Primary Health Care Interventions Research Articles

Mitigating the impact of COVID-19 on primary healthcare interventions for the reduction of under-5 mortality in Bangladesh: Lessons learned through implementation research.

The COVID-19 pandemic posed unprecedented challenges and threats to health systems, particularly affecting delivery of evidence-based interventions (EBIs) to reduce under-5 mortality (U5M) in resource-limited settings such as Bangladesh. We explored the level of disruption of these EBIs, strategies and contextual factors associated with preventing or mitigating service disruptions, and how previous efforts supported the work to maintain EBIs during the pandemic. We utilized a mixed methods implementation science approach, with data from: 1) desk review of available literature; 2) existing District Health Information System 2 (DHIS2) in Bangladesh; and 3) key informant interviews (KIIs), exploring evidence on changes in coverage, implementation strategies, and contextual factors influencing primary healthcare EBI coverage during March-December 2020. We used interrupted time series analysis (timeframe January 2019 to December 2020) using a Poisson regression model to estimate the impact of COVID-19 on DHIS2 indicators. We audio recorded, transcribed, and translated the qualitative data from KIIs. We used thematic analysis of coded interviews to identify emerging patterns and themes using the implementation research framework. Bangladesh had an initial drop in U5M-oriented EBIs during the early phase of the pandemic, which began recovering in June 2020. Barriers such as lockdown and movement restrictions, difficulties accessing medical care, and redirection of the health system's focus to the COVID-19 pandemic, resulted in reduced health-seeking behavior and service utilization. Strategies to prevent and respond to disruptions included data use for decision-making, use of digital platforms, and leveraging community-based healthcare delivery. Transferable lessons included collaboration and coordination of activities and community and civil society engagement, and investing in health system quality. Countries working to increase EBI implementation can learn from the barriers, strategies, and transferable lessons identified in this work in an effort to reduce and respond to health system disruptions in anticipation of future health system shocks.

IDF23-0537 Design of Lifestyle Intervention in Primary Health Care: the ePREDICE, Poland

IDF23-0537 Design of Lifestyle Intervention in Primary Health Care: the ePREDICE, Poland

Changes in nonalcoholic fatty liver disease and M2BPGi due to lifestyle intervention in primary healthcare.

A healthy lifestyle is the most important method for managing nonalcoholic fatty liver disease (NAFLD). Mac-2-binding protein glycosylated isomer (M2BPGi) has been suggested as a biomarker for NAFLD. This study aimed to determine the efficacy of personalized lifestyle interventions on NAFLD remission. This single-arm intervention study recruited participants with NAFLD who underwent health checkups at seven health-promotion centers in five South Korean cities. Fatty liver diagnosis was based on ultrasonography (US). The 109 individuals were recruited for personalized lifestyle interventions of hypocaloric diets and exercise. The participants attended the lifestyle intervention programs once per month for the first 3 months, and once every 3 months for the subsequent 6 months. In addition to sessions through center visits, phone-based intervention and self-monitoring at 4-, 5-, 7-, and 8-month were provided during the 9-month intervention period. And phone-based self-monitoring were also provided monthly during the 3-month follow-up period. The primary outcome was NAFLD remission at month 12 as measured on US and magnetic resonance elastography. The secondary outcomes were the changes in metabolic factors and M2BPGi. The 108 individuals (62 males and 46 females; age 51.1±12.4 years, mean±standard deviation) were finally analyzed after the 12month intervention. Body mass index, waist circumference (WC), blood pressure, blood lipids (total cholesterol, triglycerides, and HDL-C), and fasting blood sugar levels were improved relative to baseline (all P<0.05). Fatty liver at or above the moderate grade according to US was decreased at month 12 relative to baseline (67.6% vs 50.9%) (P = 0.002). M2BPGi levels decreased during the 12-month study period (P<0.001). M2BPGi levels were moderately correlated with hepatic fat fraction by magnetic resonance imaging (r = 0.33, P = 0.05). WC (OR = 0.82, 95% CI = 0.67-1.00, P = 0.05) and HDL-C (OR = 1.17, 95% CI = 1.03-1.32, P = 0.014) were associated with remission of fatty liver in the multivariate analysis. The personalized lifestyle intervention was effective in improving fatty liver and metabolic factors, but not hepatic stiffness, in NAFLD. ICTRP, cris.nih.go.kr (KCT0006380).

A Descriptive Cross-Sectional Study to assess the Practice of Home Visiting by Axillary Nurse &amp; Midwife (ANM) as a Primary Healthcare Intervention in a rural area of Aligarh, Utter Pradesh.

Home visit is an integral component of PHC delivery system. It is preventive and promotes health practice where health professionals render care to clients in their own environment and provide appropriate healthcare needs and social support services. This study describes the home visit practices in a rural area of Aligarh in the UP. Methodology. This descriptive cross-sectional study used 375 households and 11 ANM’s in the Aligarh district. Multistage sampling techniques were used to select 10 communities and study respondents using probability sampling methods. A pretested self- designed questionnaire and an interview guide for household members and community health nurses, respectively, were used for data collection. Quantitative data collected were coded, cleaned, and analyzed using Statistical Package for Social Sciences into descriptive statistics, while qualitative data were analyzed using the NVivo software. Thematic analysis was engaged that embraces three interrelated stages, namely, data reduction, data display, and data conclusion. Results. Home visit is a routine responsibility of all ANMs. The factors that influence home visiting were community members’ education and attitude, supervision challenges, lack of incentives and lack of basic logistics, uncooperative attitude, community inaccessibility, financial constraint, and limited number of staff. Household members (62.3%) indicated that health workers did not had attend to minor ailments as 78% benefited from the service and wished more activities could be conducted to the home visiting package (24.5%). Conclusion. There should be tailored training of ANMs on home visits skills so that they could expand the scope of services that can be provided. Also, community-based health workers such as community health volunteers, birth attendants, and community clinic attendants can also be trained to identify and Address health problems in the homes.

Symptom burden and follow-up of patients with neck and back complaints in specialized outpatient care: a national register study

Back and neck pain are common in the population, especially among immigrants. In Norway's specialist care system, treating these patients typically involves a multidisciplinary approach based on the biopsychosocial model. However, language and cultural differences may create barriers to participation. Immigrants are often underrepresented in clinical studies, but a register-based approach can enhance their participation in research. This study aimed to compare both the symptom burden, and treatment, among Norwegians, non-Norwegians, and patients requiring translator service for back and neck pain within the Norwegian specialist care system. The Norwegian neck and back registry is a National Quality Register, established in 2012 and fully digitized in late 2020. The baseline data includes demographics and patient recorded outcome measures including Oswestry Disability Index, Fear-Avoidance Beliefs, pain rating on a numeric rating scale, Hopkins Symptom Checklist and EuroQol five-dimensional questionnaire on health related quality of life. During the two-year study period, a total of 14,124 patients were invited, and 10,060 (71%) participated. Norwegian patients reported less pain, better function assessed by Oswestry Disability Index, lower fear avoidance beliefs, less emotional distress, and higher health related quality of life compared to non-Norwegians. We found that patients with female gender, who were younger, more educated and exhibited fear-avoidance behavior were significantly more likely to receive multidisciplinary treatment. We found no difference in the proportion of Norwegian and non-Norwegian patients receiving multidisciplinary treatment [odds ratio (OR) 1.02 (95% confidence interval (CI) 0.90–1.16)]. However, patients needing a translator were less likely to receive multidisciplinary treatment compared to those who didn't require translation [OR 0.41 (95% CI (0.25–0.66)]. We found that non-Norwegian patients experience a higher symptom burden compared to Norwegian. We found that both non-Norwegians and patient in need of translator were to a greater extent recommended treatment in primary health care. The proportion of non-Norwegians patients receiving multidisciplinary treatment was similar to Norwegians, but those needing a translator were less likely to receive such treatment.

The Role of Primary Healthcare in Improving the Maternal and Infant Mortality in Pakistan

Background: Maternal and neonatal mortality remains a significant public health challenge globally, particularly in countries like Pakistan, which exhibit some of the highest rates of such mortalities. Effective primary healthcare interventions are crucial for mitigating these rates, focusing on enhancing the quality of care provided to mothers and newborns. Understanding the scope and impact of these interventions can inform future strategies to improve maternal and neonatal health outcomes. Objective: This review aims to evaluate the existing literature on primary healthcare interventions targeting maternal and neonatal mortality, identifying the types of interventions employed, their focus areas, and the outcomes achieved, with a specific interest in the context of Pakistan. Methods: A scoping review methodology was employed, analyzing studies that investigated primary healthcare interventions designed to reduce maternal and neonatal mortality. The review included studies published in English, utilizing a mix of research methodologies, and focused on interventions such as morbidity and mortality review processes, healthcare worker training, and community engagement strategies. Databases searched included Google Scholar, OVID, and the WHO Global Health Library, among others. Results: Out of 25 studies reviewed, a majority concentrated on healthcare team and program-level interventions rather than systemic healthcare reforms. Key areas of focus included enhancing review processes for maternity and neonatal care, training and education for healthcare workers, and community development initiatives. However, there was a noted lack of interventions directly improving the healthcare experiences of mothers and newborns. Mixed methods were the most common research approach, aligning with the complexity of evaluating health system interventions. Conclusion: To improve maternal and neonatal health outcomes in Pakistan, a comprehensive approach addressing the entire health system is required. This involves not only focusing on the delivery of healthcare services but also incorporating community insights, continuous education programs, and leadership modifications in healthcare services. Future strategies should prioritize the application of standardized and relevant methods to enhance the quality of maternity and newborn care initiatives, aiming for scalable improvements in healthcare outcomes.

The feasibility of an exercise intervention after robotic-assisted radical cystectomy for urinary bladder cancer, prior to the CanMoRe trial.

Complications after radical cystectomy for urinary bladder cancer are common. Physical activity after surgery is thought to reduce complications. However, patients with urinary bladder cancer have low levels of physical activity, and interventions supporting physical exercise are needed. This study aimed to evaluate the feasibility of a physical exercise intervention in primary health care. One of the aims of the larger clinical trial will be to reduce complications. Patients with urinary bladder cancer and who were scheduled for a robotic-assisted radical cystectomy were recruited from Karolinska University Hospital, between February and May 2019. The patients had to be mobile, understand Swedish, and live in Stockholm. The exercise programme was conducted at one primary health care setting over 12weeks. The exercise programme included supervised aerobic and strengthening exercises, which were performed twice a week, as well as daily walks. Feasibility was measured with process feasibility, including eligibility criteria, adherence, and acceptability, and scientific feasibility, including the ability of outcomes to indicate change, safety, and progression in the exercise programme. Ten patients with a median age of 70years (min 53-max 86) were included. Adherence to all parts of the intervention was not feasible because of patients' postoperative complications, resulting in dropouts. For the patients who took part in the exercise programme, adherence and acceptability for the exercise period were feasible, but the 6-min walk test was not feasible at discharge from the hospital. Physiotherapists in the primary health care setting perceived the process as feasible. Moreover, the ability of outcomes to indicate change and progression in the exercise programme was feasible, meanwhile no adverse events were registered. The exercise intervention was feasible for the patients that took part in the exercise programme, with respect to safety and progression through the exercise programme. Furthermore, this study suggests that some improvements needed to be implemented in the process, prior to the upcoming randomised controlled trial.

Construção e validação do questionário de percepção dos Agentes Comunitários de Saúde sobre condições sensíveis à fisioterapia na Atenção Primária

Abstract Introduction Community health workers, like the physiotherapist, perform essential functions in primary health care, being an important element in the transformation of public policies. There are no reported studies investigating the knowledge of community health workers about health conditions amenable to physiotherapy intervention in primary health care. Objective To construct a questionnaire to investigate the perception of community health workers about health conditions that could be remedied by physiotherapy intervention in primary health care. Methods This was a methodological study in which it was initially an analysis matrix with the aim of encompassing the ideas contemplated in the questionnaire. To construct the instrument, a literature review was carried out, and health conditions treatable with physiotherapy in primary health care were chosen. To validate the content and appearance of the items, twelve physiotherapists specialized in primary health care judged the suitability of the items contained. The content validity index was used to determine the degree of agreement during the response analysis process. Subsequently, a semantic analysis was carried out through the understanding of the items by 15 community health workers. In the validation stage, two rounds of evaluation were carried out. Adjustments were made to 17 questions. Results The study investigated a questionnaire with 20 questions containing hypothetical situations of home visits, in which the resident's situation could or could not constitute a health risk amenable to physiotherapeutic intervention. Conclusion The community health workers perception instrument on health conditions amenable to physiotherapy intervention in primary health care proved to be valid for use in this context. The use of the instrument may contribute to the development of community health worker training programs, with the aim of facilitating team communication.

"OpenWHO" SEARO NCD PEN-HEARTS Courses: Training 10000 Health Care Providers in 100 Countries in 100 Days.

Enhancing health-care workforce capacity in primary care settings is critical for delivering quality care to individuals with noncommunicable diseases (NCDs). Despite significant resources allocated to traditional face-to-face training methods, challenges persist in terms of scale, coverage, training material standards, and availability of trainers across different domains. Self-paced learning through an accessible platform with evaluation is a feasible option to overcome these challenges. Taking advantage of the technology and reach of the OpenWHO platform, the WHO South-East Asia Region developed four SEARO NCD PEN-HEARTS courses. Content was adapted from WHO guidance to low- or middle-income countries context. These courses cover NCD service planning, primary health-care interventions, diabetic foot care, and palliative care. The courses target primary health-care managers tasked with planning, training, implementing, and monitoring NCD health services. This is the first set of OpenWHO courses on NCD services for primary health-care launched on October 26, 2023. Courses were rolled out through WHO country offices in SEAR. WHO staff in HQ and regions were also informed. SEAnetNCD network which includes 10 institutions from eight countries of Southeast Asia, with more than 100 members were appraised of the courses through a web-based meeting. In addition, social media platforms such as Facebook, Twitter, LinkedIn, and WhatsApp groups were used extensively. We observed a high level of interest and uptake for the courses. Within 100 days, the four courses had 18,250 enrolments with 12,090 unique users. More than 75% of users were in the 20-39 age group and covered diverse areas of work, ranging from health professionals, students, public health experts, national health ministries, and United Nations staff. Over 7,000 certificates have been awarded through graded assessments with average scores of 75%. Such courses of short duration focusing on specific skills and built with WHO guidance can be a solution to addressing gaps in capacity building.

Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial

ObjectivesTo estimate the cost-effectiveness of a primary care intervention for male lower urinary tract symptoms (LUTS) compared with usual care.DesignEconomic evaluation alongside a cluster randomised controlled trial from a UK...

Family Coping Strategies and Quality of Life of Patients with Type-2 Diabetes Mellitus in Primary Health Care in Indonesia

Background: The intricate caregiving responsibilities undertaken by family caregivers in the care of patients with chronic diseases induce stress, potentially reducing the family’s ability to provide effective care. In instances where family caregivers of patients with type-2 diabetes mellitus (T2DM) are unable to employ effective coping mechanisms, there exists the potential for an adverse impact on the patient’s quality of life. Purpose: This study aimed to analyze the relationship between family coping strategies and the quality of life of patients with T2DM undergoing treatment in primary health care in Malang, Indonesia. Additionally, it sought to investigate the influence of demographic factors on both family coping strategies and the quality of life of these patients.Methods: The study employed an observational analytic design with a cross-sectional approach. The participants included 327 individuals with T2DM and 327 family caregivers, selected from 16 primary healthcare centers using cluster random sampling techniques. Data were collected using the COPE Brief questionnaire to assess coping strategies and the DQOL (Diabetes Quality of Life) questionnaire to measure the quality of life. Statistical analysis was conducted using the Spearman rank test and multivariable logistic regression. Results: The findings of the study revealed that a majority of family caregivers employed adaptive coping strategies (93.9%), while a significant proportion of individuals with T2DM reported having a good quality of life (84.1%). The analysis demonstrated a positive relationship between family coping strategies and the quality of life among T2DM patients. Specifically, better family coping strategy was associated with higher quality of life in T2DM patients (p=0.000; r=0.447; α=0.05). Also, a comprehensive demographic analysis revealed that education significantly influences both the variables of family coping strategies and patient quality of life, with odds ratios of 1.284 and 1.561, respectively.Conclusion: The research findings emphasize the mutual influence between family coping strategies and quality of life of T2DM patients. Nurses should prioritize attention to demographic factors such as education, age, gender, and duration of diabetes to enhance family coping strategies and improve the patients’ quality of life.

Exploring Factors Shaping Primary Health Care Readiness to Respond to Family Violence: Findings from a Rapid Evidence Assessment

Abstract Purpose Family violence (FV) is defined as any situation where an individual employs abusive behaviour to control and/or harm a former or current spouse, non-marital partner, or a member of their family. The health consequences of FV are vast, including a wide range of physical and mental health conditions for individuals experiencing violence or survivors, perpetrators, and their children. Primary health care (PHC) is recognized as a setting uniquely positioned to identify the risk and protective factors for FV, being an entry point into the health care system and a first, or only, point of contact for families with professionals who can facilitate access to specialist care and support. Methods A rapid evidence assessment of empirical studies on FV interventions in PHC was conducted to examine outcomes of effective FV interventions that promote identification, assessment, and care delivery within diverse PHC settings, factors shaping PHC provider and system readiness, and key intervention components that are important for sustaining PHC responses to FV. After completing data extraction, quality appraisal, and a hand search, a total of 49 articles were included in data synthesis and analysis. Results Several FV interventions that include multiple components such as, screening and identification of FV, training of PHC providers, advocacy, and referrals to supports, have been rigorously tested and evaluated in diverse PHC settings in rural and urban areas including primary care/family medicine practice clinics and community PHC centers. These interventions have demonstrated to be effective in identifying and responding to violence primarily experienced by women. There is a dearth of FV interventions or programs from empirical studies focused on men, children, and perpetrators. Additionally, provider and system readiness measurement tools and models have been implemented and evaluated in PHC specifically to assess physician or the health care team’s readiness to manage FV in terms of knowledge and awareness of FV. The findings highlight that there is no clear or standardized definition of provider or system “readiness” in the literature related to FV responses in PHC. Further, the findings revealed four key intervention components to facilitate PHC provider and organization readiness to address FV: (1) multidisciplinary teamwork and collaboration, (2) improving provider knowledge on the social and cultural determinants impacting FV, and (3) embedding system-level supports within PHC. Conclusions FV is a serious public health concern and PHC providers have a vital role in early detection of FV and the poor health outcomes associated with violence A focus on comprehensive or multi-component FV interventions are more likely to change provider behavior, and would allow for safe, confident, and professional identification and assessment of FV within PHC.

Hospitalizations for congenital syphilis in children under one year old in the state of Pará, Brazilian Amazon: ecological study

BackgroundThe high incidence of congenital syphilis shows flaws in the resolution of primary health care, being a predictor of greater use of hospital services, whose regional differences in access to health actions and services may be reflected in health inequalities.Objectiveto investigate hospitalizations due to congenital syphilis in children under one year of age, in the state of Pará, Brazilian Amazon.Methodsan ecological study was carried out, using hospitalization, lethality and mortality rates related to congenital syphilis in children under one year of age. Temporal analysis and mapping of hospitalization flows were carried out using Joinpoint®, version 4.7.0.0, Terraview 4.2.2, Tabwin 4.1.5.ResultsA total of 6,487 hospitalizations were recorded. For the ten years of the study period (2009 to 2018), the lethality rate showed a decreasing trend of – 13.5% (p = 0.01). The crude hospitalization rate showed an increasing trend of 12.8% (p < 0.000. The regression analysis demonstrated that there was a change point in the trend with a significant growth of 12.8% until 2016 (p = 0.0006). In the mortality rate the trend was stable (p = 0.56). The analysis of hospitalization care flows made it possible to identify that most hospitalizations due to congenital syphilis occurred in the municipalities of residence, but 1,378 (21.2%) had to move. Two large care gaps were highlighted in Metropolitan health regions II and III, belonging to macroregion II. The hospitalizations of residents of these regions were carried out by the assistance networks of Belém (capital) and Marituba, both of which are part of Metropolitana I. Residents of macroregions III and IV had the greatest distances traveled to access hospital care.ConclusionsThe increase in the rate of hospitalizations with an increasing trend demonstrates the impact that syphilis still causes in Brazil, not being resolved even after national government interventions in primary health care, but there was a decreasing trend in the fatality rate. The results demonstrate a heterogeneous organization of health care networks in the state’s health regions and macroregions.

The effect of primary healthcare on mortality: Evidence from Costa Rica

This paper uses the gradual implementation of a primary healthcare (PHC) intervention in Costa Rica to examine the long-term effect of PHC on mortality. Nine years after opening a primary care center, known as a Health Area, there was an associated 13% reduction in age-adjusted mortality rate in the assigned patient population. The effect was highest among adults over 65 years of age and for those with noncommunicable diseases, such as cardiovascular-related causes of death. We also show that as Health Areas opened, more individuals sought care at primary care clinics, while fewer sought care at emergency rooms; these changes may have partially mediated the effect of the intervention on mortality.

I-MoMCARE: Innovative Mobile Technology for Maternal and Child Health Care in Cambodia—study protocol of a cluster randomized controlled trial

BackgroundThe Government of Cambodia established the village health support groups (VHSGs) in 2003 to facilitate primary healthcare activities, including maternal and child health (MCH) services. However, VHSGs face several challenges that hinder them from performing optimally, including a lack of regular structured training and remuneration and limited and inconsistent support and supervision from the health centers (HCs). This implementation research aims to develop, implement, and evaluate a digital health intervention to improve the performance of VHSGs through better support and supervision and increase the MCH service coverage in rural Cambodia.Methodsi-MoMCARE, a two-arm cluster randomized controlled trial, will be conducted between 2022 and 2025. Five operational districts (ODs) have been randomized to an intervention arm and the other five ODs to the control arm. The intervention will last for 24 months. Around 200 VHSGs in the intervention arm will be equipped with a mobile application as a job aid and 20 HC staff with a web interface to improve support and supervision of VHSGs. The potential beneficiaries will include pregnant women, mothers, and children under 2 years old. We will measure the outcomes at baseline and endline. The primary outcomes will consist of a composite MCH index constructed from maternal and newborn care indicators, child immunization, and treatment of under-two children. Secondary outcomes will include coverage of selected MCH services. We will conduct the intention-to-treat and per-protocol analyses. We will conduct qualitative interviews with selected beneficiaries and stakeholders to evaluate the intervention’s acceptability, feasibility, and scalability. We will also conduct a cost-effective analysis using decision-analytic modeling incorporating a societal perspective that explores different time horizons, intervention effects, and when scaled up to the national level.Discussioni-MoMCARE is expected to increase MCH service access and coverage in rural Cambodia. It will contribute to advancing digital health use in primary healthcare interventions, which remains in its infancy in the country. Furthermore, the study findings will be a valuable addition to a growing body of literature on the effectiveness and feasibility of mobile health to improve coverage of MCH services in rural low- and middle-income country settings.Trial registrationClinicalTrial.gov NCT05639595. Registered on 06 December 2022.

Implementability of multicomponent interventions in Primary Care: an overview of systematic reviews

Abstract Background Literature defines “implementability” as the likelihood that a given evidence-based intervention (EBI) will be adopted into routine practice. As time goes by, EBIs delivered in Primary Health Care (PHC) increasingly consist of multicomponent interventions aimed at promoting active ageing in the elderly. The aim of this review is to identify a conceptual framework that uses implementation outcomes (acceptability, fidelity, feasibility, implementation cost, appropriateness, and sustainability) to guide the implementability of multicomponent PHC interventions in the elderly population. Methods An overview of systematic reviews was conducted through PubMed, CINAHL, Scopus, Web of Science, PsycInfo, Conchrane Library including articles based on the following criteria: (1) individuals ≥65 years; (2) including multicomponent PHC interventions (3) including a framework to assess implementability. Methodological quality of systematic reviews was evaluated using the AMSTAR 2. Results Of the 14,984 articles identified, twenty-six reviews met the inclusion criteria. The characteristics of the identified conceptual frameworks included multicomponent PHC interventions based on the use of technology (n = 16) and aimed at preserving cognitive function (n = 12); The most considered implementation outcomes were: feasibility (n = 21) and implementation costs (n = 17). The RE-AIM and PRISM integrated framework were identified in five systematic reviews used to implement preventive interventions (cognitive function and physical activity) for community-dwelling older adults. Conclusions RE-AIM and PRISM are a widely used model for assessing the impact of EBIs on public health and policy. The use of this framework occurs after EBI realization, so the next steps of our research will aim to test this framework on an elderly-focused health intervention delivered in Italy through the Next Generation EU fund and to develop a revised version for use in multicomponent PHC interventions. Key messages • Identifying a framework to help guide the implementation of multicomponent PHC interventions facilitates the application of evidence-based intervention in routine practice. • RE-AIM and PRISM are a widely used framework that may help evaluate implementation outcomes.

Community health workers in clinical research at the example of a phase IIIb/ IV antimalarial drug trial conducted in five African countries

Global health, particularly in underserved settings can benefit immensely from well-trained community health workers (CHWs) supporting primary healthcare interventions. They can reduce morbidity and mortality of infectious diseases like malaria. Disease control programs can particularly benefit from a tight link between CHWs and communities and several studies have shown the benefit of the participation of non-facility-based CHWs in malaria control program activities for reducing malaria-related mortality in children. Because CHWs are often part of and trusted by served communities, they can also be an important resource to address challenges faced by their communities. Where post-marketing surveillance systems are underserved, they can relay important information about suspected safety signals and factors affecting therapeutic effectiveness in their communities. The CANTAM-Pyramax® trial was a phase IIIb/ IV cohort event monitoring study conducted at six centers in five African countries. To assess real-world effectiveness and safety of the anti-malarial pyronaridine-artesunate in 8560 malaria episodes, follow-up was not primarily conducted by medical staff but by specifically trained CHWs. This perspective paper discusses how the participation of a CHW workforce can be of benefit for effectiveness trials in limited-resource settings, using the example of the CANTAM-Pyramax trial.

Analyzing COVID-19 Vaccination Side Effects Among the Adult Population in Jeddah, Saudi Arabia.

The COVID-19 pandemic has brought vaccination to the forefront of global attention. The Pfizer-BioNTech vaccine, an mRNA vaccine that encodes the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) glycoprotein spike, has emerged as a significant player in global vaccination efforts. It is generated from lipid nanoparticles and has been subject to various regulatory approvals and authorizations. The United Kingdom became the first country to approve the Pfizer vaccine on December 2, 2020. The World Health Organization (WHO) authorized the emergency use of the Pfizer vaccine on December 31, 2020, facilitating its production and distribution worldwide. In Saudi Arabia, as well as globally, concerns about the safety and effectiveness of vaccines have been raised. Several studies have reported side effects of the Pfizer vaccine, including rare conditions such as myocarditis. In our study, we aimed to systematically investigate the symptoms experienced after vaccination, considering the administration of three doses. We also explored the duration of these symptoms and whether they necessitated hospital visits, primary healthcare interventions, or resolved on their own. Our study employed an online cross-sectional design conducted in Jeddah, Saudi Arabia, utilizing an online self-reported survey. A total of 332 participants who met the predefined criteria were recruited for the study. The rate of COVID-19 infection after 1st and 2nd doses of Pfizer and AstraZeneca vaccines was significantly lower in middle-age subgroups (31-45 years), in comparison to young (18-30 years) and upper middle-age subgroups (46-60 years). For the AstraZeneca vaccine, the infection rate in the middle-aged group was higher after 2nd dose as compared to its 1st dose. Overall, greater infection rates were observed in upper-middle-aged subgroups with all doses of Pfizer and AstraZeneca vaccines. Fatigue and fever were the most common generalized side effects while redness/swelling/pain at the injection site, muscle pain, and joint pain were the most important local side-effects. Fatigue, fever, muscle pain, and joint pain were significantly common after 1st dose of Pfizer and fever was a significant side effectafter 2nd dose of Pfizer in comparison to AstraZeneca doses. Understanding the spectrum of side effects associated with the vaccine is crucial for healthcare professionals and individuals receiving the vaccine, as it enables informed decision-making and appropriate management of potential adverse reactions.

Hearing Loss in the Elderly: A Proposal for Intervention in Primary Health Care

To evaluate the performance of professionals regarding knowledge about hearing loss in the elderly, through theoretical and practical training by a speech therapist. An intervention study was carried out with 87 Primary Health Care professionals in a municipality of Brazil. A survey of the participants’ knowledge related to hearing loss was performed using a data collection instrument composed of items related to both sociodemographic conditions and specific questions concerning the topic. This instrument was applied in two stages: before training and after training. The participants’ performance in relation to knowledge about hearing health was estimated by subtracting the post-training score from that obtained in pre-training. Participants were classified in higher performance (≥4 points) and lower performance (&lt;4 points) groups. Other variables were collected: sex, age, occupation, schooling level, and length of professional service in health. The performance comparison estimated mean and the 95% confidence interval were calculated by the aforementioned variables using Student’s t-test. A comparison of these variables with higher performance was conducted using the X2 test with a significance level of 5%. After training, there was an increase in the average performance of about 30% ( p &lt; .01). The highest performance was more frequent among professionals who reported having high school and below levels of education ( p &lt; .01) and who were community health agents ( p = .01). The performance of the professionals regarding their knowledge about screening for hearing loss increased. The training showed low complexity and was feasible for health professionals.

An evidence-based primary health care intervention to address domestic violence against women in Brazil: a mixed method evaluation

BackgroundHealth systems have a critical role in a multi-sectoral response to domestic violence against women (DVAW). However, the evidence on interventions is skewed towards high income countries, and evidence based interventions are not easily transferred to low-and middle-income countries (LMIC) where significant social, cultural and economic differences exist. We evaluated feasibility and acceptability of implementation of an intervention (HERA—Healthcare Responding to Violence and Abuse) to improve the response to DVAW in two primary health care clinics (PHC) in Brazil.MethodsThe study design is a mixed method process and outcome evaluation, based on training attendance records, semi-structured interviews (with 13 Primary Health Care (PHC) providers, two clinic directors and two women who disclosed domestic violence), and identification and referral data from the Brazilian Epidemiological Surveillance System (SINAN).ResultsHERA was feasible and acceptable to women and PHC providers, increased providers’ readiness to identify DVAW and diversified referrals outside the health system. The training enhanced the confidence and skills of PHC providers to ask directly about violence and respond to women’s disclosures using a women centred, gender and human rights perspective. PHC providers felt safe and supported when dealing with DVAW because HERA emphasised clear roles and collective action within the clinical team. A number of challenges affected implementation including: differential managerial support for the Núcleo de Prevenção da Violência (Violence Prevention Nucleus—NPV) relating to the allocation of resources, monitoring progress and giving feedback; a lack of higher level institutional endorsement prioritising DVAW work; staff turnover; a lack of feedback from external support services to PHC clinics regarding DVAW cases; and inconsistent practices regarding documentation of DVAW.ConclusionTraining should be accompanied by system-wide institutional change including active (as opposed to passive) management support, allocation of resources to support roles within the NPV, locally adapted protocols and guidelines, monitoring progress and feedback. Communication and coordination with external support services and documentation systems are crucial and need improvement. DVAW should be prioritised within leadership and governance structures, for example, by including DVAW work as a specific commissioning goal.