Primary Care Facilities Research Articles

Opportunities and challenges in delivering maternal and child nutrition services through public primary health care facilities in urban Bangladesh: a qualitative inquiry

BackgroundPublic primary health facilities are an important source of nutrition services for the urban areas in Bangladesh. We aimed to understand the challenges and facilitators of delivering maternal and child nutrition services through public sector from the perspectives of the users and service providers.MethodThe study was conducted in selected public primary health care facilities and their catchment area in Dhaka city from April-July 2019. We carried out 15 free listing exercises and 43 semi-structured interviews (SSI) with pregnant women and mothers of 0–24 months old children; 6 key informant interviews (KII) with facility managers and healthcare providers; and observed service delivery in 8 health facilities.ResultsFindings reveal that public primary health facilities address some economic and cultural barriers to access such as cost and provision of female service providers for maternal and child health services but challenges such as distance, waiting time, and cleanliness remained. In terms of service provision, there were gaps in provision of anthropometric measurement and counseling, and healthcare providers had inadequate training and therefore, knowledge of nutrition. The low priority given to nutrition services during program design hampered the delivery of nutrition services provided through urban public sector health facilities.ConclusionsThere were important gaps in terms of service provision and capacity of healthcare providers, and therefore, the quality of nutrition service provided through public primary health care facilities. To maximize the coverage of quality nutrition services in the urban areas, it is important to think through the design of nutrition service delivery and allocate adequate resources to fill the material and capacity gaps.

Predicting Capacity and Distribution of Healthcare Facilities in West Java

Inequitable distribution of healthcare infrastructure is a barrier to universal access. This research analyzes gaps in primary care facilities across 627 districts in Indonesia's West Java Province. A data-driven approach identifies shortages and proposes an evidence-based strategic construction plan to improve equity. Demand was forecast using national standards of 1 clinics per 30,000 population. While some areas meet or exceed standards, severe shortages affect many districts. Gap analysis quantified deficiencies by subtracting existing clinics from projected demand for each district using simple linear extrapolation for each kota and kabupaten. Quantifying gaps at district level highlighted disparities not evident in provincial summaries. The gap analysis methodology substantiated widespread inequities by comparing granular demand modeling to current infrastructure. Findings demonstrate analytical techniques incorporating sub-regional data can identify hidden disparities and inform targeted policy. The technique provides a data-driven approach to inform healthcare planning and resource allocation, with applications for regional systems globally. In 2020, Average demand was 2 puskesmas, ranging up to 15. In total 363 districts fell below the minimum national standard for clinics per capita. Mapping visualized clusters of highly deprived regions. In 2020, with West Java's 47 million residents, total modeled demand is 1771 puskesmas and up to 1959 in 2032. Current healthcare quantity was collected through web scraping district websites, finding only 1016 existing puskesmas. This reveals a significant shortage, with over 55% of districts below the standard. Distribution inequity was evident, with puskesmas density spanning 0-10 across District. These findings clearly demonstrate a need for expanded investment in primary care infrastructure. To achieve more equitable access, a multi-year strategic construction plan was proposed targeting new clinic development in underserved districts. The plan stratified districts into priority tiers based on the severity of shortages. Construction will be phased over 3 stages, focusing first on districts with the highest deprivation to rapidly improve equity.

Family planning service availability and readiness assessment of primary health care facilities in Delta State, Nigeria: a mixed methods survey

BackgroundThe availability of contraceptives, family planning guidelines, and Information, Education, and Communication (IEC) materials can increase access to family planning services. This study assessed the availability of commodities and readiness of primary health care (PHC) facilities in Delta State to offer family planning services.MethodsA cross-sectional design with an explanatory mixed-method approach was used i.e., the authors first collected the quantitative data, and after preliminary analysis of quantitative information, the qualitative approach was utilised to gather data on the perspectives of 32 PHC facility managers and 6 reproductive health supervisors on factors affecting family planning service availability and readiness.ResultsTwenty-one (65.6%) of the PHC facilities surveyed offered at least five modern methods of family planning. Stock-outs of emergency contraceptives, implants, intra-uterine contraceptive device (IUCD), oral contraceptive pills (OCP), condoms, and injectables were observed in 31 (96.9%), 17 (53.1%), 13 (40.6%), 4 (12.5%), 2 (6.3%), and 1 (3.1%) of the facilities respectively. Eleven (34.4%) and 8 (25.0%) of the facilities had IEC materials and family planning guidelines, and contraceptive commodity checklists respectively. Seventeen (53.1%) of the facilities did not have complete records of family planning activities.ConclusionThis study shows that a significant proportion of PHC facilities had stock-outs of contraceptive commodities, no complete records of contraceptive activities, no IEC materials and no family planning checklists. Continuous training of health providers and increased government commitment can help to improve contraceptive services.

Quantifying missed opportunities in health sector for women and girls victims of violence in Albania

Abstract Health facilities are important contact points for victims of violence against women and girls (VAWG) in need of care. In Albania relevant data about health sector utilization remain scarce. This is a first attempt aiming to quantify missed opportunities for survivors of VAWG at the health system. We used a sample of 151 victims of VAWG, residents of Tirana Capital, retrieved from the dataset of Counseling Line for Women and Girls, a non-governmental agency. All cases were victims of physical violence during 2018-2022. For each case in the sample, health records for the same period were traced in Tirana hospitals and primary health care (PHC) facilities medical registries. Hospital records were traced for all 151 cases, while PHC records were completed only for the cases with a national ID. No case of VAWG was formally registered or reported by health services in Tirana in the 5 years prior to survey. Nonetheless, 51.5% of survivors had used PHC services and 20.4% had used hospital services during the same period. 8.6% had been at the emergency service of Trauma Hospital with acute symptoms of physical body harm and 12.5% had received obstetric-gynecologic care. The average number of visits at PHC for the women using the services was 3.3, ranging from 1 to 15 visits during 5 years. The most common reasons for the visits at PHC were chronic conditions (28.7%), followed by infection diseases (22.%) and mental illness (16.5%). Health sector opportunities to provide specific treatment and support to victims of VAWG are missed at multiple levels in Albania. While piloting integrated health and social care at selected PHC facilities in the country provide a good momentum for responding to some of the unmet needs, a more comprehensive agenda for the health sector should address physician's failure to identify and deal with VAWG as a health problem. Key messages • Health sector opportunities to provide specific treatment and support to victims of violence against women and girls are missed at multiple levels in Albania. • Interventions in the health sector should address physician's failure to identify and deal with violence against women and girls as a health problem.

Experiences of catch-up vaccination among adult migrants in the UK: An in-depth interview study

Abstract WHO's Immunization Agenda 2030 emphasises equitable access to vaccination across the life course, including migrants who may have missed childhood vaccinations due to disrupted healthcare systems or differing vaccination schedules. Uptake of adult catch-up vaccination is thought to be poor in the UK, but limited evidence exists to explain this. In-depth semi-structured interviews were carried out across two studies with different adult migrant populations on views and experiences around vaccination. Study 1 recruited those resident <10 years in the UK from a range of backgrounds (remote interviews, 09/2020-01/2022, REC2020.0058) and Study 2 (in-person, 01/2022-03/2022, REC2021.0128) engaged Congolese and Angolan migrants. Interviews were conducted in English, Lingala or French and were audio-recorded, transcribed, and analysed through qualitative content analysis in NVivo 12. 71 participants were interviewed (mean age 43.6 [SD:12.4], 69% female, mean 9.5 [SD:7] yrs in UK). Most reported having never been offered or asked about vaccination history in the UK. Participants more often reported being offered seasonal or selective vaccinations (flu [n = 20], travel-related [n = 8], pregnancy-related [pertussis, n = 7]) compared to catch-up vaccines (MMR (n = 3), DTP (n = 3)) in the UK. Generally, participants were not aware of catch-up vaccination but viewed it mostly positively. Concerns included side effects, barriers to attending primary care facilities, and vaccination fatigue. Trust was an important factor in vaccination decisions, and participants expressed varying levels of trust towards healthcare professionals’ recommendations and the NHS. There is a need to increase opportunities for catch-up vaccination in primary care by incentivisation of catch-up vaccination and education of healthcare professionals. Low trust and concerns around safety exist in some migrant groups, for which tailored information campaigns or community-led interventions could be developed. Key messages • There is a need to increase opportunities for catch-up vaccination in primary care. • Low trust and concerns around safety exist in some migrant groups, for which tailored information campaigns or community-led interventions could be developed.

Uncontrolled Hypertension, Treatment, and Predictors among Hypertensive Out-Patients Attending Primary Health Facilities in Johannesburg, South Africa.

Hypertension is a poorly controlled risk factor for cardiovascular disease in South Africa, particularly among patients receiving care in the public sector who are mostly from low socioeconomic backgrounds. This cross-sectional study investigated uncontrolled hypertension, treatment, and predictors among hypertensive out-patients attending primary health care facilities in Johannesburg, South Africa. The WHO STEPwise approach to the surveillance of non-communicable diseases was used to collect data, including sociodemographic and lifestyle factors, health status, and measurements for anthropometry and blood pressure along with self-reported adherence to treatment, estimated through the general medication adherence scale. Uncontrolled hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg in diagnosed patients receiving anti-hypertensive treatment. Overweight and obesity were defined as a body mass index ≥25 and ≥30 kg/m2, respectively. Logistic regression models were used to assess the predictors of uncontrolled hypertension. Four hundred (n = 400) hypertensive out-patients (mean age: 50 ± 8 years) participated in this study, with most living in poor sociodemographic environments. The prevalence rate of uncontrolled hypertension was 57%. Obesity (62% vs. 42%, p ≤ 0.0001), salt consumption (90% vs. 55%, p ≤ 0.0001), alcohol intake (42% vs. 19%, p ≤ 0.0001), a smoking habit (23% vs. 4%, p ≤ 0.0001), alternative medicine use (51% vs. 40%, p = 0.043), and comorbidities (64% vs. 36%, p ≤ 0.0001) were higher in the uncontrolled group than the controlled group, whereas the prevalence of physical activity (38% vs. 15%, p ≤ 0.0001) was high in the controlled group vs. the uncontrolled. Overall, 85% of the patients moderately adhered to treatment, only 2% exhibited high adherence, and 13% demonstrated low adherence; over half of the patients received tri-therapy treatment. The predictors of uncontrolled hypertension are a number of prescribed antihypertensive therapies [adjusted odds ration = 2.39; 95% confidence interval: 1.48-3.87], treatment adherence [0.46; 0.21-0.97], salt consumption [28.35; 7.87-102.04], physical activity [0.22; 0.13-0.37], current alcohol use [2.10; 1.22-3.61], and current cigarette smoking [4.79; 1.88-12.18]. The high prevalence of uncontrolled hypertension in this study suggests a need to optimize prescriptions, adherence to BP-lowering medications, and lifestyle modifications. The management of comorbidities such as diabetes could offer considerable benefits in controlling blood pressure.

Cost efficiency of primary health care facilities in Ghana: stochastic frontier analysis

Primary health care (PHC) is a universally accepted key strategy to achieve universal health coverage (UHC) and Sustainable Development Goal 3 (SDG 3) due to its potential to produce a range of economic benefits through improved health outcomes, health quality, and health system efficiency. However, little evidence exists about the cost efficiency of primary health care facilities (PHCFs) in Sub-Saharan Africa. This study evaluates the cost efficiency of two main types of PHCFs in Ghana that are at the forefront of delivering PHC services to a greater proportion of the population: Community Health Centers (HCs) and Community-Based Health Planning Services (CHPS) compounds. The dataset we used for this study included 39 HCs and 55 CHPS facilities. Furthermore, it examines the factors that influence the cost efficiency of these facilities. The study applies the stochastic frontier analysis (SFA) technique to panel data. The estimated cost efficiency for HCs and CHPS is 61.6% and 85.8%, respectively. The study further revealed that facility size, medical staff density, and facility age are the main factors that explain the differences in the cost efficiency of PHCFs in Ghana. The study's policy recommendation is that the Ghana Health Service should consider utilizing modern technology such as telehealth and telemedicine to enhance access to PHC services for people living in hard-to-reach and densely populated communities. This strategic approach can significantly contribute to improving the cost-efficiency of PHCFs.

Assessment of knowledge and practice of zinc sulphate supplementation in the treatment of diarrhoea among under-five children in Primary Health Care centres in Keffi, Nigeria

Zinc supplementation reduces the severity, duration and recurrence of diarrhoea in children. This study assessed the level of knowledge and practice of zinc supplementation in the management of diarrhoea in children in primary health care facilities in Keffi, Nigeria. Retrospective and qualitative studies were conducted in nine facilities. Validated data collection form and questionnaire were used to collect medications prescribed for diarrhoea in children less than five years old. Descriptive statistics was done, and associate variables were tested using Chi-square Tests. The study assessed 380 case files and 19 health care workers in nine facilities. The finding revealed that 21.1% and 10.5% of the prescribers were aware of and had formal training on the use of zinc in the management of diarrhoea respectively. Oral rehydration salt with zinc and antibiotics were prescribed in 10.5% and 57.9% cases respectively. Only 13.2%, 8.2% and 8.5% of children managed for diarrhoea had correct doses, frequencies and durations of zinc respectively. Only 44.4% facilities had zinc tablet in stock. The study revealed low knowledge and practice among primary health care workers about treatment guidelines on zinc supplementation in the management of diarrhoea in children less than five years.

Continuing professional development training needs for primary care doctors in central Uganda.

Continuing professional development (CPD) activities relevant to medical doctors and their patients should be informed by current assessed training needs. The CPD provision is expected to improve the quality of professional practice and ethics. However, the Uganda Medical and Dental Practitioners' Council still receives about 40 reports of malpractice every month. The study aimed to describe the CPD training needs of doctors working in public primary care facilities in central Uganda. The district health system of central Uganda comprised 10 General Hospitals (GH) and 37 Health Center IVs (HC IVs) with a staffing norm of six and two doctors, respectively. This was a cross-sectional survey of 100 doctors working in public primary care facilities using the World Health Organization (WHO) Hennessy-Hicks questionnaire. Descriptive statistics of the importance, current performance, and training need of each skilled activity were calculated. Content analysis was applied to data from the open-ended questions. The response rate was 91%, majority were males, 80 (87.9%) from 7 GHs and 24 HC IVs with an average age of 37.9 years. The domain with the highest CPD training need for the doctors was research and audit, with a mean score (standard deviation [s.d.]) of 1.94 (±1.69), followed by administration 1.58 (±1.61) and clinical tasks 1.28 (±1.29). The clinical tasks domain had the most suggested CPD topics. Research and audit and clinical tasks were identified as important domains for CPD training for doctors in this setting.Contribution: The results give insight into CPD training needs of primary care doctors and guide various CPD providers.

Antimicrobial Resistance and Molecular Typing of Neisseria gonorrhoeae Isolates From the Eastern Cape Province in South Africa.

There is a paucity of Neisseria gonorrhoeae antimicrobial resistance data from resource-constrained settings because of the lack of diagnostic testing and limited scale of surveillance programs. This study aimed to determine the antimicrobial resistance profile of N. gonorrhoeae in the rural Eastern Cape province of South Africa. Specimens for N. gonorrhoeae culture were obtained from men with urethral discharge and women with vaginal discharge attending primary health care facilities. Direct inoculation of the agar plates was performed followed by culture and drug susceptibility testing using the Etest at the laboratory. Whole-genome sequencing of the isolates was performed to identify resistance-determining variants. One hundred N. gonorrhoeae isolates were obtained. Most strains were nonsusceptible to ciprofloxacin (76%), tetracycline (75%), and penicillin G (72%). The gyrA S91F mutation was present in 68 of 72 ciprofloxacin-resistant isolates (94%), with concurrent parC mutations in 47 of 68 (69%); gyrA I250M was the only mutation in 4 other resistant strains. One azithromycin-resistant isolate was identified with a minimal inhibitory concentration (MIC) of 8.0 mg/L and the 23S rDNA gene mutation C2597T. The median MIC of cefixime was 0.016 mg/L (range, 0.016-0.064 mg/L), and that of ceftriaxone was 0.016 mg/L (range, 0.016 mg/L). Whole-genome sequencing showed 58 sequence types as revealed in N. gonorrhoeae sequence typing for antimicrobial resistance and 70 sequence types in N. gonorrhoeae multiantigen sequence typing. This study confirmed high rates of N. gonorrhoeae antimicrobial resistance to ciprofloxacin, penicillin G, and tetracycline in our setting. The MICs of cephalosporins are reassuring for ceftriaxone use in syndromic treatment regimens, but the identification of azithromycin resistance warrants further attention.

Burns among adults in a major Malawian burn unit: epidemiology and factors associated with prolonged hospital stay.

This study sought to describe the epidemiology of burns and factors associated with prolonged hospital stay among adult patients admitted in the Queen Elizabeth Central Hospital burns unit. All files of patients aged at least 17 years and admitted in the Queen Elizabeth Central Hospital burns unit between 1 June 2007 and 31 May 2017 with acute burns, were reviewed. Data on socio-demographic characteristics, injuries sustained, comorbidities, length of hospital stay, and clinical outcomes were extracted from the files. Summary statistics, independent sample T-test, and odds ratios were computed to determine the distribution and associations of the variables collected. A total of 515 patient files, all from rural or informal urban settlements, were reviewed. The median age at the time of presentation was 32 years (IQR: 25-45), and 52% (n=279) were male. Most of the burns occurred at home (81.0%; n=379), were of flame etiology (75.7%; n=385), and were reported to have been accidental (94.7%, n=445). The mean monthly rate of new burn injury patients was highest in the cool-dry season, and epileptic seizures were a common precedent of burn injury (30.7%; n=158). Most (62.7%) of the patients with recorded burn sites sustained multiple burns injuries, and more than half of the patients had upper and lower limb burns (64.6% & 59.5% respectively). Thirty patients sustained additional non-burn injuries, and 26.4% (n=132) of all patients with recorded outcomes died in the hospital. The data on burn injuries among adults presenting at the QECH burns unit suggests the existence of socio-economic inequalities associated with burn incidence. There is also a need for improvement in the quality and uptake of epilepsy care in primary care facilities.

Protocol for a pragmatic cluster randomised controlled trial to evaluate the effectiveness of digital health interventions in improving non-communicable disease management during the pandemic in rural Pakistan.

The COVID-19 pandemic has revealed gaps in global health systems, especially in the low- and middle-income countries (LMICs). Evidence shows that patients with non-communicable diseases (NCDs) are at higher risk of contracting COVID-19 and suffering direct and indirect health consequences. Considering the future challenges such as environmental disasters and pandemics to the LMICs health systems, digital health interventions (DHI) are well poised to strengthen health care resilience. This study aims to implement and evaluate a comprehensive package of DHIs of integrated COVID-NCD care to manage NCDs in primary care facilities in rural Pakistan. The study is designed as a pragmatic, parallel two-arm, multi-centre, mix-methods cluster randomised controlled trial. We will randomise 30 primary care facilities in three districts of Punjab, where basic hypertension and diabetes diagnosis and treatment are provided, with a ratio of 1:1 between intervention and control. In each facility, we will recruit 50 patients who have uncontrolled hypertension. The intervention arm will receive training on an integrated COVID-NCD guideline, and will use a smartphone app-based telemedicine platform where patients can communicate with health providers and peer-supporters, along with a remote training and supervision system. Usual care will be provided in the control arm. Patients will be followed up for 10 months. Our primary indicator is systolic blood pressure measured at 10 months. A process evaluation guided by implementation science frameworks will be conducted to explore implementation questions. A cost-effectiveness evaluation will be conducted to inform future scale up in Pakistan and other LMICs. Our study is one of the first randomised controlled trials to evaluate the effectiveness of DHIs to manage NCDs to strengthen health system resilience in LMICs. We will also evaluate the implementation process and cost-effectiveness to inform future scale-up in similar resource constrained settings. ClinicalTrials.gov Identifier-NCT05699369.

Postpartum Hemorrhage et causa Atonia Uteri and Ruptured Portion with Complications of Shock Hemorrhagic and Anemia: A Case Report from Southwest Sumba, East Nusa Tenggara

Postpartum hemorrhage is one of the most common obstetric emergencies, and it is the most significant contributor to maternal mortality in the world. The most common cause is uterine atony, followed by laceration in the perineum or portion. P4A0 spontaneous postpartum at the primary health care facility (Puskesmas), a baby boy with a birth weight of 3000 grams cries spontaneously. After delivering the baby, the placenta was born 15 minutes later, with active bleeding afterwards of more than 1500 cc without uterine contractions. The patient was then diagnosed with spontaneous postpartum P4A0 with uterine atony, and the management of uterine atony was performed by massaging the fundus with external and internal bimanual compression, accompanied by fluid resuscitation by inserting a 2-line IV line. She was then given vaginal misoprostol, but contractions were still absent. She was then given a uterotonic drip of oxytocin (30 iu/30 dpm), and the contractions are getting better and stronger. Bleeding was evaluated, but still active then exploratorium on the birth canal and the source of the bleeding was found to be a portion of the tear from front to back, towards 5 o'clock. Then stitching was performed on the portion, and 1 hour after suturing, the bleeding was no longer active. The patient was treated at Puskesmas, with a final HB of 7.5 g/dL. To improve diagnosis accuracy and speed in handling emergency obstetric cases. Atonia uteri is caused by many factors, one of which is parturition as experienced by the patient. After active management of stage 3, bleeding continues, so that treatment is given, including the administration of crystalloid fluid, uterotonics, uterine massage, bimanual compression, and catheter condom placement. If the steps that have been taken have not stopped the bleeding, then the next intervention must be immediately taken, namely surgery. In cases of postpartum hemorrhage caused not by uterine atony but by a wound or tear in the portion, prompt actions must be taken to immediately eliminate bleeding by exploring and sewing the torn part and then re-evaluating to ensure that the bleeding stops. Establishing the right diagnosis in emergency cases of postpartum hemorrhage and providing prompt and appropriate treatment can prevent complications ranging from shock to death.

COVID-19 lockdown effect on healthcare utilization and in-hospital mortality in children under 5 years in Cape Town, South Africa: a cross-sectional study.

COVID-19 pandemic measures resulted in the de-escalation of non-COVID-19 healthcare provision. A retrospective cross-sectional study of routinely collected data was done to investigate the effect of COVID-19 policies on the healthcare utilization and mortality of children younger than 5 years in Eastern Cape Town, South Africa. We compared visits to primary and urgent care facilities, hospitalization, in-hospital deaths, and vaccine uptake from 1 January to 31 December 2020 to similar periods in 2018 and 2019. During April and May 2020, the most restricted period, visits to primary care facilities declined from 126 049 in 2019 to 77 000 (1.8-fold; p < 0.05). This corresponded with a 1.2-fold reduction in the provision of the first dose of measles vaccine at 6 months compared to 2019. Throughout 2020 there was a 4-fold decline in the number of fully immunized children at 1 year of age (p = 0.84). Emergency room visits fell by 35.7% in 2020 (16 368) compared to 2019 (25 446). Hospital admissions decreased significantly (p < 0.01) in 2020 (9810) compared to 2018 (11 698) and 2019 (10 247). The in-hospital mortality rate increased from 2.3% (96/4163) in 2019 to 3.8% (95/2498) (p < 0.01) in Tygerberg Hospital, where 80% (95/119) of deaths were recorded. Twelve of the 119 (10%) deaths occurred in HIV-positive children (p = <0.01). Measures instituted during the COVID-19 pandemic disrupted access to healthcare services for children. This resulted in an immediate, and potential future, indirect effect on child morbidity and mortality in Cape Town.

Exploring factors associated with hypertension self-care in primary care: The role of nurse education levels and patient-related factors.

To explore the association between nurse education levels and patient-related factors with hypertension self-care. Although self-care development is recognized as a healthcare provider-patient encounter, the attribution of nurse education level to hypertension self-care is not well addressed. A cross-sectional study. Hypertensive patients from 15 primary care facilities were sampled, and self-care was assessed using the Self-Care of Hypertension Inventory version 2.0, with standardized scores ≥70 indicating adequate self-care. Data on patient-related factors were obtained from electronic health records, self-reports and laboratory tests, while nurse education levels were categorized as standard (baccalaureate-prepared) or higher (post-baccalaureate specialty). A total of 1493 participants were included in this study, with a median age of 66 years and 77.7% being female. Approximately 10% of participants had adequate self-care, and 66% received care from higher educated nurses. The study showed the relation between nurse education levels and the self-care of the patients. Adequate hypertension self-care was significantly associated with higher educated nurse providers and patient-related factors, including intermediate to higher education, non-overweight/obese and the absence of age-related comorbidities. Hypertensive patients who had been provided care by higher educated nurses and their favourable sociodemographic, lower cardiometabolic risk and no concomitant disease were more likely to demonstrate adequate self-care.

Regional peculiarities of hospitalizations and outpatient medical treatment among the adult population with established type 2 diabetes mellitus

Purpose. To analyze the indicators of hospitalization and outpatient visits of patients aged 18 years and older with type 2 diabetes mellitus (DM) in federal districts (FD) and regions of the Russian Federation from the perspective of the World Health Organization concept of ambulatory care sensitive conditions. Materials and methods. The analysis included data from the annual forms of federal statistics (forms No. 12 and No. 14), on the number of hospitalizations and the outpatient visits of patients aged 18 years and older diagnosed of type 2 diabetes (ICD10: E11) in 2022. Results. We analyzed the data of the federal statistics (forms No. 12 and No. 14) of the Federal District and the regions of the Russian Federation in 2022. It was found that in the North Caucasus Federal District, an increased level of adult hospitalization is associated with an increased ratio of the number of hospitalizations to the number of outpatient visits to the primary health care (PHC) facilities. At the same time, in FDs with adult outpatient visits is higher than the Russian average and adult hospitalization is higher than the Russian average (Ural, Central and Volga FDs). And vice versa, in FDs with adult outpatient visits is lower than the Russian average and adult hospitalization is lower than the Russian average (Southern, Far Eastern, Siberian and North-Western FDs). When analyzing the ratio of the number of hospitalizations to the number of outpatient visits to PHC facilities among the adult population, the highest indicator was recorded in the North Caucasus FD, while the heterogeneity of the indicator within the FD was one of the highest among the other FDs. The lowest indicator of the number of hospitalizations to the number of cases of treatment in PHC facilities among the adult population with type 2 DM was recorded in the Northwestern FD, while the heterogeneity of the indicator within the FD was the lowest among the other FGs. There was a high variability of the ratio both for all subjects of the Russian Federation and FDs. The ratio values ranged from 2,55 in the Novgorod Region to 31,39 in the Chechen Republic. Conclusion. Accounting for diseases that can be treated on an outpatient basis can become one of the tools for assessing the quality of medical care to the adult population in PHC facilities. However, before including this indicator as a criterion for assessing the quality of medical services, a deeper understanding of the reasons influencing its change is required.

Reverse takotsubo after emotional distress and catecholamine bolus

A patient in his 40s was referred from a primary care facility to the emergency department because of chest pain, hypotension which was managed with a bolus of adrenaline, and diffuse ST depression on electrocardiography (ECG) after a life event with a high emotional impact. The patient was admitted with persistent hypotension and a second ECG with persistent ST depression; however, isobiphasic T was observed in some of the precordial leads. Given the evolving ECG, thoracic pain, and elevated troponin levels, the patient was admitted for percutaneous coronary angiography (PCI), considering the risk of Acute Coronary Syndrome. The latter reports coronary arteries without lesions but ventriculography with reverse Takotsubo morphology (Figure 1).

Condom Use among HIV-Positive Postnatal Women in Primary Health Care Facilities in Tshwane Sub-District 1, Gauteng Province, South Africa.

Condoms have been and are still an important part of HIV preventative measures worldwide, and many countries have designed programmes that encourage their use. Consistent and correct condom use among HIV-positive individuals is important in preventing multiple infections. Hence, the uptake and determining factors associated with condom use were investigated in this study. This study was aimed at determining the level of, and factors associated with, condom use among HIV-positive postnatal women in primary health care facilities in Tshwane sub-district 1, Gauteng Province, South Africa. A descriptive cross-sectional study was conducted among 326 HIV-positive postnatal women aged between 15 and 50 years who were conveniently selected and voluntarily participated in the study. A self-developed pretested questionnaire was used to collect data on level of condom use and factors associated with its use from the selected participants. Statistical tests of correlation were then used to determine the association between frequency of condom use during sexual encounter and condom use at last sexual encounter with the independent variables. Regular condom use during sexual encounters was reported by 63.2% of the participants while 83% of the participants reported using a condom at their last sexual encounter. Frequency of condom use during sexual encounter was found to be associated with employment status (p < 0.05), residence (p < 0.001), number of children (p < 0.05), first HIV diagnosis (p < 0.05) and disclosure of HIV status to partner (p < 0.05). Condom use at last sexual encounter was also found to have a significant statistical association with level of education (p < 0.05) and the ability to negotiate condom use (p < 0.001). A good proportion of the participants used condoms regularly. Interventions to improve condom use among this population should focus on female empowerment by investing in their education, and economic empowerment to improve their economic status, which, in turn, would help the women to better negotiate condom use. The other factors mentioned above should also be considered when developing health education policies and programmes about condom use amongst HIV-positive postnatal women.

Public Knowledge, Attitudes, and Practices Regarding the Use of Over-The-Counter (OTC) Analgesics in Indonesia: A Cross-Sectional Study.

Over-the-counter analgesics like paracetamol and nonsteroidal antiinflammatory drugs (NSAIDs) are widely accessible to the general population. However, ensuring their safe and effective usage is crucial by considering individuals' knowledge, attitudes, and practices toward these medications. This study aimed to assess the general population's knowledge, attitudes, and practices regarding the use of over-the-counter analgesics. This cross-sectional study took place in Indonesia from December 2019 to June 2020. A validated questionnaire was used to survey a total of 582 respondents. A comparative analysis examined the variations in mean scores for respondents' characteristics concerning their knowledge, attitude, and practice. A regression analysis was also employed to explore the factors associated with adopting good analgesia practices. The findings of the study revealed significant differences in average knowledge scores related to gender, educational attainment, and employment status for the use of both paracetamol and NSAIDs. Regarding knowledge, the respondents demonstrated a higher average score for analgesics (4.56 ± 1.84) than NSAIDs (2.881 ± 2.40), out of a maximum score of 6 points. The results indicate that the respondents obtained a low score for attitude (6.80 ± 3.74) out of 16 points and a positive score for practice (2.71 ± 0.48) out of 3 points regarding using analgesics. Moreover, the regression analysis revealed that gender, residing near primary health care facilities, and having sound knowledge of NSAID use were significant predictors of good analgesic practice (p < 0.05). The respondents demonstrated a greater understanding of analgesics compared with NSAIDs. However, despite this higher knowledge level, they had relatively low attitude scores but positive practice scores, indicating a discrepancy between attitudes and actual behavior in using analgesics.

The Implementation of Integrated Management of Childhood Illness (IMCI) in Sick Children from 2 Months up to 5 Years Age Old with Diarrhea in Community Health Center

Integrated Management of Childhood Illnesses (IMCI) is a program that focuses on the main childhood diseases that occur in children under five years of age with a focus on pneumonia (acute respiratory infection), diarrhea, malaria, measles, dengue hemorrhagic fever (DHF), ear and malnutrition. Diarrhea is a global health problem that causes high morbidity and mortality in developing countries due to poor environmental sanitation and hygiene, inadequate water supply, poverty and limited access to education. IMCI is a strategy that focuses on child as a whole, not on a single disease or condition, but on a combination of illnesses that need to be treated in an integrated manner at home and in primary health care facilities. Based on the Becora Community Health Center report that cases handled using the IMCI strategy totaled 2,204 cases in 2021, 4,273 cases in 2022 and 3,160 cases, from January to June 2023. Diarrhea cases ranked first, namely 584 cases in 2021, and in 2022 experienced an increase to 758 cases and until June 2023 cases of diarrhea reached 416 cases. The purpose of this residency is to know the management of cases of diarrhea by using IMCI strategies at the Becora Health Center, Dili, Timor Leste. Using descriptive studies because they only wanted to know the frequency distribution of cases handled with IMCI and specifically wanted to observe the management procedures in cases with diarrhea. Based on the results residence from 17-29 July 2023, 598 cases were not handled according to the IMCI strategy, of which 10.37% (n=62) cases had diarrhea and 0.5% (n=3) dysentery cases. In accordance with the results of observations that the IMCI management procedures are not in accordance with ministry standards or policies issued by the Ministry of Health Timor Leste. During residence it appears that health professionals conducting consultations are more directed to using general consultations than using the IMCI strategy.