Non-physician Health Workers Research Articles

The effect of results-based motivating system on metabolic risk factors of non-communicable diseases: A field trial study.

Non-communicable diseases can be controlled and managed by reducing their associated metabolic risk factors. In this study, a set of intervention packages were designed to reduce the prevalence of three common metabolic risk factors (hypertension, hyperlipidemia, and obesity and overweight) in the community by motivating non-physician health workers. A field trial study was conducted in 4 districts of Iran. Thirty-two community health centers were randomly selected. A survey of 30 to 70-year-old was conducted to measure baseline metabolic risk factors. The intervention packages focused on improving hypertension, hyperlipidemia, obesity and overweight. The interventions included goal-setting, evidence-based education, operational planning, and incentive payments for non-physician health workers. A second survey to measure the final metabolic risk factors was performed after one year. The difference-in-difference method was used to evaluate the effectiveness of the intervention packages. The average age of participants in both surveys was 49 years. The interventions had statistically significant effects only on decreasing the prevalence of overweight and obesity. The package with all the interventions except pay-for-performance decreased the odds of overweight and obesity to 0.57 (95% CI: 0.34, 0.95). Involving non-physician health workers and having action plans based on the health needs of the covered population can decrease obesity and overweight in the community. However, longer trials are needed to observe the effects on hypertension and hyperlipidemia.

Debate: Bridging the gap - role of nonspecialists in child and adolescent mental health care.

The first point of contact for patients and families seeking professional help for health problems is often in nonspecialist community healthcare settings that vary widely across the countries in funding sources, resources and support from specialist services. They typically involve general practitioners, family physicians, general and community paediatricians, and nonphysician health workers such as nurses, social workers and public health professionals. This article discusses the role of nonspecialists in addressing the challenges of limited resources in Child and Adolescent Mental Health (CAMH) care services as healthcare systems struggle to meet the high demand. Stakeholders and decision-makers need to reconsider traditional healthcare models and service delivery. Integrating nonspecialist community care can be a potential solution but is beset with ethical, geopolitical, practical and economic challenges. The urgency and complexity of the issue are highlighted, emphasising the need for global discussion around CAMH care.

P038 DIAGNOSIS AND TREATMENT OF HYPERTENSION BY NON-PHYSICIAN HEALTHCARE WORKERS UNDER REMOTE SUPERVISION OF PHYSICIANS IS FEASIBLE AND EFFECTIVE IN RURAL BANGLADESH: PRELIMINARY RESULTS FROM CB-HEARTS PILOT STUDY

Background and Objective: In rural Bangladesh, there are multiple barriers to receiving treatment for hypertension, including distant healthcare facilities [Upazila Health Complex (UHC)] and inadequate numbers of physicians. This pilot aimed to design and assess the feasibility of implementing a community-based (CB) WHO HEARTS package involving non-physician health workers (Community Healthcare Providers [CHCP]) for diagnosing and treating hypertension who are remotely supervised, using telemedicine, by a UHC physician. Methods We are conducting this single-arm pilot study in four Community Clinics (CC) in rural Bangladesh. We included patients with untreated hypertension (blood pressure [BP] 140-180/90-110 mmHg). We excluded patients with diabetes, pregnancy, and cardiovascular and kidney diseases. The CB-HEARTS package intervention components were 1) simplified treatment protocol, 2) reliable medication supply, 3) team-based care, 4) standardized follow-up, and 5) a mobile app to track patients’ BP control. After assessing eligibility, CHCPs from the CC communicated with designated physicians at UHC to confirm hypertension diagnosis and to start anti-hypertensive medications in the CC. Patients with BP controlled (<140/90 mmHg) during follow-up were provided a refill for 3 months. Patients with complications or uncontrolled BP, even after the maximum allowable dose, were referred to the UHC. Outcomes were enrollment and follow-up rates (primary), BP change from baseline and hypertension control (secondary). Results: We screened 4,220 adults, of whom 531 were eligible for the study and 220 were enrolled (Table; mean age 55.9 years, 75.9% female). Enrollment (41.4%) and follow-up within 3 months of enrollment (93.6%) rates were high. Mean systolic and diastolic BP were 153 and 92 mmHg at enrollment, respectively. BP was lowered by 31 mmHg systolic and 15 mmHg diastolic after a mean of 84 days follow-up. After this follow-up duration, 90% of participants had their BP controlled. Conclusions: This pilot study provides evidence that hypertension care provided by non-physician health workers under remote supervision of physicians in rural Bangladesh is feasible and may effectively lower BP and improve hypertension control. Table: Participant screening, enrollment, and follow-up

P019 HYPERTENSION PREVALENCE, HEALTH POLICY, AND GUIDELINES MAPPING: A COMPARATIVE ANALYTIC STUDY ACROSS NINE AFRICAN COUNTRIES 2024

Background: Hypertension, a global burden, increases mortality from cardiovascular and kidney diseases. Worldwide, in 2019, an estimated 1.3 billion adults developed hypertension. In Africa, the cumulative estimated prevalence of hypertension is ∼30.8%. Main Objective: To perform a comparative analysis between African countries focusing on hypertension prevalence, health policy, and guidelines mapping. Methods: A descriptive comparative analytic study compared hypertension data from nine African countries: Eswatini, Ethiopia, Ghana, Kenya, Malawi, Nigeria, Somalia, South Sudan, and Sudan, in 2024. Data included hypertension prevalence, health policy, guidelines’ mapping, and hypertension management responses. Mixed statistical methods of content analysis, percentages, means, and Spearman's correlations were used. Results: Hypertension prevalence varied from 27% in Ethiopia to 43% in Eswatini. Females consistently had higher prevalence than males, 30% in Ethiopia to 47% in Eswatini, suggesting gender-specific risk factors or disparities in healthcare access/utilization. Sudan had the second-highest prevalence 44%. Eswatini implemented strong blood pressure control measures, unlike Sudan. High prevalence was also found in countries with strong policies (Eswatini, Kenya, Nigeria, South Sudan), suggesting urgent improved healthcare delivery, policy enforcement, and addressing other risk factors. Ghana and Somalia had lower hypertension prevalence, though fewer policies. Spearman's test showed strong negative correlations between national responses and hypertension prevalence. Salt Intake Surveys had the strongest negative correlation (-0.707) with hypertension prevalence, highlighting countries like Ethiopia and Malawi with salt intake surveys and lower prevalence, reinforcing dietary factors’ effectiveness in managing hypertension. Kenya, Nigeria, and Ethiopia leverage trained non-physician health workers in hypertension management, thereby, improving treatment access and adherence. Treatment guidelines were moderately negatively correlated (-0.335) with hypertension prevalence. The mere presence of guidelines is insufficient, signifying their implementation and enhancement with targeted interventions Conclusions: These findings highlighted the multifaceted nature of hypertension in African countries which requires comprehensive approaches encompassing considerations of gender, socioeconomic factors, lifestyle, salt reduction, policy implementation, healthcare access, and a unified African hypertension guideline.

The development of Africa's first unified hypertension management guidelines.

Hypertension is a leading cardiovascular risk factor, contributing significantly to morbidity and mortality in Africa. The continent is plagued with a high incidence, coupled with low treatment and control rates. The causes are multifactorial, and among the major causes is an absence of standardized African guidelines for the management of hypertension. Systems of care vary across the continent, with low-income countries having less care than middle-income countries. International guidelines include recommendations for Black populations, but do not account for the cultural and sociodemographic situation of the African. There is therefore the need for African guidelines based on local data to improve the quality of hypertension care. These guidelines will cover the clinical approach to hypertension and its complications at facilities with physicians and nonphysician health workers (NPHW). It will also proffer suggestions for policies to improve the care for patients with hypertension on the continent.

Evaluating the Effectiveness of African School of Hypertension for Non-Physician Health Workers, a Qualitative Study: QuASH Hypertension Study.

The implementation of task sharing and shifting (TSTS) policy as a way of addressing the shortage of physicians and reducing the burden of hypertension in Africa birthed the idea of the African School of Hypertension (ASH). The ASH is saddled with the responsibility of training non-physician health workers across Africa continent in the management of uncomplicated hypertension. To get feedback from some faculty members and students who participated in the first ASH programme. This was a cross-sectional exploratory qualitative study conducted among eight students and eight faculty members. Feedback from the program was obtained by conducting in-depth interviews centred on description of course content; expectations and knowledge acquired from ASH; level of interaction between students and faculty members; challenges faced during the ASH; level of implementation of acquired training; and suggestions to improve subsequent ASH programs. The course content of the ASH was described as simple, appropriate and adequate while interaction between students and faculty members were highly cordial and engaging. New knowledge about hypertension management was acquired by the students with different levels of implementation post-graduation. Some identified challenges with the ASH program were poor internet connectivity during lectures, non-uniformity of TSTS policies and hypertension management guidelines across Africa, technical problems with hypertension management app and low participation from other African countries apart from Nigeria. Some recommendations to improve ASH program were development of a uniform hypertension management guideline for Africans, wider publicity of the ASH, interpretation of lectures into French and Portuguese languages and improvement of internet connectivity. The ASH programme has largely achieved its objectives with the very encouraging feedback received from both faculty members and the students. Steps should be taken to address the identified challenges and implement the suggested recommendations in subsequent ASH program to sustain this success.

Rationale, Design and Baseline Characteristics of a Randomized Controlled Trial of a Cardiovascular Quality Improvement Strategy in India: The C-QIP Trial

BackgroundQuality of chronic care for cardiovascular disease (CVD) remains suboptimal worldwide. The Collaborative Quality ImProvement (C-QIP) trial aims to develop and test the feasibility and clinical effect of a multicomponent strategy among patients with prevalent CVD in India. MethodsThe C-QIP is a clinic-based, open randomized trial of a multicomponent intervention versus usual care that was locally developed and adapted for use in Indian settings through rigorous formative research guided by Consolidated Framework for Implementation Research (CFIR). The C-QIP intervention consisted of 5 components: 1) electronic health records and decision support system for clinicians, 2) trained non-physician health workers (NPHW), 3) text-message based lifestyle reminders, 4) patient education materials, 5) quarterly audit and feedback reports. Patients with CVD (ischemic heart disease, ischemic stroke, or heart failure) attending outpatient CVD clinics were recruited from September 2022 to September 2023 and were randomized to the intervention or usual care arm for at least 12 months follow-up. The co-primary outcomes are implementation feasibility, fidelity (i.e., dose delivered and dose received), acceptability, adoption and appropriateness, measured at multiple levels: patient, provider and clinic site-level, The secondary outcomes include prescription of guideline directed medical therapy (GDMT) (provider-level), and adherence to prescribed therapy, change in mean blood pressure (BP) and LDL-cholesterol between the intervention and control groups (patient-level). In addition, a trial-based process and economic evaluations will be performed using standard guidelines. ResultsWe recruited 410 socio-demographically diverse patients with CVD from four hospitals in India. Mean (SD) age was 57.5 (11.7) years, and 73.0% were males. Self-reported history of hypertension (48.5%) and diabetes (41.5%) was common. At baseline, mean (SD) BP was 127.9 (18.2) /76.2 (11.6) mm Hg, mean (SD) LDLc: 80.3 (37.3) mg/dl and mean (SD) HbA1c: 6.8% (1.6%). At baseline, the GDMT varied from 62.4% for patients with ischemic heart disease, 48.6% for ischemic stroke and 36.1% for heart failure. ConclusionThis study will establish the feasibility of delivering contextually relevant, and evidence-based C-QIP strategy and assess whether it is acceptable to the target populations. The study results will inform a larger scale confirmatory trial of a comprehensive CVD care model in low-resource settings. Trial registrationClinical Trials Registry India: CTRI/2022/04/041847; Clinicaltrials.gov number: NCT05196659

Evaluating diabetes care in primary healthcare centers in Abuja, Nigeria: a cross-sectional formative assessment

IntroductionNoncommunicable diseases (NCDs) are associated with high and rising burden of morbidity and mortality in sub-Saharan Africa, including Nigeria. Diabetes mellitus (DM) is among the leading causes of NCD-related deaths worldwide and is a foremost public health problem in Nigeria. As part of National policy, Nigeria has committed to implement the World Health Organization (WHO) Package of Essential Non-communicable Disease interventions for primary care. Implementing the intervention requires the availability of essential elements, including guidelines, trained staff, health management information systems (HMIS), equipment, and medications, in primary healthcare centers (PHCs). This study assessed the availability of the DM component of the WHO package, and the readiness of the health workers in these PHCs to implement a DM screening, evaluation, and management program to inform future adoption and implementation.MethodsThis cross-sectional formative assessment adapted the WHO Service Availability and Readiness Assessment (SARA) tool to survey 30 PHCs selected by multistage sampling for readiness to deliver DM diagnosis and care in Abuja, Nigeria, between August and October 2021. The SARA tool was adapted to focus on DM services and the availability and readiness indicator scores were calculated based on the proportion of PHCs with available DM care services, minimum staff requirement, diagnostic tests, equipment, medications, and national guidelines/protocols for DM care within the defined SARA domain.ResultsAll 30 PHCs reported the availability of at least two full-time staff (median [interquartile range] = 5 [4–9]), which were mostly community health extension workers (median [interquartile range]) = 3 [1–4]. At least one staff member was recently trained in DM care in 11 PHCs (36%). The study also reported high availability of paper-based HMIS (100%), and DM screening services using a glucometer (87%), but low availability of DM job aids (27%), treatment (23%), and national guidelines/protocols (0%).ConclusionThis formative assessment of PHCs’ readiness to implement a DM screening, evaluation, and management program in Abuja demonstrated readiness to integrate DM care into PHCs regarding equipment, paper-based HMIS, and nonphysician health workers' availability. However, strategies are needed to promote DM health workforce training, provide DM management guidelines, and supply essential DM medications.

Interventions of eHealth technologies integrated with non-physician health workers for improving management of hypertension: Systematic review and meta-analysis

Hypertension is a major public health problem, accounting for 7.5 million deaths and 57 million disability-adjusted life years annually worldwide. The majority of hypertension-related deaths occur in low- and middle-income countries (LMICs). Despite the escalating prevalence of hypertension in many LMICs, only one-third of those affected are aware of their hypertension status. The rapid proliferation of eHealth technologies presents an opportunity to improve the detection and management of hypertension. Many LMICs face a critical shortage of physicians, and their services often come at a considerable cost to the health system. Non-physician health workers could be a cost-effective alternative to improve the detection and management of hypertension, particularly in LMICs. In this systematic review, we aim to synthesize and evaluate the effectiveness of interventions that integrated eHealth technologies with non-physician health workers to reduce blood pressure. A diverse range of eHealth technologies, such as mobile-based applications, telemonitoring, short text messaging and electronic decision support systems, are being used by non-physician health workers for the management of hypertension. We found that eHealth technologies integrated with non-physician health workers reduced overall mean systolic blood pressure by -4.09 mmHg (95%CI: -5.87 to -2.32) compared to usual care. Similarly, such an integrated approach also reduced diastolic blood pressure by -1.25 mmHg (-2.31 to -0.81) in the intervention group than usual care. Therefore, leveraging the use of cost-effective eHealth technologies to support task-sharing with non-physicians presents an effective strategy for enhancing blood pressure management, applicable to both high- and low-income countries.

Enhancing care quality and accessibility through digital technology-supported decentralisation of hypertension and diabetes management: a proof-of-concept study in rural Bangladesh

ObjectiveThe critical shortage of healthcare workers, particularly in rural areas, is a major barrier to quality care for non-communicable diseases (NCD) in low-income and middle-income countries. In this proof-of-concept study,...

“Actually, the psychological wounds are more difficult than physical injuries:” a qualitative analysis of the impacts of attacks on health on the personal and professional lives of health workers in the Syrian conflict

IntroductionAttacks on healthcare in armed conflict have far-reaching impacts on the personal and professional lives of health workers, as well as the communities they serve. Despite this, even in protracted conflicts such as in Syria, health workers may choose to stay despite repeated attacks on health facilities, resulting in compounded traumas. This research explores the intermediate and long-term impacts of such attacks on healthcare on the local health professionals who have lived through them with the aim of strengthening the evidence base around such impacts and better supporting them.MethodsWe undertook purposive sampling of health workers in northwest and northeast Syria; we actively sought to interview non-physician and female health workers as these groups are often neglected in similar research. In-depth interviews (IDIs) were conducted in Arabic and transcribed into English for framework analysis. We used an a priori codebook to explore the short- and long-term impacts of attacks on the health workers and incorporated emergent themes as analysis progressed.ResultsA total of 40 health workers who had experienced attacks between 2013 and 2020 participated in IDIs. 13 were female (32.5%). Various health cadres including doctors, nurses, midwives, pharmacists, students in healthcare and technicians were represented. They were mainly based in Idlib (39.5%), and Aleppo (37.5%) governorates. Themes emerged related to personal and professional impacts as well as coping mechanisms. The key themes include firstly the psychological harms, second the impacts of the nature of the attacks e.g. anticipatory stress related to the ‘double tap’ nature of attacks as well as opportunities related to coping mechanisms among health workers.ConclusionViolence against healthcare in Syria has had profound and lasting impacts on the health workforce due to the relentless and intentional targeting of healthcare facilities. They not only face the challenges of providing care for a conflict-affected population but are also part of the community themselves. They also face ethical dilemmas in their work leading to moral distress and moral injury. Donors must support funding for psychosocial support for health workers in Syria and similar contexts; the focus must be on supporting and enhancing existing context-specific coping strategies.

Physicians' perception of task sharing with non-physician health care workers in the management of uncomplicated hypertension in Nigeria: A mixed method study.

Task sharing and task shifting (TSTS) in the management of hypertension is an important strategy to reduce the burden of hypertension in low-and middle-income countries like Nigeria where there is shortage of physicians below the World Health Organization's recommendations on doctor-patient ratio. The cooperation of physicians is critical to the success of this strategy. We assessed physicians' perception of TSTS with non-physician health workers in the management of hypertension and sought recommendations to facilitate the implementation of TSTS. This was an explanatory sequential mixed method study. TSTS perception was assessed quantitatively using a 12-item questionnaire with each item assigned a score on a 5-point Likert scale. The maximum obtainable score was 60 points and those with ≥42 points were classified as having a good perception of TSTS. Twenty physicians were subsequently interviewed for in-depth exploration of their perception of TSTS. A total of 1250 physicians participated in the quantitative aspect of the study. Among the participants, 56.6% had good perception of TSTS in the management of hypertension while about two-thirds (67.5%) agreed that TSTS program in the management of hypertension could be successfully implemented in Nigeria. Male gender (p = 0.019) and working in clinical settings (p = 0.039) were associated with good perception. Twenty physicians participated in the qualitative part of the study. Qualitative analysis showed that TSTS will improve overall care and outcomes of patients with hypertension, reduce physicians' workload, improve their productivity, but may encourage inter-professional rivalry. Wide consultation with stakeholders, adequate monitoring and evaluation will facilitate successful implementation of TSTS in Nigeria. This study showed that more than half of the physicians have good perception of TSTS in hypertension management while about two-thirds agreed that it could be successfully implemented in Nigeria. This study provides the needed evidence for increased advocacy for the implementation of TSTS in the management of hypertension in Nigeria. This will consequently result in improved patient care and outcomes and effective utilization of available health care personnel.

HEARTS in the Americas clinical pathway. Strengthening the decision support system to improve hypertension and cardiovascular disease risk management in primary care settings.

HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative. It is implemented in 24 countries and over 2,000 primary healthcare facilities. This paper describes the results of a multicomponent, stepwise, quality improvement intervention designed by the HEARTS in the Americas to support advances in hypertension treatment protocols and evolution towards the Clinical Pathway. The quality improvement intervention comprised: 1) the use of the appraisal checklist to evaluate the current hypertension treatment protocols, 2) a peer-to-peer review and consensus process to resolve discrepancies, 3) a proposal of a clinical pathway to be considered by the countries, and 4) a process of review, adopt/adapt, consensus and approval of the clinical pathway by the national HEARTS protocol committee. A year later, 16 participants countries (10 and 6 from each cohort, respectively) were included in a second evaluation using the HEARTS appraisal checklist. We used the median and interquartile scores range and the percentages of the maximum possible total score for each domain as a performance measure to compare the results pre and post-intervention. Among the eleven protocols from the ten countries in the first cohort, the baseline assessment achieved a median overall score of 22 points (ICR 18 -23.5; 65% yield). After the intervention, the overall score reached a median of 31.5 (ICR 28.5 -31.5; 93% yield). The second cohort of countries developed seven new clinical pathways with a median score of 31.5 (ICR 31.5 -32.5; 93% yield). The intervention was effective in three domains: 1. implementation (clinical follow-up intervals, frequency of drug refills, routine repeat blood pressure measurement when the first reading is off-target, and a straightforward course of action). 2. treatment (grouping all medications in a single daily intake and using a combination of two antihypertensive medications for all patients in the first treatment step upon the initial diagnosis of hypertension) and 3. management of cardiovascular risk (lower BP thresholds and targets based on CVD risk level, and the use of aspirin and statins in high-risk patients). This study confirms that this intervention was feasible, acceptable, and instrumental in achieving progress in all countries and all three domains of improvement: implementation, blood pressure treatment, and cardiovascular risk management. It also highlights the challenges that prevent a more rapid expansion of HEARTS in the Americas and confirms that the main barriers are in the organization of health services: drug titration by non-physician health workers, the lack of long-acting antihypertensive medications, lack of availability of fixed-doses combination in a single pill and cannot use high-intensity statins in patients with established cardiovascular diseases. Adopting and implementing the HEARTS Clinical Pathway can improve the efficiency and effectiveness of hypertension and cardiovascular disease risk management programs.

Motivating non-physician health workers to reduce the behavioral risk factors of non-communicable diseases in the community: a field trial study

BackgroundNon-communicable diseases behavioral risk factors can be improved if effective interventions are designed considering the health system’s capabilities and local resources. This study evaluated the effectiveness of interventions that aimed at increasing non-physician community health workers’ motivation in reducing non-communicable diseases behavioral risk factors in the community.MethodsA randomized field trial study was conducted in 32 community health centers in 4 Iranian districts after a baseline population survey on the status of NCDs of 30–70-year-old individuals (n = 1225). The interventions were performed to improve insufficient physical activity, insufficient fruit consumption, insufficient vegetable consumption, high salt intake, and tobacco use. Four intervention packages were implemented in 24 community health centers; the other 8 centers were used as control groups. The non-physician community health workers performed the interventions. The packages additively included goal-setting, evidence-based education, operational planning, and incentive payments. A second survey was conducted 1 year after the start of the interventions to identify the effects on an independent random sample of 30–70-year-old individuals (n = 1221). Difference-in-difference method was used to quantify the interventions’ effects.ResultsThe average age of participants in both surveys was about 49 years. Also, about half of the participants were female, and about 43% were illiterate or had a primary school education. The interventions had statistically significant effects only on decreasing the prevalence of insufficient physical activity. The package with all the intervention components decreased the odds of insufficient physical activity to 0.24 (95% CI, 0.08, 0.72). The package with operational planning but no performance-based financing did not change the odds of insufficient physical activity.ConclusionsThis study highlighted the importance of components, design, and implementation details of interventions intended to reduce NCDs behavioral risk factors. Some risk factors, such as insufficient physical activity, seem more easily modifiable with limited low-cost interventions in a one-year horizon. However, risk factors related to healthy food consumption and tobacco use need more extensive interventions.Trial registrationThis trial was registered on the Iranian Registry of Clinical Trials (IRCT20081205001488N2) on 3 June 2018 (https://en.irct.ir/trial/774).

Capacity of the health facilities to manage Alzheimer’s and related dementia diseases in Mukono district: Challenges and recommendations

IntroductionWith the projected increase in the number of older persons in both low and middle-income countries, the burden of Alzheimer’s and related dementia diseases (AD/ARDs) is projected to increase as well. However, the health systems are inadequately prepared to offer optimal care for patients with AD/ARDs, despite the growing disease burden.ObjectivesThe aim of this study was to assess the capacity of the health facilities to optimally manage Alzheimer’s and related dementia diseases in the Mukono districtMethodsWe conducted a cross-sectional between August and December 2018. A survey of 32 facilities (3 hospitals, 2 health center IV (HCIV), 15 health center III (HCIII) and 6 health center II (HCII), and 6 Private health facilities) in Mukono district. We conducted a thorough assessment of medical records, interviewed heads of the facilities, and a questionnaire was administered to 46 health workers. The study assessed the service provision for AD/ARDs, Knowledge of AD/ARDs management, challenges, and opportunities.ResultsOut of 32 health facilities assessed, 4 in 10 (42%) facilities reported managing (diagnosing/treating) clients with AD/ARDs, and the majority (90.2%) were run by Non-Physician Health Workers (NPHW). Only 2 in 10 had guidelines for managing AD/ARDs. Less than half (46.4%) had AD/ARDs medicines in stock (mainly Haloperidol) and all of the private facilities lacked essential medicine to treat AD/ARDs. All health center IIs lacked drugs for AD/ARDs. A significant knowledge gap in assessing and diagnosing AD/ARDs was observed among all the health workers. All health workers highlighted the need for additional training in AD/ARDs. A multitude of client and health provider challenges were observed in this studyConclusionsHealth facilities in Mukono district are inadequately prepared to offer optimal services for the management of AD/ARDs. AD/ARDs drugs, knowledge gap, and human resources for health presented a great challenge. In order to address the inadequately capacity to manage AD/ARDs, emphasis should be dwelt on strengthening the health facilities.Disclosure of InterestNone Declared

Training community health workers to limit the transmission of monkeypox virus in India: an urgent need for action.

Training community health workers to limit the transmission of monkeypox virus in India: an urgent need for action.

Incentivizing community health workers for scaling up mental health care in rural communities in India: A critical look at principles that work.

Given the low availability of trained mental health professionals, there is evidence on task sharing where basic mental healthcare can be provided by trained community health workers (CHWs). A potential way to reduce the mental health care gap in rural and urban areas in India is to utilize the services of community health workers known as Accredited Social Health Activists (ASHAs). There is a paucity of literature that have evaluated incentivizing non-physician health workers (NPHWs) vis-à-vis maintaining a competent and motivated health workforce especially in the Asia and Pacific regions. The principles around what works and does not work in terms of a mix of incentive packages for CHWs, while providing for mental healthcare in rural areas have not been adequately evaluated. Moreover, performance-based incentives which are receiving increasing attention from health systems worldwide, though evidence on the effectiveness of these incentives in Pacific and Asian countries is limited. CHW programs that have shown to be effective rely on an interlinked incentive framework at the individual, community, and health system levels. Drawing learnings from the past eight years in implementing the SMART (systematic medical appraisal, referral and treatment) Mental Health Program in rural India, we critically examine some of the emerging principles in incentivizing ASHAs while scaling up mental healthcare in communities using a systems approach.

The ability of non-physician health workers to identify chest indrawing to detect pneumonia in children below five years of age in low- and middle-income countries: A systematic review and meta-analysis.

Non-physician health workers play a vital role in diagnosing and treating pneumonia in children in low- and middle-income countries (LMICs). Chest indrawing is a key indicator for pneumonia diagnosis, signifying the severity of the disease. We conducted this systematic review to summarize the evidence on non-physician health workers' ability to identify chest indrawing to detect pneumonia in children below five years of age in LMICs. We comprehensively searched four electronic databases, including MEDLINE, Embase, Web of Science, and Scopus, and reference lists from the identified studies, from January 1, 1990, to January 20, 2022, with no language restrictions. Studies evaluating the performance of non-physician health workers in identifying chest indrawing compared to a reference standard were included. We used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool to assess the methodological quality of the selected studies and conducted a meta-analysis following a bivariate random effects model to estimate the pooled sensitivity and specificity. We identified nine studies covering 4468 children that reported the accuracy of a non-physician health worker in identifying chest indrawing. Most studies were conducted in the 1990s, based at health facility settings, with children aged 2-59 months, and with pediatricians/physicians as the reference standard. Using the QUADAS-2, we evaluated most studies as having a low risk of bias and a low concern regarding applicability in all domains. The median sensitivity, specificity, positive predictive value, and negative predictive value were 44%, 97%, 55%, and 95%, respectively. We selected five studies for the meta-analysis. The pooled sensitivity was 46% (95% confidence interval (CI) = 37-56), and the pooled specificity was 95% (95% CI = 91-97). We found the ability of non-physician health workers in LMICs in identifying chest indrawing pneumonia is relatively poor. Appropriate measures, such as targeted identification and training, supportive supervision, regular performance assessment, and feedback for those who have a poor ability to recognize chest indrawing, should be taken to improve the diagnosis of pneumonia in children. New studies are needed to assess the new generation of health workers. PROSPERO (CRD42022306954).

S-53-1: SOCIOECONOMIC FACTORS AND PREVENTION OF CARDIOVASCULAR DISEASES IN ASIA

Focus on social determinants of health is important for primordial and primary prevention of cardiovascular diseases (CVD). There are multiple social determinants and are macrolevel factors: social and human development, location related factors, and policies that influence rural and urban planning, environmental pollution, healthcare infrastructure, health financing, quality of health systems, taxation on harmful products (tobacco, alcohol, trans fats), and subsidizing healthy foods. Individual level factors are: multiple social factors, education, income, employment, stress, early life events, addictions including tobacco, and availability, affordability and adherence to medicines and healthy lifestyles. Studies have shown that countries with better development have lower CVD incidence and mortality, also in Asia. Healthy lifestyles (healthy diet, physical activity, tobacco control) and awareness, treatment and control of major risk factors (hypertension, diabetes, dyslipidemias) are more in better developed Asian countries due to better health systems and universal health coverage policies. At individual level higher socioeconomic status and better educational level are associated with lower prevalence of CVD risk factors and better treatment and control of hypertension, dyslipidemias and diabetes. Interventions to address social determinants are limited and include focus on political, economic and social interventions. UN Sustainable Development Goals related to poverty eradication, zero hunger, good health and wellbeing, quality education, gender equality, decent work, economic growth, reduced inequalities, sustainable communities, responsible consumption or production, and climate action address social determinants of health. Creation of health infrastructure in rural and deprived locations, macrolevel financing, manpower deployment and workforce training are important evidence-based interventions. Interventions to improve quality of general education and health literacy and education of medical professionals and non-physician health workers have shown to ameliorate CVD related disparities. Public health interventions include life-course approach for prevention and control of risk factors, better and safe facilities for promotion of physical activity, tobacco, smoking and alcohol control policies, taxation on trans fats, sugars, sugar-sweetened beverages and salt, universal health care focussed on early CVD diagnosis and management, availability of medicines and focus on technological innovations to promote adherence to medicines and healthy lifestyles. At the individual level better CVD risk-factor control can be achieved by focus on individual social determinant and improved professional-patient communication via professional medical education, health worker related focus, patient health literacy, and greater patient involvement.

Attitudes of non-physician health workers working in the Emergency Department towards euthanasia, death, and the terminally patient

<b>Aim: </b>The use of the right to die in the center of the individual's own decision is called euthanasia. This decision, was evaluated from legal, religious, and medical perspectives. In different countries applied euthanasia, which can be performed actively or passively. In our study, we planned to investigate the perspectives of healthcare professionals working in the emergency department about euthanasia and their thoughts on diseases that can be applied to euthanasia.<br /> <b>Material and methods: </b>A survey was conducted from June to October 2022 on non-physician health workers working in the Emergency department. A questionnaire including demographic data, professional knowledge, and Attitude Scale towards Euthanasia, Death, and the Terminally Patient was administered to the healthcare professionals who agreed to participate in the study. The obtained data were analyzed.<br /> <b>Results</b>: In the study, the feedback of 60 participants, 37 of whom were women, was evaluated. The mean age of the entrants was found to be 39.07±10.11 years. 60% of the participants had received cardiopulmonary resuscitation training in the past year. 70% of the participants stated that they could be euthanized for coma, 38.33% for severe disability, and 36.67% for severe and incurable neurological diseases.<br /> <b>Conclusion</b>: In the process of euthanasia, which does not have a legal infrastructure in our country, different perspectives are seen from different departments of health services.<br /> <b>Key words:</b> emergency department, euthanasia, non-health workers