Primary Health Care Facilities Research Articles

Assessing red blood cell distribution width in Vietnamese heart failure patients: A cross-sectional study.

Heart failure (HF) is becoming a growing public health concern. Diagnostic tests for determining the severity of HF often come with high costs and require specialized expertise, which makes it difficult to assess HF severity, especially in low-income countries or at primary healthcare facilities. Recently, red blood cell distribution width (RDW) has emerged as a promising, easily accessible marker associated with HF severity. The study aimed to assess changes in RDW levels in HF patients and the diagnostic value of RDW in detecting acute heart failure (AHF) among HF patients. We conducted a cross-sectional examination involving 351 participants divided into HF and non-HF cohorts. HF was defined and categorized according to the diagnostic and treatment guidelines for AHF and chronic heart failure (CHF) set forth by the European Society of Cardiology (2021). Univariate and multivariate analysis of factors associated with AHF was performed. The study revealed that HF patients displayed higher median RDW levels (14.90% [13.70-17.00]) compared to non-HF individuals (13.00% [12.23-13.78]). RDW was notably elevated in HF patients with left ventricular ejection fraction < 50% compared to those with left ventricular ejection fraction ≥ 50%. ROC curve analysis of RDW for AHF detection identified a cutoff value of 13.85%, with a sensitivity of 86.05% and specificity of 47.18%, statistically significant at p < 0.001. RDW > 13.85% was identified as an independent risk factor for AHF in patients with HF, with odds ratios of 2.644 (95% CI, 1.190-5.875; p = 0.017). The study revealed significant RDW variations in patients with CHF and AHF compared to the control group. These findings suggest that RDW could be a biomarker for detecting HF severity.

Health-Related Quality of Life Perception Among Older Persons with Non-Communicable Diseases in Primary Healthcare Facilities: A Qualitative Inquiry.

Unveiling the understanding of older persons with non-communicable diseases (NCDs) regarding health well-being is paramount and can translate to increased self-efficiency, independence, and enhanced well-being. However, little is known about older persons' understanding of the concept of health-related quality of life (HRQoL) in Uganda. The study explored perceptions of older persons with NCDs on HRQoL in central Uganda. This exploratory qualitative study design involved 23 participants recruited from selected Primary healthcare facilities in Central Uganda. Thematic analysis using an inductive approach generated themes that informed the study's qualitative findings. The key themes that emerged from the study include holistic well-being, lifestyle modification, and financial stability. The key component of HRQoL that came out clearly from the study was the physical domain. There is a need to embrace a person-centered approach based on the perceptions of older persons on HRQoL, which has the potential to improve well-being and enhance a healthy aging journey.

Analysis of Risk Factors for the Quality of Health Services in Primary Health Facilities: An Observational Study in North Bengkulu Regency, Indonesia

Primary health care (PHC) is crucial for overall health system performance, particularly in developing nations. However, variations in the quality of PHC services in Indonesia, particularly in North Bengkulu Regency, raise concerns. This study aimed to identify and analyze risk factors associated with suboptimal quality of health services in these facilities. This observational, cross-sectional study was conducted in 20 primary health centers (PHCs) in North Bengkulu Regency. A multi-stage random sampling technique was used to select 400 patients and 80 healthcare providers. Data were collected using validated questionnaires assessing various dimensions of service quality (tangibles, reliability, responsiveness, assurance, and empathy), patient satisfaction, and potential risk factors (socio-demographic, facility-related, and provider-related). Descriptive statistics, bivariate analysis, and multivariate logistic regression were used for data analysis. The study found a significant association between perceived service quality and patient satisfaction. Socio-demographic factors (lower education and income), facility-related factors (inadequate staffing and lack of essential medicines), and provider-related factors (insufficient communication and perceived lack of empathy) were identified as risk factors for lower service quality. The quality of health services in North Bengkulu PHCs is influenced by a complex interplay of patient, facility, and provider factors. Interventions targeting these risk factors, such as community education, capacity building for providers, and improvements in resource allocation, may improve PHC service quality and patient satisfaction in this region.

Evaluating Human Needs: A Study on the Spatial Justice of Medical Facility Services in Social Housing Communities in Guangzhou

Mainstream empirical studies on the spatial justice of medical facilities focus on equal accessibility or resource availability based on population scale, overlooking critiques that emphasize the importance of assessing inequality and the multidimensionality of human needs. However, access to medical care, particularly for vulnerable groups in social housing, often demands a higher level of consideration. Evaluating whether people can access the facilities they demand and expect is crucial for improving living standards. This study categorizes medical facilities into primary healthcare and hospital facilities based on their service grade, and integrates survey-based satisfaction into a spatial analysis of cost–distance-based accessibility and gravity-2SFCA-based availability. Analysis reveals that satisfaction primarily correlates with two factors: the distance to primary healthcare and the ease of reaching hospital facilities. While low accessibility to primary healthcare contributes to the evident distribution injustice of medical resources, satisfaction with service quality and scope is more strongly associated with the ease of reaching hospitals. To reduce injustice in social housing, specific remedies are needed to improve the difficult conditions for accessing primary healthcare faced by communities such as Guangdan, Likang, and Jinshazhou. Moreover, improving the easiness of reaching hospital facilities may significantly enhance the resident satisfaction with the level of medical service provided. Findings obtained in this research may not only enlighten Guangzhou’s urban planning, but may also be noteworthy for developing livable cities, which people anticipated.

Healthcare workers' views on type 2 diabetes mellitus management at selected clinics in Mthatha.

Diabetes is a non-communicable disease of global public health importance. Healthcare workers play a vital role in the management of this disease. This study aimed to explore healthcare workers' views on managing patients with type 2 diabetes at primary health care facilities. The study was conducted at two primary health care facilities in Mthatha, South Africa. This exploratory descriptive qualitative study included 28 primary health care workers. Data were collected through individual interviews and focus group discussions and analysed using a thematic analysis approach. Study participants' views of poor control of type 2 diabetes mellitus were categorised under patient- and healthcare system-related factors. The patient-related factors included poor adherence to an ideal diabetic diet, poor medication adherence, a lack of personal glucometers, and dearth of support systems. The healthcare system-related factors identified were inadequate patient education, long waiting times at the health facilities, high patient volumes, limited resources, and delayed service provision. Proposed solutions to address poor control of diabetes included improving patient health education, providing diabetic patients with glucometers, multi-stakeholder management of diabetes, allocating designated areas for patients with chronic illnesses, improved resource allocation, and regular staff training. Study participants perceived an improved level of control of diabetes among patients managed at the Community Health Centres. When designing interventions for the management of diabetes, both patient and healthcare system-related factors and the proposed solutions should be considered.Contribution:This study's findings could promote better management of diabetes at the primary health care level.

Performance and acceptability of the STREAM Disinfectant Generator for infection prevention and control practices in primary health care facilities in Uganda

BackgroundEffective infection prevention and control programs can positively influence quality of care, increase patient safety, and protect health care providers. Chlorine, a widely used and effective chemical disinfectant, is recommended for infection prevention and control in health care settings. However, lack of consistent chlorine availability limits its use. Electrolytic chlorine generators can address limited chlorine supply and stockouts by enabling onsite production of readily usable, high-quality chlorine cost-effectively. We report the feasibility (i.e., performance, acceptability, chlorine availability, and cost) of the electrolytic STREAM Disinfectant Generator (Aqua Research, New Mexico, USA) device for infection prevention and control in primary health care facilities in Uganda.MethodsWe installed STREAM devices in 10 primary health care facilities in central and western Uganda. Commercial chlorine inventory records (stock cards) were reviewed in each facility to calculate average liters of chlorine received and used per month. These values were compared with actual STREAM chlorine production volumes over the study period to determine its impact on chlorine availability. We collected acceptability data from a purposive sample of device users (n = 16), hospital administrators (n = 10), and district health officers (n = 6) who had been directly involved in the operation or supervision of the STREAM device. We descriptively analyzed the acceptability data by user group and evaluated qualitative responses manually using a thematic approach. Cost data were normalized and modeled to determine a break-even and cost-savings analysis across a five-year period (the minimum expected lifespan of the STREAM device).ResultsChlorine was consistently available without any reported stockouts during the evaluation period. STREAM chlorine production resulted in a 36.9 percent cost-savings over a five-year period compared to commercial chlorine. User acceptability of the STREAM device was high among STREAM operators, hospital administrators, and district health officers, with all respondents reporting that STREAM moderately or significantly improved infection prevention and control practices in the health facility. Overall, 88 percent of device users and 100 percent of hospital administrators wished to continue using the STREAM device instead of commercial chlorine products.ConclusionThe STREAM device has demonstrated significant potential to strengthen infection prevention and control practices in health care facilities in Uganda. Based on the preliminary results, the STREAM device should be considered a promising tool for district hospitals and large health centers facing infection prevention and control challenges in Uganda and elsewhere, provided water and electricity are available. Going forward, implementation of the STREAM device could also be considered in smaller health care facilities in Uganda and elsewhere.

De-implementation strategy to reduce unnecessary antibiotic prescriptions for ambulatory HIV-infected patients with upper respiratory tract infections in Mozambique: a study protocol of a cluster randomized controlled trial

BackgroundAntibiotics are globally overprescribed for the treatment of upper respiratory tract infections (URTI), especially in persons living with HIV. However, most URTIs are caused by viruses, and antibiotics are not indicated. De-implementation is perceived as an important area of research that can lead to reductions in unnecessary, wasteful, or harmful practices, such as excessive or inappropriate antibiotic use for URTI, through the employment of evidence-based interventions to reduce these practices. Research into strategies that lead to successful de-implementation of unnecessary antibiotic prescriptions within the primary health care setting is limited in Mozambique. In this study, we propose a protocol designed to evaluate the use of a clinical decision support algorithm (CDSA) for promoting the de-implementation of unnecessary antibiotic prescriptions for URTI among ambulatory HIV-infected adult patients in primary healthcare settings.MethodsThis study is a multicenter, two-arm, cluster randomized controlled trial, involving six primary health care facilities in Maputo and Matola municipalities in Mozambique, guided by an innovative implementation science framework, the Dynamic Adaption Process. In total, 380 HIV-infected patients with URTI symptoms will be enrolled, with 190 patients assigned to both the intervention and control arms. For intervention sites, the CDSAs will be posted on either the exam room wall or on the clinician´s exam room desk for ease of reference during clinical visits. Our sample size is powered to detect a reduction in antibiotic use by 15%. We will evaluate the effectiveness and implementation outcomes and examine the effect of multi-level (sites and patients) factors in promoting the de-implementation of unnecessary antibiotic prescriptions. The effectiveness and implementation of our antibiotic de-implementation strategy are the primary outcomes, whereas the clinical endpoints are the secondary outcomes.DiscussionThis research will provide evidence on the effectiveness of the use of the CDSA in promoting the de-implementation of unnecessary antibiotic prescribing in treating acute URTI, among ambulatory HIV-infected patients. Findings will bring evidence for the need to scale up strategies for the de-implementation of unnecessary antibiotic prescription practices in additional healthcare sites within the country.Trial registrationISRCTN, ISRCTN88272350. Registered 16 May 2024, https://www.isrctn.com/ISRCTN88272350

Maternal Death Self-Risk Perception as a Predictor of Women’s Delivery Site Preferences in Ile-Ife, Nigeria

Background: Increased uptake of health facility delivery could improve the worsening maternal mortality in low and middle-income countries. Several factors that determine women’s preferred delivery site had been reported in the literature, but none had explored women’s self-perception of maternal death as a predictor of their delivery site, hence this study. Subjects and Method: A cross-sectional study of 183 women recruited serially at the immuni­za­tion clinic of two primary health facilities in Ile-Ife, Nigeria. Data was obtained using an interviewer-administered questionnaire. Their maternal death self-risk perception score by type of delivery site was determined with a minimum and maximum obtainable score of 7 and 35. Descriptive and inferential statistical analysis was done including a simple and multiple binary logistic regression. Results: The mean age of the respondents (Mean= 29; SD= 5.26). About 130 (71.0%) of the women delivered at a health facility. The majority of the women (91.8%) were aware of maternal death, while 32 (17.5%) feared death in their last pregnancy, with a mean maternal death self-risk perception score ((Mean= 24.96; SD= 2.69) (95% CI= 24.55 to 25.33)). The higher the maternal death self-risk perception score, the greater the odds of a facility-based delivery (AOR=1.40, 95% CI=1.20 to 1.64, p&lt;0.001). However, alongside other confounding variables, only a facility-based ANC registration (AOR= 607.52, 95% CI= 1.39 to 2.66*105, p=0.039) and women’s personal reasons (AOR=0.02; 95%CI= 0.01 to 0.51; p=0.018) significantly influenced delivering at a health facility and non-health facility respectively. Conclusion: The place of ANC registration and personal reasons such as the women’s influential decision-makers better predicted their eventual delivery site. Nonetheless, the development and standardization of maternal death self-risk perception criteria for women is encouraged.

Diagnostic pattern of mental, neurological and substance use disorders at primary health care facilities in Uganda

Integration of diagnosis and treatment for mental, neurological, and substance use (MNS) disorders into primary health care is a recommended strategy to improve access to services in low-and middle-income countries. Despite numerous initiatives for integration of mental health care in Uganda, there has not been an evaluation of health management information system (HMIS) records to determine whether MNS disorders are routinely diagnosed. We sought to determine diagnostic pattern of MNS disorders at primary health facilities in Wakiso and Kampala districts, the most populous regions of Uganda. Lower-level primary health facilities were visited to obtain records from HMIS registers, to document diagnoses of MNS disorders. Secondary data analysis was conducted and descriptive statistics reported. A total of 40 primary health care facilities were visited representing 58.6% of the health facilities in the study districts. More than half (54.8%) and almost all (87.5%) of the lower-level health facilities in Wakiso district and Kampala district respectively were visited. The proportion of MNS disorders diagnosed at lower-level primary health facilities in Uganda is very low with Epilepsy the most common MNS diagnosis recorded. Reasons for such low numbers of diagnoses at primary health facilities are discussed as are possible solutions.

An Assessment of Health Behaviours in Primary Care Patients: A Cross-Sectional Study.

A healthy lifestyle is a key determinant of health, especially for people with chronic diseases such as diabetes or hypertension. The health behaviours which contribute to a healthy lifestyle include the following: regular physical activity, preventive examinations, maintaining a proper diet and avoiding the consumption of alcohol or cigarettes. They have a significant impact on the disease process, controlling symptoms and preventing complications. The aim of this study was to examine the health behaviours related to diet, physical activity and prevention among Polish primary health care patients and to identify predictors of health behaviours. For this reason, the standardized Health Behaviour Scale (HBS) questionnaire was used. The study was conducted among 269 patients (including 61.71% women) in primary health care facilities. The mean age of participants was 52.89 years (±17.76). The mean HBS score was 36.93 ± 9.66. A statistically significant association was found between HBS scores and such sociodemographic variables as education (p = 0.0061, r = 0.17), body mass index (p = 0.0018, r = -0.20, β = -0.36) and self-assessed economic status (p = 0.0094, r = 0.16). Women's health behaviours as measured by HBS were significantly better than men's (p < 0.001, β = -6.82). A special focus should be given to the groups manifesting poorer health behaviours (e.g., men, older people and persons with low socioeconomic status) by offering them tailored health-promoting interventions.

Analysis of Health Workers’ Use of Libraries and Digital Platforms in Accessing and Sharing Health Information in Tanzania

Background Health information comprises valuable data and knowledge that supports healthcare delivery. Although libraries and digital platforms are valuable for providing health information, there is a lack of documentation regarding their use by health workers in Tanzania. This study sought to analyze health workers’ use of libraries and digital platforms to access and share health information. Method A cross-sectional study using a mixed research approach was conducted from August to September 2022 at primary, secondary, and tertiary health facilities in Kilimanjaro and Mbeya regions. Semi-structured questionnaires and interviews were used to collect data from 500 health workers from all selected health facilities in all regions. IBM SPSS version 21 was used to analyze quantitative data, while thematic analysis was used to analyze qualitative data. Results Very few health workers (32.6%) used libraries while lack of physical libraries, limited time, and use of mobile phones hindered health workers from using libraries to access and share health information. Most of the health workers (56%) used digital platforms to access and share health information. Insufficient skills, lack of internet connectivity, and high cost of internet bundles limited health workers from utilizing digital platforms for accessing and sharing health information. Conclusion Many health workers do not use libraries and digital platforms to access and share health information. As a result, efforts should be made to increase the use of libraries and digital platforms among health workers to increase access to reliable and relevant health information to improve the quality of healthcare services.

Long-term impact of an integrated HIV/non-communicable disease care intervention on patient retention in care and clinical outcomes in East Africa.

To describe rates of retention in care and control of hypertension, diabetes and HIV among participants receiving integrated care services for a period of up to 24 months in East Africa. Between 5 October 2018 and 23 June 2019 participants enrolled into a prospective cohort study evaluating the feasibility of integrated care delivery for HIV, diabetes and hypertension from a single point of care in Tanzania and Uganda (MOCCA study). Integrated care clinics were established in 10 primary healthcare facilities and care was provided routinely according to national guidelines. Initial follow-up was 12 months. Outcomes were rates of retention in care, proportions of participants with controlled hypertension (blood pressure <140/90 mmHg), diabetes (fasting blood glucose <7.0 mmol/L) and HIV (plasma viral load <1000 copies/ml). The study coincided with the COVID-19 pandemic response. Afterwards, all participants were approached for extended follow-up by a further 12 months in the same clinics. We evaluated outcomes of the cohort at the end of long-term follow-up. The MOCCA study enrolled 2273 participants of whom 1911 (84.5%) were retained in care after a median follow-up of 8 months (Interquartile range: 6.8-10.7). Among these, 1283/1911 (67.1%) enrolled for a further year of follow-up, 458 (24.0%) were unreachable, 71 (3.7%) reverted to vertical clinics (clinics providing services dedicated to study conditions), 31 (1.6%) died and 68 (3.6%) refused participation. Among participants who enrolled for longer follow-up, mean age was 51.4 ± 11.7 years, 930 (72.5%) were female and 509 (39.7%) had multiple chronic conditions. Overall, 1236 (96.3%) [95% confidence interval 95.2%-97.3%] participants were retained in care, representing 1236/2273 (54.3%) [52.3%-56.4%] of participants ever enrolled in the study. Controlled hypertension, diabetes and HIV at the end of follow-up was, 331/618 (53.6%) [49.5%-57.5%], 112/354 (31.6%) [26.8%-36.8%] and 332/343 (96.7%) [94.3%-98.4%] respectively. Integrated care can achieve high rates of retention in care long term, but control of blood pressure and blood sugar remains low.

Brief intervention protocol by telephone delivered by nurses to patients with harmful alcohol use in primary health care: A feasibility trial

AimThe aim of this study is to examine the feasibility of a brief intervention protocol by telephone performed by nurses in primary health care facilities. MethodsA nonrandomized single-arm feasibility study was performed. The proposed intervention of this study is the Brief Intervention carried out by the nurse delivered by telephone, synchronously with alcohol users. The brief intervention is a motivational approach based on the FRAMES model, with its components being: Feedback, Responsibility, Advice, Menu of options, Empathy and Self-efficacy. To assess the feasibility of the protocol, we evaluated the procedure for enrolling participants, the acceptability of the protocol to participants, the satisfaction of the participants, convenience and treatment continuity. The quantitative data analysis was carried out in the R software, using descriptive statistics, categorical variables were reported by frequencies and percentages. For continuous variables, medians, means, standard deviations and range values were computed. ResultsWe followed the participants (n = 165) from baseline (T0) until 3 months (T1) and 6 months (T2) after the brief intervention. The partial effect suggests a reduction in alcohol consumption, and statistically significant differences were observed from baseline before the BI, with a decrease of 0.66 points in AUDIT scores at T1. Among the patients who completed the 3-month follow-up, 48 % reported a positive experience of receiving the brief intervention by the nurses, and 44 % reported a decrease in alcohol consumption. ConclusionsBrief intervention delivered by telephone was considered feasible and acceptable by primary health care patients, and they perceived improvement in their alcohol consumption after receiving the BI performed by nurses.

Quality of nutritional status assessment and its relationship with the effect of rainfall on childhood stunting: a cross-sectional study in rural Burkina Faso

ObjectivesIn Burkina Faso, one in every four children under 5 years is stunted. Climate change will exacerbate childhood stunting. Strengthening the health system, particularly the quality of nutrition care at primary health facilities, can minimise the adverse climate effect on stunting. Thus, we examined the quality of nutritional status assessment (QoNA) during curative childcare services in primary health facilities in rural Burkina Faso and its relationship with rainfall-induced childhood stunting. Study designWe conducted a cross-sectional analysis using anthropometric, rainfall, and clinical observation data. MethodsOur dependent variable was the height-for-age z-score (HAZ) of children under 2 years. Our focal climatic measure was mean rainfall deviation (MRD), calculated as the mean of the difference between 30-year monthly household-level rainfall means and the corresponding months for each child from conception to data collection. QoNA was based on the weight, height, general paleness and oedema assessment. We used a mixed-effect multilevel model and analysed heterogeneity by sex and socio-economic status. ResultsAmong 5027 young (3–23 months) children (mean age 12 ± 6 months), 21% were stunted (HAZ ≤ −2). The mean MRD was 11 ± 4 mm, and the mean QoNA was 2.86 ± 0.99. The proportion of children in low, medium, and high QoNA areas was 10%, 54%, and 36%, respectively. HAZ showed a negative correlation with MRD. Higher QoNA lowered the negative effect of MRD on HAZ (β = 0.017, P = 0.003, confidence interval = [0.006, 0.029]). Males and children from poor households benefited less from the moderating effect of QoNA. ConclusionImproving the quality of nutrition assessments can supplement existing efforts to reduce the adverse effects of climate change on children's nutritional well-being.

A qualitative study of maternal and paternal parenting knowledge and practices in rural Mozambique

BackgroundProviding nurturing care for young children is essential for promoting early child development (ECD). However, there is limited knowledge about how mothers and fathers across diverse contexts in sub-Saharan Africa care for their children and from whom they receive guidance and support in their caregiving roles. We aimed to examine caregivers’ nurturing care practices and sources of parenting knowledge in rural Mozambique.MethodsThis is a secondary analysis using data from a qualitative evaluation of a pilot intervention to improve nurturing care for early child health and development within existing health systems. The evaluation was conducted across three primary care health facilities and their catchment areas in Nampula province, Mozambique. For this study, we analyzed data from in-depth interviews conducted with 36 caregivers (32 mothers and 4 fathers) to investigate mothers’ and fathers’ daily caregiving experiences. Data were analyzed using thematic content analysis.ResultsCaregivers described various caregiving roles relating to general caregiving of young children (e.g., feeding, bathing, caring for child’s health) and stimulation (e.g., play and communication) activities. Mothers more commonly engaged in general caregiving activities than fathers, whereas both mothers and fathers engaged in stimulation activities. Other family members, including siblings, grandparents, and aunts/uncles, were also actively engaged in general caregiving activities. With respect to sources of parenting knowledge, caregivers received parenting guidance and support primarily from their own mothers/parents and facility-based health providers.ConclusionsThese findings highlight the importance of adopting a holistic approach involving caregivers and their context and reveal potential strategies to promote caregiving and ECD in rural Mozambique and similar contexts.

Evaluation of destruction of bacterial membrane structure associated with anti-quorum sensing and ant-diabetic activity of Cyperus esculentus extract

Recently, there has been an increasing demand for medicinal plants to control diseases for good health and well-being, as primary health facilities are inadequate in certain populations to cure infections. Since synthetic medicines are toxic to humans and other animals, the present research is thus focused on using traditional medicine for treating various ailments as they are harmless. Based on the above facts, the current study was conducted to assay the antimicrobial, anti-diabetic, anti-cholinesterase, anti-oxidant, anti-quorum sensing, and anti-antibiotic resistance modifying effect of extracts of Cyperus esculentus. This study found 37 and 30 chemicals in butanol and dichloromethane (DCM) extracts using a gas chromatograph mass spectrophotometer (GC-MS). Most active compounds identified were benzofuran, 2,3-dihydro-, 1,2,3-benzenetriol, 3-bornanone, oxime and oleic acid by extracts of butanol whereas dichloromethane extracted three major active compounds (2,3-dihydro-3,5-dihydroxy-, 4H-pyran-4-one 3-deoxy-d-mannoic lactone and 5-hydroxymethylfurfural). Both dichloromethane and butanol extracts showed the highest antimicrobial activity. Compared to aqueous extracts, dichloromethane, and butanol showed excellent anti-diabetic anti-cholinesterase activities and inhibited virulence factors regulated by quorum sensing (QS). Anti-oxidants increased in solvent extracts (DCM and butanol) compared to aqueous extracts. Results of scanning electron microscope (SEM) and Fourier Transmission Infrared (FTIR) indicated damage to the cell membrane of S. aureus by the formation of pits and breakage in functional groups exposed to the extracts of butanol and dichloromethane compared to aqueous extracts. The above results confirmed that C. esculentus can be an alternative medicine for treating diseases.

Health System Responses to Address Treatment Gaps of Unsuppressed Adolescents on HIV Treatment in Public Primary Health Care Facilities in Windhoek, Namibia.

Adolescents living with HIV (ALHIV) face unique challenges that result in persistent gaps in achieving and maintaining suppressed viral load. Although effective evidence-based interventions to address treatment gaps in adolescents are readily available, health systems in resource-constrained, high HIV prevalence settings are challenged to implement them to achieve epidemic control. Here, we describe the health system responses to address the treatment gap of unsuppressed ALHIV on antiretroviral therapy in Windhoek, Namibia. We conducted a qualitative descriptive and exploratory study in Windhoek between June and October 2023. Nineteen purposively selected key informants, ranging from pediatric HIV program managers to healthcare providers, were interviewed. In-depth interviews were audio-recorded and transcribed verbatim. The transcripts were uploaded to ATLAS.ti and subjected to thematic analysis. The four main themes elucidated challenges related to adherence and retention as well as health system responses in the form of interventions and support programs. The predominant adherence and retention challenges faced by ALHIV were mental health issues, behavioral and medication-related challenges, and inadequate care and social support. The health system responses to the identified challenges included providing psychosocial support, peer support, optimization of treatment and care, and the utilization of effective service delivery models. Key health system support elements identified included adequately capacitated human resources, efficient medication supply chain systems, creating and maintaining an enabling environment for optimum care, and robust monitoring systems as essential to program success. The health system responses to address the remaining treatment gaps of unsuppressed ALHIV in Windhoek are quite varied and, although evidence-based, appear to be siloed. We recommend harmonized, multifaceted guidance, integrating psychosocial, treatment, care, and peer-led support, and strengthening client-centred differentiated service delivery models for unsuppressed adolescents.

Awareness and Perception of Physical Activity among Nigerian Pregnant Women Attending Primary and Tertiary Health Facilities: A Comparative Study

Background: Despite the benefits of physical activity (PA) during pregnancy, expectant women are not meeting the exercise recommendations. This may be connected with their level of awareness, perception, and attitude to physical exercise. Objective: To assess and compare the awareness and perception of pregnant women about PA at primary and tertiary health care facilities (PHC and THC) in a local government in Nigeria. Methods: A comparative, cross-sectional study recruited 502 pregnant women from six selected health facilities (250 PHC vs 252 THC). Their perception and awareness of PA were assessed using an interviewer-administered questionnaire. Results: Pregnant women accessing care in THC have a higher level of awareness than PHC attendees (60.7% vs 34.4%; p = 0.001). Women accessing care at PHC had a better perception of PA (67.2%) than women assessing care at THC 55.2% (p = 0.006). Age and occupation were significantly associated with awareness of PA among participants in PHC, while only occupation was significantly associated with THC. Age, occupation, and number of children alive were significant predictors of awareness of PA; in contrast, age, education, monthly income, and number of pregnancies were the predictors of perception of PA among the PHC participants. Conclusion: Awareness of PA was good in the tertiary facility but poor in PHC, while perception of PA was good in both facilities. Women, irrespective of parity, should be inspired to exercise as women who habitually exercise are more likely to continue during pregnancy.

Utilisation of Children's Emergency Services in a Semi-urban Nigerian Tertiary Health Facility

Background: Children's emergency services are still evolving in Nigeria. The description of the attributes of children attending Children Emergency Services in Nigeria is yet to be extensively studied in recent times. This can guide resource allocation and help develop health policies that advance children's emergency care. Objective: To review the profile of children patronising children’s emergency services in a tertiary health institution in a semi-urban setting in Nigeria. Methods: The study was a descriptive, cross-sectional survey among seventy-five caregiver-child pairs attending the children's emergency room of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Results: The mean age of the parents was 39.76±9.21 years and 33.47±8.11 years for the fathers and mothers, respectively. About two-thirds (65.4%) of the children were aged five years and below with male preponderance (69.3%). The highest educational level reported was secondary among 53.3% of the fathers and 42.7% of the mothers. Sixty-eight per cent (68%) of the children came on self-referral. Fever was the most common presenting complaint (72.0%) and paracetamol was the most commonly used medication as home remedy (21.3%). Conclusion: Most children utilising emergency services arrived at the facility on self-referral. There is a need for increased advocacy to ensure that the referral systems effectively function in referring patients to tertiary facilities from either primary health or secondary facilities.

Exploring the experiences of school-going children with HIV in Eswatini: A qualitative inquiry.

Infection by human immunodeficiency virus (HIV) is a major disease in children, affecting an estimated 1.8 million children and adolescents worldwide. Eswatini has the highest prevalence of HIV in the world. Only 76% of children in Eswatini are on anti-retroviral treatment. This study aimed to gain an in-depth understanding of the lived experience of school-going children with HIV in Eswatini. Being aware of these children's experiences can assist schools in supporting them. The study was conducted in four primary health care facilities in Eswatini. Employing a qualitative, exploratory, descriptive research design, 12 school-going children with HIV were interviewed through semi-structured face-to-face interviews. The data were coded, categorised and clustered into themes and sub-themes using Georgi's data analysis. Ethical considerations and measures to ensure trustworthiness were adhered to throughout the study. The findings revealed three themes: Experiences after HIV disclosure, experience of disclosure and discrimination, and experience of desire to fulfil educational needs. Six sub-themes were identified: A feeling of sadness and worry relating to knowledge of HIV diagnosis, a desire to disclose their status to their teachers but not to their peers, a need for protection against discrimination, a desire to learn, illness affecting their learning and expectation for teachers to be supportive in their educational needs.Conclusion and contribution:The findings of the study guided recommendations that may assist, the Eswatini Ministry of Health, schools, parents and caregivers, and siblings to support school-going children with HIV.