Primary Facilities Research Articles

Oral Octreotide Capsules and Paltusotine in Management of Acromegaly.

Injectable somatostatin receptor ligands (iSRL) are the most frequently utilized medical therapy in patients with acromegaly; however, satisfaction rates are suboptimal. Injections can result in local erythema, discomfort and subcutaneous nodule formation, encompassed with the inconvenience of attending either primary or secondary care medical facilities for injections every 4 weeks. Some patients also note breakthrough of acromegaly-related symptoms towards the end of the injection cycle. To improve acceptance and ultimately improve wellbeing of these individuals, two oral SRLs, oral octreotide capsules (OOC) and paltusotine, have been developed. The OOC combines an enteric coating to allow delivery to the small intestines and a transient permeability enhancer to enable oral bioavailability. Comparable octreotide levels are obtained with twice-daily OOC and subcutaneous octreotide 100 µg. Phase III studies show OOC to maintain equivalent biochemical control in at least 60% of patients previously receiving a stable dose of iSRL. In longer-term studies, the response to OOC was durable up to 3 years. Paltusotine is a novel potent orally available non-peptidyl somatostatin receptor subtype-2 ligand. Studies in healthy volunteers show dose-dependent suppression of growth hormone-releasing hormone-induced growth hormone secretion and suppression of insulin-like growth factor-I (IGF-I) with repeat doses. In the recent phase II study, patients with acromegaly who were partial responders (IGF-I 1.0 - 2.5 x upper limit of normal) to monotherapy with iSRL when switched to once-daily paltusotine maintained control of IGF-I within 20% of baseline or lower in 87% after 13 weeks. Adverse events with both OOC and paltusotine were reflective of those recognized with iSRL and occurred at a similar frequency. OOC and paltusotine are well-received additions to the therapeutic armamentarium in medical therapy for the management of acromegaly; however, further data on efficacy, tumour control and shrinkage are required to allow positioning of this medication within the management algorithm for acromegaly.

Применение геоинформационных технологий в изучении уровня обеспеченности объектами дошкольного образования на территориях Новой Москвы

The high growth rate of the population of Moscow determines the development of new territories, an increase in the density of buildings, which requires a constant increase in the number of social infrastructure facilities. Particular attention in spatial development projects is paid to the placement of primary educational facilities, namely preschool educational institutions. The study emphasizes the important role of the rational placement of these facilities in the Novomoskovsky and Troitsky administrative districts of Moscow, as a prerequisite for the effective development of the educational system in these areas. The authors calculated the provision of districts with preschool educational institutions, considering their design capacity and the actual need in order to solve the problem of lack of educational places. Graphic materials of the obtained research results were generated in the QGIS geographic information system. As a result of the work, parameters for the classification of settlements were determined; analyzed and mapped spatial information on the objects of preschool education in Novomoskovsk and Troitsk administrative districts. The initial data in the QGIS GIS system were materials from the website of the Department of Education and Science of the city of Moscow, as well as information from open sources and official pages of educational organizations. Based on the classification of settlements in the studied districts obtained during the study, cartographic images were generated that clearly display the availability of preschool education institutions in the territories of New Moscow. The authors singled out the settlements of New Moscow in terms of indicators characterizing the level of provision of these territories with objects of preschool education relative to standard indicators. The final version of the cartographic images of the resulting classification was created using the Layout Manager tool in the QGIS GIS system. The result of the work was the classification of settlements, reflected on the map, which allows (considering current data) to visualize the location of preschool educational organizations in the districts of New Moscow. The results of research and mapping may be taken into account during development of the Master Plans of the districts.

A digital twin-based approach for optimizing operation energy consumption at automated container terminals

The sustainable development of port operation management is strongly related to the energy consumption of production at automated container terminals (ACTs). This paper focuses on the production activities at a container yard, which is the primary facility of ACTs. A digital twin-based approach is proposed to optimize the operation of an automatic stacking crane (ASC) handling containers in terms of energy consumption. A virtual container yard that syncs with a physical container yard in the ACT digital twin system for observation and validation is developed. A mathematical model is established to minimize the total energy consumption of completing all tasks. Then, the Q-learning algorithm is adapted to optimize a solution based on the operating data from the ACT digital twin system. Numerical experiments are conducted to demonstrate the effectiveness of the proposed approach by comparing it with two other solution algorithms, viz., genetic algorithm (GA) and particle swarm optimization (PSO). The total energy consumption of two operation strategies (i.e., centralized and decentralized) are also compared using the proposed digital twin-based approach. With digital twin, the operational environment and energy consumption are visualized to support optimization and management of ASCs. Managers and operators can choose an appropriate strategy according to the designated sustainable goal.

Challenges in setting up a primary human papillomavirus-DNA testing facility in a lower and middle income country: lessons learned from a pilot programme.

Detection of high-risk human papillomavirus (hrHPV) is the most sensitive test for the screening of cervical cancer. Although most high-income countries have adopted this strategy in their screening programme, there are a lot of barriers in low and middle-income countries (LMICs) in setting up this facility for screening. The lessons learned based on this experience can be useful for other LMICs in their first steps to integrate HPV testing into a screening programme. HPV testing using self-sampling was offered to eligible women residing in one district of Sikkim state. To implement the same, a testing laboratory was set up in the district and the challenges faced are listed. The cost of testing equipment, sampler and cold storage was beyond the budget capping. Setting up of the HPV testing lab accessible to study sites and referral centre was a difficult decision to make. Training the health care providers in their proficiency in triaging and treatment was challenging. Coordinating with community health workers and beneficiaries for effective screening and establishing referral linkages was not easy, as we expected. The cost of transportation, consumables and contingencies was higher due to the difficult terrain. The cost of the equipment and consumables for primary HPV screening can be reduced in bulk purchases through negotiations. Adequate knowledge of the terrain and economic implications of the area of interest is crucial during the budgeting of the programme. Collaborating with the state government, integration with the existing health system and repurposing the available resources are key for success. The barriers faced during implementation are stepping stones for improvement.

The Sehat Ghar: An Innovation to Improve Primary Healthcare in Rural Punjab

An effective healthcare sector essentially relies on a strong primary healthcare system. The primary healthcare system governs all major aspects of preventive healthcare and family planning services including immunization, hygiene, communicable disease prevention, sanitation, etc. In addition to this, a major bottleneck limiting the quality of healthcare at secondary and tertiary health facilities is the very high patient footfall that these hospitals. The primary healthcare facilities are designed to be the first tier of facility that a patient falls onto, and hence is either treated there or referred to higher level facilities by screening and limiting patient flow to next levels. Supporting this tier hence helps reduce burden on secondary and tertiary facilities of patients that could have been treated at primary facilities and hence exponentially improve the quality of health services in these lager hospitals. The document discusses some of the major issues faced by the primary healthcare sector in Punjab. These issues were studied and analyzed in detail at South Punjab Health Department, which is an arm of the provincial health department governing 11 districts of Southern Punjab – districts where socio-economic conditions are generally much poorer than the rest of Punjab. This document discusses the initiative of Sehat Ghar, its model, potential to ensure basic health services delivery to the local population and its direct & indirect contribution to tackle major issues of primary healthcare in Punjab.

Extrapulmonary tuberculosis in China: a national survey

ObjectivesExtrapulmonary tuberculosis (EPTB) is not a notifiable infectious disease in China but is a heavy burden on public health. However, the epidemic situation of EPTB nationwide is unclear. This study aimed to investigate the magnitude and main subtypes of EPTB in China. MethodsWe conducted a national cross-sectional study with multistage, stratified cluster random sampling during 2020-2021. We calculated proportions of EPTB in all patients with TB by organs. Logistic regression models were used to estimate odds ratios by characteristics. ResultsA total of 6843 patients with TB were included. Of them, 24.6% were patients with EPTB, and the proportion of EPTB solo was 21.3%. Higher EPTB burden was observed in children, female patients, clinically diagnosed patients, provincial-level and prefectural-level health facilities, and Central and West China. EPTB occurred most frequently in respiratory (35.5%), musculoskeletal (15.8%), and peripheral lymphatic (15.8%) systems with top three subtypes, including tuberculous pleurisy (35.0%), spinal TB (9.8%) and cervical tuberculous lymphadenopathy (7.9%). With the increase of age, proportion of peripheral lymphatic TB decreased, and proportion rank of genitourinary TB rose. ConclusionIt is essential to strengthen the diagnosis and treatment capacity for EPTB in primary medical facilities. EPTB should be added to the National Tuberculosis Program as a notifiable disease.

Facilities Planning in the Dynamic Environment in Tanzanian Public Primary Schools

The article explains the improvement of Tanzanian public primary schools facilities planning in the dynamic environment. The main contribution is that School Facilities Planning (SFP) in the dynamic environment to enhance adequate and quality school facilities is determined by the presence of vision and mission statements, positive school culture, technological environment and monitoring and evaluation. This article looks not beyond the planning but rather at the dynamics of planning discourse itself. It explains how dynamic environment in Tanzania facilitates, and sometimes constrains, the mobilization of resources to implement school facilities plans. It draws from the discursive construction of social actors in SFP from 2010 to 2019. Critical Discourse Analysis (CDA) was used as a theory, methodology, and data analysis strategy. Major findings indicate that, in order to improve planning in the dynamic environment, vision and mission statements should be established in schools and emphasize SFP; there should be a culture of facilities planning in schools; technological environment should be emphasized to facilitate durable and quality school facilities; and monitoring and evaluation should be emphasized to facilitate SFP.

Distance Analysis Measuring for Clustering using K-Means and Davies Bouldin Index Algorithm

The purpose of this research is to analyze mapping results in the form of clusters formed using clustering method measures. This is done to determine the connections that the existing clusters create. Some of the measurements used are mixed measurements, Bregman differences, and number measurements (Mixed Euclidean Distance, Generalized Divergence, Squared Euclidean Distance, Mahalanobis Distance, and Euclidean Distance). Distance measurement shall be applied on number with primary school facilities in Indonesia. The Davies Bouldin Index (DBI) is different from the cluster number test (k = 2-10) for each Distance Measure. The average DBI value in the type of measure (mixed measure) and numerical measurement (Mixed Euclidean Distance) is 0.54. The average DBI value in the type of measure (Bregman divergences) and numeric measurements (generalized IDivergence) is 0.66. The average DBI value is 0.77 for the measurement type (Bregman divergences) and numerical measurement (Squared Euclidean Distance). From the results, the measurement of distance with mixed measurement and the mixed Euclidean distance with the cluster number (k = 2), namely 0.269, have the best DBI value.

The effect of catchment based mentorship on quality of maternal and newborn care in primary health care facilities in Tigray Region, Northern Ethiopia: A controlled quasi-experimental study.

In Ethiopia, quality of maternal and newborn care is poor. This situation has persisted, despite the wide implementation of several capacity building-oriented interventions including clinical mentoring for skilled birth attendants that were anticipated to translate in to high-quality maternal and newborn care on each encounter. The effectiveness of mentoring programs is not yet well documented in the research literature. Therefore, we evaluated the effect of a catchment based clinical mentorship in improving the quality of maternal and newborn care in primary level facilities of Tigray, Northern Ethiopia. We conducted a controlled quasi-experimental pre-post study among 19 primary health care facilities, with 10 facilities assigned to the group where the catchment based clinical mentorship program was implemented (intervention group), and 9 facilities to the control group. We assigned the group based on administrative criteria, number of deliveries in each facility, accessibility, and ease of implementation of the intervention. A sample of 1320 women(662 at baseline; 658 at post intervention) and 233 skilled birth attendants(121 at baseline and 112 at end line) were included. We collected data from mothers, skilled birth attendants and facilities. The first round of data collection (baseline) took place two weeks prior the inauguration of the intervention, 05 October to 04 November 2019. The end line data collection occurred from 22 May to 03 July 2020. The primary Outcome was "receipt quality of maternal/newborn care". We analyzed the data using difference in differences (DiD) and logistic regression with Generalized Estimating Equation. The level of significance of predictors was declared at p-value less than 0.05in the multivariable analysis. We deployed a team of local clinical mentors working at primary hospitals to provide clinical mentorship, and direct feedback in routine and emergency obstetrical and newborn care to the mentees (all skilled birth attendants performing maternal and newborn health services) functioning in their catchment rural health centers for duration of six months. While visiting a facility, mentors remain at the facility each lasting at least five to seven days per month, over the course of intervention period. A significantly higher proportion of women at intervention facilities received quality of care services, compared with women at comparison facilities. (DiD = 18.4%, p<0.001). Moreover, following the implementation of the intervention we detected a difference in the occurrences of maternal complication outcome during delivery and immediately after birth. This was decreased by 4.5%, with significant differences between intervention and comparison sites (DiD = 4.5%, p = 0.013). We also found a favorable difference in occurrences of neonatal obstetric complications, with a decrease of 4.8% in the intervention site and almost no change in the comparison site (DiD = 4.8%, p = 0.002). Among the determinants of quality of care, we found that providers' job satisfaction (AoR = 2.95, 95%CI: 1.26 to 6.91), and making case presentation at regular basis(AoR = 1.89, 95%CI: 1.05 to 3.39) were significantly associated to improve the quality of care. However, delivery load(AoR = 0.95, 95%CI: 0.93 to 0.98) was negatively associated with quality of care. We conclude that the catchment based clinical mentorship intervention is effective to improve quality of care and reduce childbirth complications in northern Ethiopia. This finding further elaborated that incorporating maternal and newborn health catchment based clinical mentorship activities into the existing health system strengthening strategies can catalyze improvement processes to quality practice and health systems. This is seen as a necessary step to achieve the effective quality universal health care required to meet the health-related Sustainable Development Goals. Besides, more attention needs to be given to develop interventions and strategies that directly enhance providers' job satisfaction and reduce delivery work load.

Patient Experience Performance at a Primary Cancer Center vs. Satellite Facilities

<h3>Purpose/Objective(s)</h3> Patient experience tools are used throughout healthcare as a means of evaluating the performance of providers and the department. In radiation medicine, these tools are important in evaluating patient-specific metrics through their care journey. This study assessed patient experience outcomes from a central tertiary cancer program and multiple community satellite clinics in a single academic healthcare network. <h3>Materials/Methods</h3> Radiation medicine patient experience survey data was collected from a central facility and 5 satellite locations from January 2017 through June 2021. Surveys were distributed to all patients after completion of their radiation treatment. The study cohort was divided by our central facility and satellite locations respectively. Questions were scored on the Likert scale (1-5) and were converted to a 0-100 scale. To compare the scores between central and satellites, 2-way Analysis of Variance (ANOVA) tests were completed on each question followed by an adjustment for multiple comparisons (Dunnett's test). <h3>Results</h3> Approximately 4,000 consecutively returned surveys were reviewed. During the study period, the central site conducted a total of 117,583 LINAC, 1,425 non-invasive stereotactic radiosurgery, 273 SRS, and 830 SBRT procedures. The combined satellites conducted a total of 76,788 LINAC, 131 non-invasive stereotactic radiosurgery, 95 SRS, and 355 SBRT procedures. Patient satisfaction scores were compared between central & satellites. The central facility fared better than the satellites on "Convenience of Parking" (95.9 vs 87.9, <i>p</i>=.0001), but worse across the board (Table 1). <h3>Conclusion</h3> All sites yielded exemplary patient experience rates with satellites scoring higher than the main campus. These results exemplifying enhanced patient experience at the satellite sites require a deeper analysis of factors influencing the central facility, as the survey did not account for varying patient volumes and disparities in complexity of care across sites. Further, these results are counter to the variety of clinical resources at the main campus such as full-time social workers, patient concierge, dieticians, psychiatrists, et cetera. Attributes related to the community clinics include a smaller setting where the practice layout is easier to navigate and where patients likely feel a more individualistic relationship with the staff. These results suggest that high volume, tertiary facilities will require unique program initiatives to improve the patient experience.

Towards Shorter, Child-Friendly Regimens for Treatment of Tuberculosis Disease and Infection in Children.

Towards Shorter, Child-Friendly Regimens for Treatment of Tuberculosis Disease and Infection in Children.

Effects of computed distances, and other determinant factors on place of child delivery in Magadi Ward, Kenya

The choice of place of delivery is still debatable in most sub-Saharan African societies’ especially pastoral communities. The decision on whether to deliver at a health facility or at home varies across households. This study sought to evaluate the effects of computed distance, demographic and socio-economic factors on the place of child delivery in rural Magadi, Kenya. The integration of both spatial and statistical techniques was adopted. Distances (straight-line distance, road network distance to the nearest health facility and primary facility) were computed using tools in the Network Analyst toolbox. Computed distances of 246 sampled households together with demographic and socioeconomic factors were further analysed using univariate and multivariate logistic regression. The findings showed that calculated road network distance to the primary facility was a determinant of access and use of place of delivery both for the adjusted and the unadjusted odds. Women aged 20 years or below, having more children, secondary education or above and those who are unmarried are more likely to deliver at health facility. Receiving 1 or 2 childbirth services from a health facility, being aware of a private actor who set up the health facility and involvement of the spouse in the decision-making of place of birth are also linked to the use of health facility for child delivery. Deliveries at home were related to family monthly income level, family occupation, opinion on health facility location and being aged between 21 – 30 years. It was found that though computed road distance to the primary facility was the dominant factor, other variables such as level of education, parity, awareness of local actors, other childbirth services received prior to child delivery and marital status determined whether a woman would access and use health facilities for child delivery.

Impact of IoT on Achieving Smart Primary Healthcare Building Facilities in Gauteng, South Africa.

Processes and services undertaken in smart primary healthcare building facilities capture operational data through advanced monitoring and enable experts to use these building facilities for efficient healthcare service delivery. This study assessed the impact of Internet of Things (IoT) services on achieving efficient primary healthcare in the rural areas of South Africa. The study identified three (3) basic constructs of IoT services. They include IoT location recognition and tracking services, the application of the IoT high-speed communication network-based services, and the application of IoT-based services. The study is quantitative, and a questionnaire was used to collect data from the project managers and healthcare practitioners working with the primary healthcare agency in South Africa. The study found a variable degree of impact between the three (3) IoT constructs and the successful development of primary healthcare building facility services in South Africa. The study recommends adopting IoT essential services for achieving efficient primary healthcare services in the rural areas of South Africa and other developing countries facing similar primary healthcare delivery challenges.

Evaluation of Essential and Emergency Surgery Provide in Primary Hospitals of Gedeo Zone and Sidama Region, South, Ethiopia, 2020.

BackgroundSurgical services at level referral hospitals were an essential part of overall health care. The surgical uhservice was approximated to account for 11% of the worldwide load of disease, with a large percentage of that burden being uncovered in resource-constraint settings. Even though the surgery service is significant and growing across all economic sectors, the majority of resource-limited countries have been unable to provide essential surgical services.ObjectiveTo investigate the capacity of essential and emergency surgical services in primary hospital facilities in the Gedeo zone and Sidama region.MethodologyIn the Gedeo zone and Sidama region, a cross-sectional study was undertaken in eight district hospitals. By looking at four areas of data: infrastructure, human resources, interventions available, and equipment, a World Health Organization tool for conditional analysis was used to assess a health set-up competence to perform essential surgical and anesthetic procedures. The tool looked for eight different categories of healthcare giving 35 surgical procedures, and 67 different pieces of instruments.ResultsThis research found that 48.57% of the 35 essential interventions counted in the test, including cesarean section, were available at all hospitals. Prior to admission, each hospital reported a total of 53 beds, with an average travel distance of 28 kilometers. There were 189 healthcare providers in the eight facilities. According to the research, basic instruments were not always present at all of the sites.ConclusionInfrastructure, health profession, service supply, and key instruments and supplies deficiencies reveal major inadequacies in hospitals’ capacity to perform EESC and efficiently treat the growing surgical load of disease and damage in primary care.

Kepuasan Konsumen Pengukuran Indeks Kepuasan Konsumen di Puskesmas Dago Bandung

PUSKESMAS, Is a Public health center, which is the primary health service facility for the local government, is required to provide the best possible service for the surrounding community who need health services. Measuring customer satisfaction is done by using the Importance Performance Analysis (IPA) method. In this method, it is necessary to measure the level of conformity to find out how much the customer is satisfied with the company's performance, and how much the service provider understands what the customer wants for the services they provide. In the Importance-Performance Analysis, mapping is carried out into 4 quadrants for all variables that affect service quality. Quadrant divisions in Importance-Performance Analysis are categorized on the X-axis Very Unsatisfactory to Very Satisfying, and the Y-axis Very Unimportant to Very Important. The study was conducted on 31 consumers of the Dago Health Center in Bandung, which aimed to determine customer satisfaction with the services provided by the Puskesmas. There are five factors measured, the quality of service facilities, reliability, responsiveness, confidence, and empathy. The results are then calculated using the Customer Satisfaction Index, and Importance Performance Analysis. The results of testing the validity and reality, resulted in all questionnaire points and respondents declared valid and reliable. The results of the analysis of the average value of expectations and customer satisfaction can be seen that the quality of service facilities, quality of service reliability, quality of service responsiveness, quality of service confidence, quality of service empathy, has an achievement or work performance above 90%. This means that the Dago Health Center in Bandung City has succeeded in fulfilling the desires or satisfying consumers, in fact, the Quality of Service Confidence item has a value of 101% this means that the consumer's belief service exceeds the expectations of consumers. The results of the analysis of the expectation and performance matrices, where the quality of service facilities, service reliability quality, service responsiveness quality, service assurance quality, service empathy quality. The five criteria are in quadrant I, which means that the Dago Health Center is in the strategy to maintain the achievements that have now been achieved, because the five criteria for services provided have met consumer expectations.

No increase in use of hospitals for childbirth in Tanzania over 25 years: Accumulation of inequity among poor, rural, high parity women.

Improving childbirth care in rural settings in sub-Saharan Africa is essential to attain the commitment expressed in the Sustainable Development Goals to leave no one behind. In Tanzania, the period between 1991 and 2016 was characterized by health system expansion prioritizing primary health care and a rise in rural facility births from 45% to 54%. Facilities however are not all the same, with advanced management of childbirth complications generally only available in hospitals and routine childbirth care in primary facilities. We hypothesized that inequity in the use of hospital-based childbirth may have increased over this period, and that it may have particularly affected high parity (≥5) women. We analysed records of 16,080 women from five Tanzanian Demographic and Health Surveys (1996, 1999, 2004, 2010, 2015/6), using location of the most recent birth as outcome (home, primary health care facility or hospital), wealth and parity as exposure variables and demographic and obstetric characteristics as potential confounders. A multinomial logistic regression model with wealth/parity interaction was run and post-estimation margins analysis produced percentages of births for various combinations of wealth and parity for each survey. We found no reduction in inequity in this 25-year period. Among poorest women, lowest use of hospital-based childbirth (around 10%) was at high parity, with no change over time. In women having their first baby, hospital use increased over time but with a widening pro-rich gap (poorest women predicted use increased from 36 to 52% and richest from 40 to 59%). We found that poor rural women of high parity were a vulnerable group requiring specifically targeted interventions to ensure they receive effective childbirth care. To leave no one behind, it is essential to look beyond the average coverage of facility births, as such a limited focus masks different patterns and time trends among marginalised groups.

Responsiveness level and its effect on services quality from the viewpoints of the older adults hospitalized during COVID-19 pandemic

BackgroundAging is a sensitive period of life. Attention to the needs of this stage is considered a social necessity. This study is conducted to investigate the responsiveness level and its effect on service quality from the hospitalized older adults’ viewpoints during the COVID-19 pandemic in the south of Iran.MethodsIt was a cross-sectional descriptive-analytic study that was conducted on 386 old patients. The study instrument was a standard questionnaire that includes three sections of demographic information, World Health Organization Responsiveness, and SERVQUAL. Data were analyzed applying descriptive and inferential statistics the same as Independent T-test, ANOVA, Pearson correlation, and multiple linear regression.ResultsThe mean levels of responsiveness and service quality were 90.72 ± 9.38 (from 160) and 68.01 ± 8.51 (from 110) respectively. This indicates the average level of these variables from the old patients’ viewpoints. There was a significant positive correlation between responsiveness and service quality (r = 0.585). According to the results of multiple linear regression, the dimensions of communication, dignity, prompt attention, primary facilities, social support, information confidentiality, right to choose, and autonomy were identified as the predictors of service quality.ConclusionThe average level of responsiveness and service quality perceived from the old patients’ viewpoints during the COVID-19 pandemic can be considered a necessity for supportive planning among the older adults. Meanwhile, according to the impacts of responsiveness on service quality, educational programs are recommended to promote the level of healthcare providers’ responsiveness.

The Sehat Ghar: An Innovation to Improve Primary Healthcare in Rural Punjab

An effective healthcare sector essentially relies on a strong primary healthcare system. The primary healthcare system governs all major aspects of preventive healthcare and family planning services including immunization, hygiene, communicable disease prevention, sanitation, etc. In addition to this, a major bottleneck limiting the quality of healthcare at secondary and tertiary health facilities is the very high patient footfall that these hospitals. The primary healthcare facilities are designed to be the first tier of facility that a patient falls onto, and hence is either treated there or referred to higher level facilities by screening and limiting patient flow to next levels. Supporting this tier hence helps reduce burden on secondary and tertiary facilities of patients that could have been treated at primary facilities and hence exponentially improve the quality of health services in these lager hospitals. The document discusses some of the major issues faced by the primary healthcare sector in Punjab. These issues were studied and analyzed in detail at South Punjab Health Department, which is an arm of the provincial health department governing 11 districts of Southern Punjab – districts where socio-economic conditions are generally much poorer than the rest of Punjab. This document discusses the initiative of Sehat Ghar, its model, potential to ensure basic health services delivery to the local population and its direct &amp; indirect contribution to tackle major issues of primary healthcare in Punjab.

Predictors of loss to follow up from antiretroviral therapy among adolescents with HIV/AIDS in Tanzania.

Access to Antiretroviral Therapy (ART) is threatened by the increased rate of loss to follow-up (LTFU) among adolescents on ART care. We investigated the rate of LTFU from HIV care and associated predictors among adolescents living with HIV/AIDS in Tanzania. A retrospective cohort analysis of adolescents on ART from January 2014 to December 2016 was performed. Kaplan-Meier method was used to determine failure probabilities and the Cox proportion hazard regression model was used to determine predictors of loss to follow up. A total of 25,484 adolescents were on ART between 2014 and 2016, of whom 78.4% were female and 42% of adolescents were lost to follow-up. Predictors associated with LTFU included; adolescents aged 15-19 years (adjusted hazard ratio (aHR): 1.57; 95% Confidence Interval (CI); 1.47-1.69), having HIV/TB co-infection (aHR: 1.58; 95% CI, 1.32-1.89), attending care at dispensaries (aHR: 1.12; 95% CI, 1.07-1.18) or health center (aHR: 1.10; 95% CI, 1.04-1.15), and being malnourished (aHR: 2.27; 95% CI,1.56-3.23). Moreover, residing in the Lake Zone and having advanced HIV disease were associated with LTFU. These findings highlight the high rate of LTFU and the need for intervention targeting older adolescents with advanced diseases and strengthening primary public facilities to achieve the 2030 goal of ending HIV as a public health threat.

Safety Risks of Primary and Secondary Schools in China: A Systematic Analysis Using AHP–EWM Method

Owing to the frequent accidents in primary and secondary schools (PSS) in China in the past decades, a systematic analysis of indicators influencing safety risks in PSS is critical to identifying preventive measures. A two-hierarchy structure of indicators was identified by analyzing various cases, intensive interviews, and related previous literature. A combination of the analytic hierarchy process and the entropy weight method was developed to synthetically assess the primary and secondary risk indicators through a case study of Ma Shan School in China. The results are as follows: (1) the primary risk indicators, namely, natural disasters, public health, facility safety, accidental injury, public security, school bullying, and individual health constitute the evaluation framework of the safety risks in PSS. (2) Public health risks and accidental injury risks are the most critical factors that should be prioritized. In addition to providing academic implications, several managerial implications are proposed for these stakeholders to reduce the safety risks in PSS.