XW26. Dataset licensePhysioNet Credentialed Health Data Use Agreement 1.5.0.

Awareness, Attitudes, and Willingness: A Cross-Sectional Study of Organ Donation in Saudi Arabia.

Organ transplantation is inherently dependent on the availability of organ donors. There is a noticeable paucity of literature addressing the rates of organ donation registration and the awareness of Islamic regulations (Fatwa) regarding organ donation within Saudi Arabia. Our study aimed to evaluate the level of organ donation registration, awareness of Islamic regulations, and knowledge of the Saudi Center for Organ Transplantation (SCOT) within the Saudi society. We conducted a cross-sectional survey from 30 March to 9 April 2023. This survey aimed to assess the awareness of Islamic (Fatwa) guidance on organ donation, the role of SCOT, and the rate of organ donation registration facilitated through the Tawakkalna app, the official health passport application in Saudi Arabia. Out of 2329 respondents, 21% had registered as potential deceased organ donors, despite 87% acknowledging the importance of organ donation. Awareness of the Islamic Fatwa regarding organ donation was reported by 54.7% of respondents, and 37% recognized the Fatwa's acceptance of brain death criteria. The likelihood of registration as organ donors was higher among Saudi citizens under 45 years of age, females, healthcare workers (HCWs), individuals with higher education, relatives of patients awaiting organ donations, those informed about the Islamic Fatwas, and those willing to donate organs to friends. Conversely, being over the age of 25, Saudi nationality, employment as an HCW, awareness of SCOT, and prior organ donation registration were predictive of a heightened awareness of Islamic Fatwas. However, perceiving the importance of organ donation correlated with a lower awareness of the Fatwas. Significant positive correlations were found between awareness of SCOT, awareness of Fatwas, and registration for organ donation. While the Saudi population exhibits a high regard for the importance of organ donation, this recognition is not adequately translated into registration rates. The discrepancy may be attributable to limited awareness of SCOT and the relevant Islamic Fatwas. It is imperative to initiate organ donation awareness campaigns that focus on religious authorization to boost organ donation rates and rectify prevalent misconceptions.

The Health and Functional Age Trend Self-assessment of the Older Workers and Retirees in Ukraine from Online Data Human Health Passport in COVID-19 Pandemic

For a general health assessment of the workers in organized industries, and unorganized groups of the unemployed and retirees, systematic online health monitoring has been used. Health monitoring includes a scale assessment of functional tests. The actual state of population health is still not included in the registers of National Statistics of Ukraine for example workers, pensioners and unemployment. The purpose of the study was systemic online health monitoring, to assess the impact of professional, demographic, and socio-economic factors in the Covid-19 pandemic condition and the limited capacity of the health care system in Ukraine. Methods: The study used the intrinsic capacity assessment scales, the five-question scale to detect muscle dysfunction in older persons, as well as some questions regarding residual performance, psychophysiological methods, and characteristics of the functional age. The questionnaire Human Health Passport 1.1 includes 70 questions; 21 of them were assessed by 1 point for positive answer and zero for negative case. The screening was carried out online on social media to Internet users aged 31 to 90. In the study 377 respondents of which 83.83% were employees. The Human Health Passport screening showed reliability (Cronbach alfa = 0.737), and correlation relationships of the main estimated indicators are significant. So, 54% of respondents do need health care under a physician’s supervision. The 39% of respondents need should convey the proper individual schedule of workout and labour hours, as well as physical activity and breathing exercises because only 7% of respondents are healthy. Correlation analysis of the scale results showed a significant relationship between age, with static balancing, falls during the last 6 months, and the ability to 5 times sit to stand test within 14 seconds. The optimal management of Human Health Passport screening helps to reduce the harmful influence on the environment, and transport expenses for doctor visits and saves the doctor's time for patient examination and prevention of the exposure and the spread of COVID-19. The screening showed the existing reserves of training for health promotion and, the overstrain of the functional systems of the body in the working population - 76%—by the purpose. _________________________________________________________________________________________ Keywords: remote health screening; retirees; biological age; ageing; elderly workers

Usability of the medical mobile application for patients: Kazakhstani case

Object: Covid-19 pandemic was impact in all aspects of our life, especially digital health care. This study was aimed to examine the usability of the state medical mobile application called Damumed with neuromarketing tool – eye-tracking. Damumed is the main state health information system designed to facilitate the work of medical personnel, thereby improving the quality and accessibility of medical services for patients, where patients can find all medical appointments, health passport and all health-related information. This research is aimed to achieve SIG Goal of Good health and well-being for people.Methods. Using neuromarketing instrument with unstructured interviews to identify key features of usability aspects of the medical mobile application.Findings: Overall, 23 patients were separated into 2 age groups of young (18-24) and adults (35-44). They engaged in the study to participate both in neuromarketing research and unstructured interviews. Adults had difficulties in understanding the navigation of the app, while younger group could navigate in the app intuitively.Conclusions. Neuromarketing studies and individual interviews clarified assessing the usability of the medical mobile application interface. Since the respondents have different background, for adults it was a bit challenging to assess the app’s interface. In this respect, for older generation would a barrier to adopt this kind of information systems.

Exploring the need for an oral health passport

Exploring the need for an oral health passport

Can health passport overcome political hurdles to COVID-19 vaccination?

In this paper we examine whether a health passport that increases the cost of not getting vaccinated, can change the individual trade-off in favor of vaccination. To address this question, we study the impact of the announcement of the French health passport on factors affecting vaccine hesitancy. First, using data from a survey conducted on the eve of the announcement date, we examine the determinants of vaccine hesitancy, and find that, prior to the introduction of the health passport, political preferences were significantly associated with vaccination rates. Then, using actual district-level data, we estimate the short-term impact of the health passport announcement on weekly COVID-19 vaccination rates and show that vaccine uptake significantly increased in the overall population, and particularly among the 20 to 39-year-old cohort. Focusing on the role of political factors, we find that vaccination rates increased significantly in districts with a high proportion of far right voters, thus highlighting that the health passport reversed the impact of some extreme political preferences on vaccine hesitancy.

An agent-based secure privacy-preserving decentralized protocol for sharing and managing digital health passport information during crises.

The aim of this article is to identify a range of changes and challenges that present-day technologies often present to contemporary societies, particularly in the context of smart city logistics, especially during crises. For example, the long-term consequences of the COVID-19 pandemic, such as life losses, economic damages, and privacy and security violations, demonstrate the extent to which the existing designs and deployments of technological means are inadequate. The article proposes a privacy-preserving, decentralized, secure protocol to safeguard individual boundaries and supply governments and public health organizations with cost-effective information, particularly regarding vaccination. The contribution of this article is threefold: (i) conducting a systematic review of most of the privacy-preserving apps and their protocols created during pandemics, and we found that most apps pose security and privacy violations. (ii) Proposing an agent-based, decentralized private set intersection (PSI) protocol for securely sharing individual digital personal and health passport information. The proposed scheme is called secure mobile digital passport agent (SMDPA). (iii) Providing a simulation measurement of the proposed protocol to assess performance. The performance result proves that SMDPA is a practical solution and better than the proposed active data bundles using secure multi-party computation (ADB-SMC), as the average CPU load for SMDPA is approximately 775 milliseconds (ms) compared to about 900 ms for ADB-SMC.

“Enter with Green Code Only”

This article uses the app Health Code, a smartphone-based application for contact tracing and risk assessment that serves as a COVID-19 health passport, as an example to explore how “biometric citizenship,” a new mode of preemptive social regulation, functions and malfunctions in contemporary China. First, through a review of China's transition from socialism to neoliberalism, the authors trace how the tenet of citizenship shifts from biological/biopolitical to biometric as the party-state's agenda changes along the process. Second, drawing on media coverage and comments from social media, we show how Health Code consolidates the biometric paradigm of citizenship and turns the relatively stabilized temporal basis of biological/biopolitical citizenship into fragmented temporalities to tighten social control. This preemptive control system improves the state's acumen for self-revamping and self-preservation and enhances its capacities to harness people's re/productivities. It also disrupts the habituated way of living and further marginalizes the groups with diminishing re/productive potentialities.

Abstract 4241: Reducing your risk cancer-focused health events to meaningfully engage the medically underserved and diminish future cancer disparities

Abstract Lack of access to cancer prevention education, early screening, and timely treatment, particularly in low socioeconomic, underserved communities, are cited as substantial barriers to improving survivorship. Outreach educational efforts with on-site screenings offered in partnership with community groups are known to be valuable in encouraging community members’ uptake of healthy behaviors and adherence to screening recommendation. To create more engaging events, a community-academic partnership, We Engage 4 Health (WE4H), co-created 11 unique 4-panel comic-style stories designed to be read aloud together as attendees visit each event table. These colorful stories are shared on boards that stand on each table and are offered in both English and Spanish at this time. Many tables also have an accompanying hands-on activity. Together, they lead to meaningful “low stakes” discussions which support understanding of seemingly complex health information. Story topics include the cause of cancer (Cells Gone Wrong), cancer risk factors (Reducing Your Risk), the role of primary care in cancer screening (Primary Care for Prevention), the purpose of research (short Research Ready) and details about specific cancer types (Combatting Colon Cancer, Blocking Breast Cancer, Looking for Lung Cancer, Silencing Skin Cancer, Hindering HPV, and Professional Prostate Protection) and COVID-19 (Take Your Best Shot FAQs). A health passport is used to facilitate table visitation and survey collection at each table enables meaningful evaluation of the event as well as provides the community hosts and their partners baseline cancer data to inform future programing. In 2022, WE4H and the University of Cincinnati Cancer Center partnered with three different communities to co-host pilot events that served over 100 adult residents. Community, research interns and university students volunteered to work the tables at the event and received training prior. Post event surveys and discussions indicated that community partners appreciated the different take on a health fair event. Most volunteers indicated that they would enjoy volunteering again. Attendees indicated that they liked the graphic-style story format used and most preferred it to text and text with graphics approaches. Taken together, the data indicates that Reducing Your Risk events are useful in meaningfully engaging hard to reach, at risk attendees. Additional in-person and virtual events are being planned for 2023 as an approach to reach the medically underserved throughout our region. Citation Format: Melinda Butsch Kovacic, Susan Gertz, Lauren Bates, Susan Hershberger, We Engage 4 Health Community-Academic Partnership. Reducing your risk cancer-focused health events to meaningfully engage the medically underserved and diminish future cancer disparities. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4241.

Monitoring of training activity as a determinant of people’s health in the COVID-19 pandemic crisis

Reliable determination of metabolic and physical activity pa- rameters and influences of blood pressure indicators is relevant in the development of rehabilitation training programmes for people of all ages, especially in the context of the COVID-19 pan- demic and the aging of the working population. The purpose of the study was to determine reliable parameters that were shaping general health during the COVID-19 pandemic crisis in the age- related aspect. This study used the results of comprehensive health monitoring data of 603 adults aged 20–89 from the Human Health Passport online tool (Ukraine) for the period of 2020–2022. On- line health monitoring showed the consequences of mild forms of COVID-19 disease. The main indicators informing about this effect were the laboratory-method indicator for confirming a viral disease and the number of cases of mild forms of the dis- ease. The indirect influence of this factor on various indicators of health, physical activity, metabolism, indicators of blood pressure compensation should also be considered. As for the age aspect, the state of health had a higher influence on the indicators of body mass index (BMI), blood pressure and its correction with drugs, the daily walking distance and exercises performed, and a danger- ous loss of appetite. A noticeable drop in body weight and loss of appetite are reliable factors in the incidence of falls and decline in health. The leading factors shaping the health of the active popu- lation in mild forms of COVID-19 are physical activity (7.77%), metabolism (5.91%), and the blood pressure level (5.21%).

Health Passport: A blockchain-based PHR-integrated self-sovereign identity system

During the COVID-19 pandemic, it was necessary to validate a person’s health status along with their identity to permit travel. This was facilitated via paper-based certificates and centralized digital apps. Even after COVID-19, it is anticipated that such health status verifications will be required for travel and other purposes. As a result, there needs to be an additional credential, a “Health Passport,” that establishes whether a person satisfies the health requirements for various purposes. Digital credentials so prepared should be trustable, unforgeable, and verifiable. The Health Passport should be designed to protect the end-users’ privacy and give people control over the data they use to confirm their credentials. This article explores the requirements for a generalized Health Passport system and uses agent-oriented modeling (AOM) to design a blockchain-based self-sovereign identity (SSI) system integrated with the Personal Health Record (PHR) to address this requirement. The article demonstrates the feasibility of the solution by implementing a proof of concept on Hyperledger Indy and Aries, integrated with the PHR – MediTrans. Credential issuance and verification time were calculated, and it was observed that the time overhead was minimal. This solution allows users to verify their credentials with the verifier without revealing any significant personal information. Our solution can be integrated into any PHR solution as the SSI solution is added as a plugin to the PHR accessible via a mobile/web app.

‘It is the child with the big head’ – Primary healthcare providers’ perceptions of paediatric hydrocephalus in Blantyre, Malawi: A qualitative study

ABSTRACT Children in Africa are disproportionately burdened by the neurosurgical condition hydrocephalus. In Blantyre, Malawi, paediatric hydrocephalus represents the majority of surgical procedures performed in the neurosurgical department at Queen Elizabeth Central Hospital. To reduce morbidity and mortality, timely detection followed by referral from surrounding primary health centres is crucial. Aiming to explore perceptions and identify enablers and barriers to detection and referral, we conducted a qualitative study among primary healthcare providers (n = 30) from ten health centres in Blantyre district. Using a semi-structured interview-guide, we audio-recorded and transcribed the interviews before conducting a thematic analysis. One main finding is that there is a potential to improve detection through head circumference measurements, which is the recommended way to detect hydrocephalus early, yet healthcare providers did not carry this out systematically. They described the health passport provided by the Malawian Ministry of Health as an important tool for clinical communication. However, head circumference growth charts are not included. To optimise outcomes for paediatric hydrocephalus we suggest including head circumference growth charts in the health passports. To meet the need for comprehensive management of paediatric hydrocephalus, we recommend more research from the continent, focusing on bridging the gap between primary care and neurosurgery.