Primary Health Care Centers Research Articles

Improving Medical Emergency Team Response Time for Urgent Care Patients in Primary Health Care Centers, Riyadh, Saudi Arabia

Background: Emergency healthcare systems are of increasing concern in international healthcare developments and the global fight against the burdens of disease. Concerns about focusing on ambulance response time as a single indicator are addressed by showing a case-sensitive approach for developing emergency health care systems that in return can identify ambulance response as the main indicator for a particular system. Problem description: Data collected by monitoring the time of receiving the call at the ambulance division until transport time.Methods: The fishbone diagram is used as a tool for understanding the process variation, investigate and eliminating unusual occurrences by the following methodology: M.M.M.Main outcomes: Responding time in emergency cases not exceeding 5 minutes; To improve responding time; To improve types of communication; To improve compliance with the logbook of the emergency referred cases. The intervention plan was Continuous Training for the staff and Clear Guidelines for emergency calls. Review and assess the actual implementation of the project. Data will be collected by an Emergency Medical specialist. A copy of the data should be sent to CQI for a continuous monitoring process. Check the data for process improvement (incident report analysis). Document the results of the change. Modify the change, if necessary and possible. The Emergency Medical Technicians quality coordinator will check the Data. Continue improvement by close monitoring of the compliance.Results: the mean response time dropped from 15 minutes in January 2023 to less than 5 minutes in December 2023.Conclusion: this initiative positively impacts the emergency team's response time and improves patient satisfaction. Response time reduction was evident, and the quality of the health care service was improved. Reduction of response time also improved emergency preparedness

P207 MAY MEASURE MONTH 2022 AND 2019: AN ANALYSIS OF BLOOD PRESSURE SCREENING RESULTS PRE COVID-19 AND POST COVID-19 FROM ULAANBAATAR, MONGOLIA

Background: Mongolia has experienced high mortality rates from ischaemic heart disease and haemorrhagic stroke, with hypertension as a major risk factor. Two separate hypertension screening campaigns were conducted: the May Measurement Month (MMM) campaign in May 2019 and a follow-up campaign after the COVID-19 pandemic between July and September 2022. Methods: The 2019 MMM campaign involved screening at 80 sites, primarily workplaces, using trained health volunteers. Blood pressure was measured using clinically verified digital devices. In contrast, the 2022 campaign was conducted at five primary healthcare centers in Ulaanbaatar, with participants voluntarily attending the screening, where blood pressure was measured over three sessions. Results: In 2019, 6522 individuals were screened, with a hypertension prevalence of 32.5%, where 62.2% were aware of their condition and 50.1% were on medication. The control rate among those treated was 27.1%. In 2022, 1774 individuals were screened, showing a higher prevalence of 56.1%, with 95.4% awareness and 52.7% receiving treatment. The control rate for treated individuals was significantly higher at 48.5%. Conclusion: Both campaigns highlight the critical public health issue of hypertension in Mongolia. The increase in hypertension awareness and control rates in 2022 may be due to smaller sample size and participants are already patients who came to visit primary healthcare centers.However, the persistent high prevalence of hypertension underscores the need for continued prioritization and enhanced strategies in hypertension management.

Physician practices in referring rheumatoid hand and thumb carpometacarpal arthritis cases to hand surgeons.

To investigate the referral practices across different medical specialties and identify possible barriers to hand surgery referral. Rheumatoid hand deformities (RHDs) and thumb carpometacarpal (CMC) arthritis may require surgery once deformities occur. However, in Saudi Arabia, the rate of referrals to hand surgeons remains low. This was a cross-sectional study that included 102 consultants of family medicine, rheumatology, and orthopedics across various regions of Saudi Arabia. A total of 30 institutions were contacted and requested to distribute a survey questionnaire to their physicians; these institutions included 8 private hospitals, 16 government hospitals, and 6 primary healthcare centers. The survey included questions on the incidence, rate, management, knowledge, and referral of patients with RHD and CMC arthritis using a 5-point Likert scale. The Kruskal-Wallis H test was utilized in our analysis to evaluate the differences in responses among the 3 specialties. For RHD and thumb CMC arthritis, the referral rate was higher among orthopedic surgeons compared to rheumatologists and family medicine physicians. The main barriers to referral were patient refusal, medical treatment alone being deemed adequate, and a lack of awareness of surgical options for management. Our findings highlight discrepancies in patterns of physician referral of RHD and thumb CMC arthritis cases to hand surgeons, indicating the need for targeted interventions to improve referral rates and enhance patient outcomes.

Pattern of Utilization of Antenatal Care Services and Adherence Among Females Following Up at Primary Healthcare Centers in Al-Ahsa.

Background Antenatal care (ANC) is a crucial component of maternal and child health, yet disparities in utilization persist globally. This study aimed to assess the patterns of ANC service utilization and adherence among pregnant women attending primary healthcare centers (PHCCs) in Al-Ahsa, Saudi Arabia. Methodology A quantitative, cross-sectional study was conducted among 277 women attending PHCCs in Al-Ahsa. Data were collected through structured questionnaires, assessing demographic characteristics, ANC follow-up patterns, structural and personal barriers, and mental health conditions using the Depression, Anxiety, and Stress Scale. Results Significant regional variations in ANC follow-up patterns were observed, with higher proportions of pregnant women attending ANC in the Middle and Eastern regions. Prominent structural barriers included transportation challenges (structural barrier 3, 61.0%) and limited service availability (structural barrier 6, 56.0%), while personal barriers encompassed transportation problems (personal barrier 6, 36.8%) and forgetfulness regarding appointments (personal barrier 4, 19.9%). Mental health assessments revealed predominantly normal levels of depression, anxiety, and stress, with some regional variations in distress levels. Conclusions The study highlights regional disparities in ANC service utilization and adherence, influenced by structural barriers, personal barriers, and mental health conditions. Tailored interventions addressing these barriers, improving access to care, and providing targeted support are crucial for enhancing ANC service utilization and promoting maternal and child health in Al-Ahsa.

Primary care physicians' knowledge and attitudes about obesity, adherence to treatment guidelines and its' association with confidence to treat obesity at the Saudi Ministry of Interior primary health care centers.

Many primary care physicians (PCPs) believed that managing overweight and obesity is essential to their jobs, however, many believe that they were doing it ineffectively, unsatisfying, and had negative attitudes. We conducted this study to explore the knowledge, attitudes and adherence to obesity management guidelines, identify potential barriers that may prevent adherence of PCPs to obesity treatment guidelines. We conducted this cross-sectional study and conducted a questionnaire sent via email to all PCPs in the Ministry of Interior centers in Riyadh, Al-Kharj, AlQassim, Wadi Ad Dawasir, Hail and Tabuk in Saudi Arabia. A total of 119 PCPs participated in the survey, 61 (51.3%) males and 58 (48.7%) females. All respondents (n = 119, 100%) answered correctly that obesity is a disease. Of PCPs surveyed, genetics accounted for 75.6% of the responses as the cause of obesity. 79.8% believed that the best way for patients with obesity to lose weight was to engage in regular physical activity. The majority of PCPs (87.4%) thought that treating obesity should be a top priority, and 88.2% would typically recommend obesity therapy to their patients. Around 68.9% of PCPs thought that it's their patients' responsibility to lose weight. The majority will recommend obesity treatment and 75.6% would talk to their patients about weight concerns, while 60.5% would refer their patients to obesity surgery. There was a positive significant association between higher knowledge and better attitude and better adherence to treatment guidelines. More experienced PCPs were more confident. The most common perceived barrier was the patients' lack of desire to follow obesity treatment. Primary care clinics and PCPs play a crucial role in diagnosing and treating patients with obesity, according to Ministry of Health guidelines on the prevention and management of obesity. PCPs must not only acknowledge obesity as a chronic illness and the possible long-term consequences it may cause, but also provide comprehensive, multi-component interventions that include lifestyle changes, medication, and appropriate referrals for bariatric surgery when needed. Healthcare professionals must form a cooperative relationship with obese patients to ensure that the patients follow treatment protocols.

Assessment of the risk of falls among elderly persons in primary care settings

<p><strong>Aim </strong>To investigate the risk for falls in elderly patients treated in the Primary Health Care Centre Gradiška, Bosnia and Herzegovina.<br /><strong>Methods </strong>This study included 500 patients aged 65 and older. They were chosen randomly by 10 family physicians. Data collection took place every Wednesday and Friday, between January 2022 and July 2022. The patients' gait and balance assessments were performed using the Tinetti Gait and Balance Tool to assess the risk of falls. A supplementary questionnaire was created to record data about the patients' age, sex, chronic diseases, and drugs they take.<br /><strong>Results </strong>Among the included patients there were 266 females (53.2%) and 234 (46.8%) males, with the mean age of 75.25 years. The Tinetti test showed that the risk of falls was high for patients older than 75 years, 111 patients (69.8%), and 48 patients (30.2%) aged 65 to 74 (p=0.000). The risk of falling was higher for female, 93 (35%), than male patients, 66 (28.2%) (p=0.018). Considering chronic diseases, a high risk of falls was found in 32 (2.1%) patients with heart failure (p=0.029) and 19 (11.9%) patients with osteoporosis (p=0.000). Patients who used antihypertensive drugs had the highest risk for falls, 124 (78.0%) (p=0.757).<br /><strong>Conclusion </strong>About two-thirds of the examinees over the age of 75 had a high risk of falls, which indicates that family doctors should be more involved in fall prevention of elderly patients and consistently educate older patients and their families about it.</p>

Novel Metabolic Indicators and the Risk of Cardiovascular Disease in Patients with Hypertension: A Primary-care Cohort Study

Background and AimsData are limited on whether several easily measured indices serve as effective tools for Cardiovascular disease (CVD) risk assessment in hypertensive patients. This study aimed to assess the associations of metabolic score for insulin resistance (METS-IR), lipid accumulation product (LAP), and visceral adiposity index (VAI) with CVD risk in hypertensive patients. Methods and ResultsOur data were drawn from the medical records of primary-care institutions in China. The present study included 306,680 individuals with hypertension attending primary healthcare centers. Cox regression analyses were applied to assess the associations of novel metabolic indicators with the risk of CVD. During a median follow-up of 1.98 years, 5820 participants developed CVD. When comparing with the lowest quartile of the indices, the highest quartile of METS-IR, LAP, and VAI was associated with 1.25-fold (95% CI: 1.16-1.35), 1.15-fold (95% CI: 1.05-1.25), and 1.19-fold (95% CI: 1.10-1.28) risk of CVD after adjusting for potential confounders. ConclusionThis study provided additional evidence that novel metabolic indicators like METS-IR, LAP, and VAI were associated with the risk of CVD. These results suggest that proactive assessment of visceral adiposity and insulin resistance could be helpful for the effective clinical management of the hypertensive population.

Depression and Anxiety Screening of Patients With Type II Diabetes Mellitus Attending Primary Healthcare Centers in Saudi Arabia.

Diabetes mellitus is a chronic condition affecting both physical and mental health. High blood sugar levels can lead to serious complications if not managed properly. Individuals with diabetes are also at a higher risk of developing mental health disorders like depression and anxiety. The objective was to assess the prevalence of depression and anxiety among patients with type II diabetes attending primary healthcare centers in Makkah, Saudi Arabia. An analytical cross-sectional study design was employed, targeting adults with type II diabetes attending primary healthcare centers in Makkah. A total sample size of 412 participants was selected through systematic random sampling. Data were collected using validated Arabic versions of the patient health questionnaire (PHQ-9) and the general anxiety disorder (GAD-7) questionnaire, along with demographic information. Statistical analysis was conducted with non-parametric tests used to evaluate the significance of outcome variables. The median age of participants was 47 years, with 237 (57.5%) being male and 373 (90.5%) Saudi nationals. Neuropathy was the most prevalent complication, affecting 181 (43.9%) of participants. The median GAD-7 score was 5, and the median PHQ-9 score was 7. Mild to moderate depression was observed in 224 (54.4%), and 194 (47%) had mild-to-moderate anxiety. Significant associations were found between mental health outcomes and several factors: nationality (non-Saudis showed higher depression and anxiety scores, p = 0.010 and p = 0.020, respectively), marital status (divorced participants had the highest mean ranks for both conditions, p = 0.003 for depression and p < 0.001 for anxiety), and monthly income (p = 0.007 for depression and p = 0.008 for anxiety). Additionally, the presence of diabetes complications was strongly associated with higher depression and anxiety scores (p < 0.001 for both). The findings indicate a high prevalence of depression and anxiety among patients with type II diabetes in Makkah. These mental health issues are significantly associated with socio-demographic factors and diabetes complications. Integrated medical and psychological care is needed to improve the quality of life and treatment outcomes for diabetic patients.

Burden of noncommunicable diseases and COVID-19 pandemic prevention and control strategies

Noncommunicable diseases (NCDs) are the leading cause of death in 21st century. The risk factors for development and progression of NCDs include sedentary lifestyle, inadequate fruits and vegetables intake, tobacco use, high blood pressure, high total cholesterol levels, obesity, high salt intake, low physical activity, and air pollution. People with NCDs and comorbidities like hypertension, cardiovascular diseases, diabetes, chronic respiratory infection and cancer are more vulnerable to severe COVID-19 infection that ultimately results into mortality. To reduce the impact of NCDs on COVID-19 cases, prevention is the best measure. Primary and secondary level prevention of NCDs plays a main role to control bad outcome in COVID-19 cases. The strategies that are required to address this comorbidity includes integration and convergence of the existing communicable and NCD programs, strengthening health care systems by giving major focus on primary health care services, health and wellness centers, universal health coverage, updating guidelines, enhancing community participation, capacity building, appropriate policy making, multi-sectoral participation and coordination.

Voluntary Care for Older People: A symbolic Health Efficacy of Community-based Health Meetings

Community healthcare in Indonesia relies on volunteer workers who engage their clients outside fixed health facilities with limited resources and formal training. These volunteers are called cadres who learn their tasks to improve community wellbeing through ongoing engagement and without prior skills. They are drawn from the community to serve the community. This paper is based on field research carried out with cadres through interviews and visits to integrated health meetings (Posyandu) held by primary healthcare centres for older adults in villages. The paper first discusses the recruitment requirements and the incentives for being a healthcare volunteer. It suggests that both recruitment and incentives are rooted in community values of helping and doing good for the community. Volunteer cadres must have a direct normative and semiotic connection with clients, as they must be members of the community who speak the same language and understand local norms. In line with this community-centred approach, the paper then focuses on the health efficacy of Posyandu as a recurring structured symbolic event held in the village. The argument is made that a more qualitative approach should be taken to understanding the efficacy of these meetings, drawing on research methods from the anthropology of ritual (symbolic and therapeutic) healing.

Facilitators and barriers in the implementation of a fall prevention program based on physical activity for elderly people living in the community: A qualitative study.

Physical activity is recognized as beneficial for older individuals in preventing falls. Achieving high adherence to exercise programs among the elderly poses challenges for administrations and healthcare systems. This study explored the facilitators and barriers perceived by both the participants and nurse trainers involved in an exercise program aimed at preventing falls in primary healthcare. Sixteen semi-structured interviews with elderly people who had participated in the Otago Exercise Program and a focus group of nurse trainers of this program were conducted between October 2018 and September 2019 in primary health care centers in Lleida, Spain. Interviews were transcribed and analyzed using inductive thematic analysis with Atlas.ti 8 software. Analysis revealed five overarching categories and 17 subcategories. Key facilitators included personal motivation, the perceived benefits of exercise, and the supportive role of nurse trainers. Primary barriers encompassed factors such as the excessive duration of the program, not considering personal preferences for individual or group participation, and differences in physical condition among group participants. To increase participation and adherence to exercise programs, it is necessary to consider the important role of the nursing professionals that recommend program enrolment and the participants' personal motivations. The program with group sessions is a model that is easy to integrate into Primary Healthcare centers, which must always take into account the preferences and physical conditions of the participants.

Work-restricting musculoskeletal pain after bariatric surgery or usual obesity care in the Swedish Obese Subjects study.

The objective of this study was to study the recovery from, and incidence of, work-restricting musculoskeletal pain after bariatric surgery compared with usual obesity care. Pain in different body regions was monitored using questionnaires in the nonrandomized, prospective, controlled Swedish Obese Subjects (SOS) study, which included 2007 participants treated with bariatric surgery and a matched control group of 2040 participants receiving usual obesity care at primary health care centers. Self-reported pain in the neck and shoulders, back, hips, knees, and ankles was captured from questionnaires administered at baseline and after 1, 2, 3, 4, 6, 8, 10, 15, and 20 years. Compared with matched controls, bariatric surgery was associated with better recovery from baseline work-restricting knee and ankle pain in both the short (1-4 years) and long term (up to 20 years), as well as from back and hip pain in the short term. In participants without pain at baseline, bariatric surgery was associated with a lower incidence of developing new pain in the knee and ankle in the short and long term. Bariatric surgery was associated with better recovery from pain, primarily in weight-bearing joints, as well as with prevention of pain development in the knee and ankle compared with matched controls receiving usual obesity care.

Knowledge and Associated Factors Affecting the Use of Contraceptive Among Women Attending Two Selected Primary Health Care Centre in Ogun State

Knowledge and Associated Factors Affecting the Use of Contraceptive Among Women Attending Two Selected Primary Health Care Centre in Ogun State

Tackling unmanaged oropharyngeal dysphagia in primary care: a behavioural science realist review of interventions

IntroductionOropharyngeal dysphagia (OD) is difficulty manipulating a food bolus from the mouth to the throat. Up to 70% of older adults develop OD; however, it is unmanaged in primary care,...

Facilitators and barriers to interprofessional collaboration among health professionals in primary healthcare centers in Qatar: a qualitative exploration using the “Gears” model

BackgroundThe number of patients seeking medical care is increasing, necessitating more access to primary healthcare services. As several of these patients usually present with complex medical conditions, the need for interprofessional collaboration (IPC) among health professionals in primary care is necessary. IPC is essential for facing the increasing and challenging healthcare demands. Therefore, the facilitators of and the barriers to IPC should be studied in the hope that the results will be used to promote such endeavors.ObjectivesThis study aimed to explore the perspectives of different health professionals regarding the facilitators of and the barriers to IPC in the primary healthcare settings in Qatar.MethodsA qualitative study using focus groups was conducted within the Primary Health Care Corporation (PHCC) in Qatar. Several health professionals were invited to participate in the focus groups. The focus groups were uniprofessional for general practitioners (GPs), nurses, and dentists, while they were interprofessional for the other health professionals. Focus groups were audio-recorded and transcribed verbatim and validated by the research team. The data were analyzed by deductive thematic analysis using the “Gears” Conceptual Model as a coding framework.ResultsFourteen focus groups were conducted involving 58 participants (including 17 GPs, 12 nurses, 15 pharmacists, 3 dentists, and 11 allied health professionals) working in PHCC in Qatar. The findings revealed a spectrum of factors influencing IPC, categorized into four main domains: Macro, Meso, Micro, and individual levels, with each accompanied by relevant barriers and facilitators. Key challenges identified included a lack of communication skills, insufficient professional competencies, and power imbalances, among others. To address these challenges, recommendations were made to implement dedicated training sessions on IPC, reduce hierarchical barriers among different health professionals, and enhance the effectiveness of existing systems. Conversely, it was emphasized that projects and campaigns focused on IPC, alongside the development of enhanced communication skills and the presence of supportive leadership, as essential for facilitating effective IPC in PHCCs.ConclusionThe interplay between the meso, macro, micro, and individual levels highlight the significance of a multifaceted approach to interventions, aiming to enhance the successes of IPC. While initiatives like interprofessional education training are underway, numerous challenges persist before achieving improved collaboration and more efficient integration of IPC in the PHCC setting.

Impact of a package of point-of-care diagnostic tests, a clinical diagnostic algorithm and adherence training on antibiotic prescriptions for the management of non-severe acute febrile illness in primary health facilities during the COVID-19 pandemic in Burkina Faso

ObjectiveTo assess the impact of an intervention package on the prescription of antibiotic and subsequently the rate of clinical recovery for non-severe acute febrile illnesses at primary health centers.MethodsPatients over 6 months of age presenting to primary health care centres with fever or history of fever within the past 7 days were randomized to receive either the intervention package constituted of point-of-care tests including COVID-19 antigen tests, a diagnostic algorithm and training and communication packages, or the standard practice. The primary outcomes were antibiotic prescriptions at Day 0 (D0) and the clinical recovery at Day 7 (D7). Secondary outcomes were non-adherence of participants and parents/caregivers to prescriptions, health workers’ non-adherence to the algorithm, and the safety of the intervention.ResultsA total of 1098 patients were enrolled. 551 (50.2%) were randomized to receive the intervention versus 547 (49.8%) received standard care. 1054 (96.0%) completed follow-up and all of them recovered at D7 in both arms. The proportion of patients with antibiotic prescriptions at D0 were 33.2% (183/551) in the intervention arm versus 58.1% (318/547) under standard care, risk difference (RD) -24.9 (95% CI -30.6 to -19.2, p < 0.001), corresponding to one more antibiotic saved every four (95% CI: 3 to 5) consultations. This reduction was also statistically significant in children from 6 to 59 months (RD -34.5; 95% CI -41.7 to -27.3; p < 0.001), patients over 18 years (RD -35.9; 95%CI -58.5 to -13.4; p = 0.002), patients with negative malaria test (RD -46.9; 95% CI -53.9 to -39.8; p < 0.001), those with a respiratory diagnosis (RD -48.9; 95% CI -56.9 to -41.0, p < 0.001) and those not vaccinated against COVID-19 (-24.8% 95%CI -30.7 to -18.9, p-value: <0.001). A significant reduction in non-adherence to prescription by patients was reported (RD -7.1; 95% CI -10.9 to -3.3; p < 0.001).ConclusionThe intervention was associated with significant reductions of antibiotic prescriptions and non-adherence, chiefly among patients with non-malaria fever, those with respiratory symptoms and children below 5 years of age. The addition of COVID-19 testing did not have a major impact on antibiotic use at primary health centers.Trial registrationClinitrial.gov; NCT04081051 registered on 06/09/2019.

Prevalence and Factors Associated With Using Complementary Medicine Among Adults With Type 2 Diabetes in Primary Healthcare Centers of Al-Ahsa, Eastern Saudi Arabia.

Background and aim Type 2 diabetes mellitus (T2DM) is a major health problem in Saudi Arabia. The use of complementary and alternative medicine (CAM) for the management of T2DM is increasing, but there is limited research on its safety and efficacy. This study aimed to investigate the prevalence and factors associated with CAM use among patients with T2DM attending primary healthcare centers in Al-Ahsa, Saudi Arabia. Methods A cross-sectional study was conducted between January and March 2024 to assess CAM use among T2DM patients in Al-Ahsa. Data were collected through telephone interviews using a validated questionnaire covering demographics, diabetes information, and CAM use. A total of 499 participants completed the questionnaire. Results CAM use was reported by 106 (21.2%) participants, with fenugreek (51, 48.1%), cinnamon (48, 45.3%), and blackseed (29, 27.4%) being the most common. Key factors associated with CAM use included residence in the Eastern or Northern Region, older age, having diabetic complications, and lower frequency of doctor visits. Only 24 (22.6%) participants consulted their doctor about CAM, and 83 (78.3%) believed that CAM could prevent diabetes progression. Conclusion This study provides insights into the use of CAM among T2DM patients in Al-Ahsa, Saudi Arabia. The findings highlight the need for larger-scale longitudinal research to better understand the patterns and potential benefits and/or harms of CAM use. Developing targeted interventions and promoting evidence-based integration of CAM into the healthcare system could optimize patient care and encourage patient-provider communication regarding these therapies.

Dietary intake knowledge and reasons for food restriction during pregnancy among pregnant women attending primary health care centers in Ile-Ife, Nigeria

The study investigated dietary intake knowledge and reasons for food restriction during preg-nancy among pregnant women attending antenatal clinics in Ile-Ife, Nigeria. This cross-sectional survey involved 530 pregnant women visiting 35 primary health care (PHC) centers in Ile-Ife. Interview-er-administered questionnaire used to collect data included a 30-point knowledge scale and food restric-tion related questions. Data were analyzed using descriptive statistics and chi-square at P = 0.05. Mean age was 27.0 &amp;plusmn; 5.3 years, 44.5% had tertiary education and 11.1% earned above ₦50,000 monthly (ap-proximately US$315). Mean knowledge score was 23.6 &amp;plusmn; 4.2 and 75.5% had good knowledge. Higher education was significantly associated with good knowledge of dietary intake. Reasons for food restric-tion during pregnancy included cultural taboos (36.5%) and religious beliefs (12.1%). Major foods that were restricted or avoided for cultural reasons were protein and vitamin-rich foods such as snail (97.5%) and walnut (84.0%). Foods avoided based on religious beliefs included pork (87.4%) and dog (76.9%). A higher proportion (94.8%) of respondents who earn more than ₦50,000 avoided foods due to cultural taboos (94.8%) compared with those without monthly income (58.3%) (P&amp;le;0.05). The proportions of respondents who avoided foods due to cultural taboos with no formal, primary, secondary, and tertiary education were 95.5%, 93.8%, 79.8%, and 86.4% respectively (P&amp;le;0.05). Overall, respondents were knowledgeable about dietary intake. However, cultural taboos and religious beliefs were major reasons for food restriction among pregnant women and were more pronounced among women with low educa-tion and low monthly income. Nutrition education interventions are needed to address the phenomenon.&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp;&amp;nbsp;

Modelling efficiency in primary healthcare using the DEA methodology: an empirical analysis in a healthcare district

BackgroundPrimary healthcare management efficiency conditions the functioning of specialized care and has a direct impact on the outcomes of the health system and its sustainability. The objective of this research is to develop models to evaluate the efficiency, including health outcomes, of the primary healthcare centres (PHC) of the Clínico – La Malvarrosa Health District in Valencia.MethodsTo evaluate efficiency, Data Envelopment Analysis (DEA) was used with output orientation and variable returns to scale, with panel data from the years 2015 to 2019. In rates per 10,000 inhabitants, the inputs are: medical and nursing staff and pharmacy cost. The outputs are: number of consultations, hospital emergencies, referrals, avoidable hospitalisations, avoidable mortality and pharmaceutical prescription efficiency. As exogenous variables: the percentage of population over 65 years old, over 80 and case-mix. Three models were developed, all of them with the same inputs and different combinations of outputs related to: healthcare activity, outcomes, and both, in order to study the influence of the different approaches on efficiency. Each model is analysed both without exogenous variables and with each of them.ResultsThe efficiency results vary depending on the model used, although certain PHCs are always on, or very close to, the efficient frontier, while others are always inefficient. When healthcare activity outputs are considered, efficiency scores improve and the number of efficient PHCs increases. However, in general, the PHC score decreases throughout the evaluated period. This decrease is more pronounced when only activity outputs are included.ConclusionsDEA allows the inefficiencies of PHCs to be analysed and the efficient ones are clearly distinguished from the inefficient, although different efficiency scores are obtained depending on the model used. Evaluation can be according to healthcare activity, health outcomes or both, making it necessary to identify the expected objectives of the PHCs, as the perspective of the analysis influences the results.

Primary health care in Nigeria: best practices and quality of care in Nigeria

IntroductionThe significance of Primary Healthcare Centers (PHCCs) in fostering health equity and enhancing health outcomes cannot be overstated, especially in low and middle-income countries. This paper’s primary area of interest is to create evidence and innovation for PHCs, with a particular emphasis on underserved groups. Thus, the study aimed to investigate the state of primary health care in Nigeria, with a particular emphasis on best practices, challenges to best practices, and quality of care.MethodologyA cross-sectional quantitative study was conducted to collect secondary data from 29 primary healthcare facilities. The data was collected using staff and facility activity indicators over a year (2022). Descriptive statistics and chi-square tests were used to analyze the collected data.ResultOur study data showed that all of the PHCCs have service rosters that can be utilized for follow-up with patients. About 85 (84.1%) respondents have reported that deliveries were taken by the reporting midwife, and 55 (54.5%) respondents indicated that their facilities provided on-the-job training to their staff. This is considered as the best practice in the facility. However, the majority of the PHCCs (71.3%) lacked assessment teams, which was found to have a negative impact on the quality of healthcare provided at these facilities (p < 0.05).ConclusionOur study underscores the pressing need for primary healthcare services in Nigeria. Government authorities and healthcare providers must take action to overcome the challenges of limited capacity, service delivery, and quality of care. By adopting effective strategies and ensuring access to primary healthcare, citizens’ health outcomes can be greatly enhanced. Thus, it is essential to revamp and optimize healthcare facilities to establish an efficient healthcare system that caters to the needs of all citizens.