Primary Health Care Facilities Research Articles

Association between Maternal HIV and Adverse Birth Outcomes in the Era of Universal Antiretroviral Therapy in Malawi.

We evaluated the relationship between maternal HIV and birth outcomes in pregnant women. Primary health care facilities in Malawi. In this prospective cohort study, pregnant women attending their first antenatal care (ANC) visit between 20-36 weeks gestation were categorized by HIV status. Women living with HIV were grouped by HIV viral load at ANC and delivery (detectable >400 copies/mL), CD4+ count at delivery (low <250 cells/mm3), and ART regimen (tenofovir- and efavirenz-based ART). We evaluated low birth weight (LBW, <2500g), preterm birth (PTB, <37 weeks gestation), small for gestational age (SGA, <10th percentile for gestational age), fetal death (pregnancy loss >28 weeks gestation), and perinatal death (<7 days) at delivery using multivariate log-binomial regression. We enrolled 1208 pregnant women (633 and 575 living with and without HIV, respectively) from 2018-2022. HIV was significantly associated with increased risk of fetal or perinatal death (adjusted risk ratio (aRR) 2.09, 95% CI 1.21, 3.70), LBW (aRR 1.88, 95% CI 1.30, 2.76), and PTB (aRR 1.49, 95% CI ( 1.07, 2.09). The strength of the association with LBW increased with increasing exposure to viral load, with an aRR of 2.35 (1.01, 3.99) for LBW among women with detectable viral loads throughout pregnancy. Low CD4+ count at delivery was associated with LBW. HIV was not significantly associated with SGA. Adverse birth outcomes did not differ by ART regimen. Maternal HIV infection is a risk factor for adverse birth outcomes and the effect is partially mitigated by viral suppression.

Development and implementation of a digital clinical decision support system to increase the quality of primary healthcare delivery in a refugee setting in Chad

BackgroundDigital clinical decision support systems (CDSS) enhance the quality of primary healthcare service delivery for vulnerable populations in resource-limited settings. This improvement occurs by strengthening healthcare providers’ clinical skills and enabling them to operate more independently while adhering to standard treatment guidelines. From January 2019 to June 2023, we developed and implemented a digital, tablet-based CDSS for children aged 2–59 months. The phases of development, validation, and implementation, as well as lessons learnt and bottlenecks requiring attention, are analysed.MethodsThe project was carried out in three primary healthcare facilities within a health district in southern Chad, covering a population of 48,000, which includes a significant number of refugees from the Central African Republic. The intended end users were nurses, nurse assistants, and midwives, with supervision provided by health district teams.ResultsThe CDSS, based on the WHO’s Integrated Management of Childhood Illness (IMCI) and national guidelines, was tailored to the context of available resources and epidemiological patterns. From the outset, the active involvement of a diverse group of local, national, and international technical stakeholders (clinicians, information and communication technology (ICT) specialists, health workers, and district health authorities) facilitated mutual knowledge sharing and product co-creation processes. The CDSS was adapted to the local context, which enhanced local ownership. However, its complexity requires significant effort from clinicians and ICT specialists for development and validation. Additionally, health centres must rely on a technical infrastructure (electricity, internet connection, and server solutions).ConclusionsFrom the outset, a participatory approach involving key stakeholders from the local to the national level of the health system significantly contributed to the successful development and implementation of the CDSS. The sustainability of such an intervention necessitates ongoing long-term commitment. This includes establishing and maintaining the infrastructure, ensuring continuous human resources and technical expertise for implementation and quality assurance, and updating content to reflect advancements in clinical medicine.

Healthcare Workers Factors Contributing to HIV Testing Service Integration in Primary Healthcare Facilities of Homa Bay County, Western Kenya

Introduction: HIV Testing Service Integration refers to the process of embedding HIV testing and related services into the existing healthcare systems and other service delivery platforms. This approach ensures HIV testing is not provided in isolation but as part of a comprehensive package of health services. The goal of HIV Testing Service Integration is to make testing accessible, convenient and non-stigmatizing, while also improving efficiency and overall healthcare delivery focused at improving patient outcomes. Methods: This cross-sectional study aimed to determine Healthcare Workers (HCWs) factors contributing to HIV Testing Service Integration in Primary Healthcare Facilities of Homa Bay County in Western Kenya. Structured questionnaire was used to collect quantitative data from 60 Healthcare Workers picked from four health facilities that were purposively selected. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 24.0 software. Results: Healthcare Worker’s age (25-35 years) was significantly associated with HIV Testing Service Integration (95%CI=1.22-1.68, p-value=0.001). Female Healthcare Workers were found to be statistically significant in contributing to HIV Testing Service Integration (95%CI=1.24-2.03, p-value=0.002). Additionally, nursing cadre (95%CI=0.95-4.05, p-value=0.003) and Healthcare Workers training on HIV Testing Service Integration (95%CI=5.39-5.84, p-value=0.025) were found to be statistically significant in contributing towards HIV Testing Service Integration. Out of 60 Healthcare Workers, 40% cited workload as a hinderance to HIV Testing Service Integration and 75% agreed that integrating HIV Testing services into primary healthcare was a noble idea. Lastly, the perception of Healthcare Workers on HIV Testing Service Integration was statistically significant in contributing towards HIV Testing Service Integration (95%CI=1.47-1.84, p-value=0.014). Conclusion: This study showed Healthcare Workers’ age, gender, cadre and training on HIV Testing Service Integration as factors contributing to HIV Testing Service Integration within Primary Healthcare facilities of Homa Bay County. Hence, the need to scale up training of Healthcare Workers on HIV Testing Service Integration to ensure program sustainability during this period of donor dwindling support including conducting further study to determine the community, patient-related and structural factors that could be influencing HIV Testing Service Integration.

Outpatient follow-up of patients with chronic heart failure by a general practitioner in primary health care. Guidelines

Outpatient follow-up in primary care is one of the resources for reducing mortality from diseases of the circulatory system and increasing life expectancy. These guidelines contain a description of current issues related to the organization of outpatient follow-up of patients with chronic heart failure by a general practitioner.The guidelines are intended for district internists, general practitioners (family doctors), district internists of the shop medical district, as well as for secondary medical personnel working with these doctors, for paramedics of paramedic-obstetric stations (paramedic health centers) in case they are assigned the functions of the attending physician.The guidelines can be used by public health physicians, heads of primary health care facilities and their divisions.

Exploring care pathways of patients conveyed by emergency medical services (EMS) through electronic health records

BackgroundEmergency Medical Services (EMS) and Emergency Departments (ED) have reported increased patient volumes in the last decades. Despite high rates of non-conveyance decisions, unnecessary conveyances by EMS still occur. The aim of this study was to explore care pathways of conveyed patients by EMS through registry data.MethodsThis was a retrospective cohort study of EMS patients in Finland. The primary outcomes were EMS recontacts and visits to a primary health care facility or ED within seven days. The secondary outcome was mortality within one week. Univariate and multivariable associations between the outcome variables and categorical variables were analysed with logistic regression. Results are presented with odds ratios (ORs) together with 95% confidence intervals (CIs) and p-values.ResultsThe conveyed patients’ visits to health care facilities were mainly brief. EMS arrival during night-time (20:00–08:00) (OR 1.69; 95% CI 1.59 to 1.80), in urban area (OR 1.21; 95% CI 1.13 to 1.29) and alcohol use (OR 2.55; 95% CI 2.26 to 2.86) predicted short ED visits (< 24 h). 77% of the patients were discharged from primary health care within one hour (median 22 min, IQR 18–60). After EMS conveyance and visit to the ED or primary health care facility, 10.5% of the patients were readmitted within one week. Non-urgent patients (OR 1.26; 95% CI 1.14 to 1.39), an EMS mission at night (OR 1.36; 95% CI 1.24 to 1.50), and based on univariate analyses, the usage of alcohol (OR 1.26; 95% CI 1.09 to 1.45) increased the likelihood of a readmission. 449 patients of all conveyed EMS patients (n = 20376) died within one week (2.2%).ConclusionsEMS non-conveyance reduces patient flow in EDs, but there is a possibility that more could be done related to unnecessary conveyances to health care facilities, especially in urban areas and at night. The pathway analyses of post conveyance re-contacts show that a small number of patients burden the system. Further in-depth studies are needed to understand of unnecessary conveyances, find solutions, and provide repeated users the appropriate care.

Cervical cancer screening data from the case-based national electronic registry in Bangladesh

BackgroundThe Government of Bangladesh established a visual inspection with acetic acid (VIA)-based cervical cancer screening programme at 600 primary, secondary and tertiary health facilities following a pilot programme in 2005. An aggregated data collection system was initiated using District Health Information System 2 (DHIS2) software in 2013 and a case-based electronic data registry system was developed utilising its “tracker” component since January 2018. The purpose of this study is to review the cervical cancer surveillance situation based on the data of the national cervical cancer screening, treatment and follow-up through the DHIS2-based electronic registry.MethodsWomen aged 30 to 60 were enrolled in the DHIS2 electronic registry in health facilities of all tiers including the community clinics and screened for cervical cancer using the VIA method at Upazila Health Complexes and upper tiers. The VIA-positive women were referred for colposcopy in the nearest colposcopy centres. The screen-positive women were offered treatment and followed up at certain intervals following the national standard protocol. During each encounter, required data were captured in DHIS2. Anonymised data from the DHIS2 covering January 2018 to May 2023 were extracted and analysed for this study.ResultsA total of 1,562,963 women were enrolled in 497 screening facilities and 6398 community clinics. Among them, 1,557,002 (99.6%) availed VIA tests, and primary health facilities performed 74.4% enrolments and 72% VIA tests. Among screened women, 51,913 (3.3%) were VIA positive, of which only 20,954 (40.4%) attended for colposcopy. Among colposcopy-positive women, 6.3% (1,327) and 6.2% (1,302) women had cervical intraepithelial neoplasia (CIN) II/III and cervical carcinoma, respectively. Among women who received treatment for cervical precancer, 81.6% (5062) had thermal ablation, and 17.6% (1089) had loop electrosurgical excision procedure. Histopathology reports (n = 3079) revealed 16.1% (n = 495) of women had squamous cell carcinoma, 4.0% (n = 123) had micro-invasive squamous cell carcinoma, 11.7% (n = 36) had CIN II, and 8.1% (n = 250) had CIN III.ConclusionsThe National Cervical Cancer Screening and Treatment Programme for women in Bangladesh using a DHIS2-based electronic case-based tracking system is effective in understanding the screening situation and can be a valuable lesson for other countries.

Looking into opportunities for maternity continuum of care improvement within the primary health care system in Northwest Ethiopia: primary health care-oriented research

BackgroundThe maternity continuum of care (MCC) is an integral component of universal health coverage and a crucial strategy for reducing maternal and neonatal mortality. Despite its importance, MCC coverage remains low in low- and middle-income countries (LMICs), including Ethiopia, which bear the highest burden of maternal and neonatal mortality. This underscores the need for proactive interventions. In this perspective, the primary health care (PHC) approach holds significant potential for enhancing MCC. Exploring demand- and/or supply-side opportunities for improving MCC within the PHC system could help inform policy, practice, and further research. However, there is limited evidence on these aspects in Ethiopia. Therefore, this study aims to explore demand- and/or supply-side opportunities for MCC enhancement within the PHC system in northwest Ethiopia.MethodsWe conducted a qualitative study using an interpretive description approach within the PHC system in northwest Ethiopia from March 3 to November 27, 2022. Data collection included four key informant interviews, three focus group discussions with 29 participants, and 28 in-depth interviews, all selected through maximum variation sampling. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed using reflexive thematic analysis in ATLAS.ti version 7.1.4 software.ResultsThree themes and 11 sub-themes have emerged. These include: (1) PHC structural enhancement with its categories: onsite mentorship, decentralized ambulance service platform, structural networks, and expansion of the scope of frontline PHC facilities; (2) PHC input enhancement with its categories: expansion of the maternity service workforce and technological advancements; and (3) PHC maternity service delivery enhancement with its categories: community engagement, approaches for reducing wait times, tailored maternity service provision in conflict-affected communities, flexible schedules for maternity service, and integrated midwifery model of care.ConclusionsThis study finds that there are several structural, input, and service delivery opportunities for enhancing the MCC within the PHC system in northwest Ethiopia. These opportunities indicate potential pathways to strengthen PHC resilience for MCC. Widespread utilization of these opportunities could significantly improve the existing MCC within the PHC system. We also recommend further research to assess the impact of these opportunities on MCC.

The Curative Role of the Main Primary Health Facility in Indonesia: Analyzing Patient Visits at a Single PUSKESMAS with a Focus on General and Maternal-Child Health Clinics

Aims: to analyze the curative role of a single PUSKESMAS based on the number of its patients visit with focus in its clinic which has the highest number of patient. Methodology: simple descriptive cross sectional approach on data of patients in PUSKESMAS Bogor Timur from July 2019 until December 2024. Results: This PUSKESMAS has 10 clinics, with total number of patients registered from July, 1st, 2019 until December, 31st 2024 was 97,934 patients; 33,873 [34.68%] male and 64061 [65.41%] female. Mean age of male patients was 34.13 (SD=0.125) while in the female patient was 33.68 (SD=0.84). the top three clinics visited by the patients were the general clinic with 54,628 patients [55.8%], the maternal and child health clinic with 24,371 patients [24.9%] and the supportive clinic (PUSKESMAS PEMBANTU) with 13,190 patients [13.5%]. Further analysis of the patients in the general clinic revealed that it handles 55.8% from the whole PUSKESMAS service and the maternal and child health clinic handle 24.9% of the whole patients. In these two clinics, all showed an increase in number of patient and also in yearly trend line from 2019 until 2024. The numbers revealed its hidden potency to up grade its service, qualitatively and also quantitatively. Conclusion: PUSKESMAS is still the main backbone of Indonesia’s primary health facilities. The tendency to rise in number is very huge, and all stake holders must be aware of the positive and negative impact of the increment of patient population that come to the PUSKESMAS.

Does a waiting room increase same-day treatment for sexually transmitted infections among pregnant women? A quality improvement study at South African primary healthcare facilities

BackgroundSame-day testing and treatment of curable sexually transmitted infections (STI) is a strategy to reduce infection duration and onward transmission. South African primary healthcare facilities often lack sufficient waiting spaces. This study aimed to assess the proportion of, and factors influencing, pregnant women waiting for on-site STI test results before and after the installation of clinic-based waiting rooms.MethodsWe conducted an observational quality improvement study at 5 public primary healthcare facilities in South Africa from March 2021 to May 2023. The intervention was the installation of a waiting room in two clinics. Three clinics were used as comparators: two already had a waiting room in an existing building and one had access to a shared waiting area. The outcome was the percentage of women who waited for their STI test results. We conducted univariable and multivariable analyses and report marginal risk differences (with 95% confidence intervals, CI) of the proportions of women who waited for results. A subset of women answered structured questions about factors influencing their decision to wait for results.ResultsWe analysed data from 624 women across the 5 facilities. Overall, 36% (95% CI 31 to 40) waited for their test results (range 7 to 89%). In the two intervention clinics, 17% (95% CI 11 to 24) waited for results before the introduction of a waiting room and 10% (95% CI 5 to 18) after (crude absolute difference − 7% (95% CI -16 to + 3), adjusted difference, -6% (95% CI -17 to + 5)). The percentages of pregnant women waiting for STI test results were higher throughout the study period in 2 clinics which always had a dedicated waiting room than in 2 clinics where a waiting room was installed, or in 1 clinic, which only had access to a shared waiting area. Most women reported before testing that they did not intend to wait and none of the suggested factors would change their decision.ConclusionsIntroduction of a waiting room did not increase the proportion of women who waited for their results in this observational study. Future studies should investigate infrastructure, individual and test-based factors that affect same-day STI testing and treatment.

Perceptions about chronic health conditions, multimorbidity and self-management practices in rural northeast South Africa: findings from a qualitative study

IntroductionChronic health conditions are the leading causes of morbidity and mortality worldwide, with a disproportionately high burden in low-income and middle-income countries. The burden arising from these conditions presents immense...

Epistaxis management in Nigeria: strength, challenges and recommendations.

The purpose of this study was to review epistaxis management in Nigeria in the context of current global rhinology practice. It aimed to identify the current strengths in practice that require consolidation and the gaps that require recommendations. The consistent predominance of otolaryngological interventions in tertiary hospitals reflects the paucity of specialists and lack of equipment for the optimal management of epistaxis in primary and secondary healthcare facilities in Nigeria. Endoscopic intervention was apparent in the most recent publications, but it is still a key limitation, given that it is not widely available in all facilities. The commencement of rhinology fellowships and the emergence of interventional radiology is a ray of hope for an imminent, excellent practice. Management of nosebleeds in Nigeria is safe despite limited resources. We believe that there has been progress in endoscopic management; however, this is not widely available. Therefore, there is a need for inclusive advancement. Moreover, local management guidelines would be an excellent tool for unified practice in the advent of rhinology fellowships and evolving interventional radiology. It is vital to fortify primary and secondary health systems.

Contribution of Human Resources for Health competence and skill mix on compliance with healthcare quality standards among Primary Healthcare Facilities in Tanzania: evidence from dispensaries

BackgroundGlobally, it is known that, there is a close correlation between the concentration of qualified Human Resources for Health (HRH) and key health outcomes. Inadequate numbers with poor skill mix compromise health system functioning that negatively affect delivery of quality healthcare services.ObjectiveThis study aims to study the effect of HRH skills and competence mix on the compliance with healthcare quality standards (HCQS) among dispensaries in Tanzania.MethodsThis is a quantitative secondary data analysis using the Star Rating Assessment (SRA) data collected in the fiscal year 2017/2018 involving 4239 dispensaries majority of which were rural located (81.2%) and public owned (83.6%). Compliance with HCQS was measured by considering service delivery areas of SRA. HRH availability that estimated skill mix status were deduced by considering its recommended number by staffing levels guidelines. Proportions of skill mix status and compliance with HCQS were compared by chi square test while Prevalence Ratios were estimated by Multivariable Poisson Regression with 95% Confidence Interval.ResultsOn average, 36.8% of dispensaries had skill mix. Results indicated that, the higher the skill mix, the more the compliance with HCQS. Dispensaries with optimal skill mix (APR = 2.68, P < 0.001, 95% C.I = 2.00–3.59), Desirable skill mix (APR = 2.41, P < 0.001, 95% C.I = 2.03–2.86) and poor skill mix status (APR = 1.72, P < 0.001, 95% C.I = 1.48–1.99) were more likely to comply with HCQS compared to dispensaries with no skills mix at all.ConclusionsThis study demonstrates the critical role that HRH skill mix has in ensuring adherence to HCQS. The observed challenge of HRH availability and hence skill mix should be worked on. Given that, over two-thirds of Tanzanians who reside in rural areas rely on dispensaries for accessing healthcare services, to achieve equity in healthcare accessibility, deliberate measures including increasing recruitment budgets and equitable distribution of available HRH should be taken to address the challenge.

A pragmatic covariate-constrained cluster-randomised controlled trial of hybrid parents and health workers adaptive intervention for optimal (timely, cumulative age-appropriate) community-wide routine childhood immunisation coverage: the AGINTOPIC trial

IntroductionVaccine-preventable infectious diseases (VPDs) covered by routine childhood immunisation programmes are major causes of morbidity/mortality as outbreaks continue to reoccur despite repeated efforts to increase immunisation coverage. This trial aimed...

Exploring community nurses` experiences on the decentralization of non-communicable diseases care in the Lubombo region, Eswatini

Background and Aim: Non-Communicable Diseases (NCDs) remain a global challenge. The primary healthcare has been identified as a vital aspect of the healthcare system that will assist in addressing the burden of NCDs in low and middle-income countries. As such, the Eswatini Ministry of Health-NCD program had embarked on the decentralization of NCDs` services to primary healthcare facilities. This initiative called for nurses to deliver NCD treatment services in primary healthcare facilities. However, the experiences of community nurses about this initiative have not been explored. Therefore, this study explored and described the community nurses` experiences with decentralizing care for NCDs in the Lubombo Region of Eswatini. Methods and Materials: A descriptive qualitative study design approach was used to explore and describe the experiences of ten purposively sampled community nurses. Data was collected through audio-recorded face-to-face interviews using a semi-structured interview guide. Data was subjected to thematic analysis using Colaizzi’s descriptive method of data analysis. Results: Three themes emerged from the study findings; 1) Decentralising NCD care is a good move by the Government, 2) Challenges brought by the decentralization of NCD services, and 3) Nurses’ perceived support needs in managing NCDs at clinics. Conclusion: Community nurses applauded the government`s move to decentralized NCD services even though they viewed rural clinics as not well prepared to offer NCD services due to the challenges faced. There is a need for more support for rural clinics regarding human resources

HIV Stigma and Self-Efficacy Caring for Women Living With HIV: A Mixed-Methods Study of Labour and Delivery Providers-Empirical Research Mixed Methods.

To understand HIV stigma and self-efficacy of labour and delivery (L&D) providers in caring for women living with HIV (WLHIV). Cross-sectional descriptive mixed methods. Data were collected in six primary healthcare facilities in the Kilimanjaro region, Tanzania between February and November 2022. We conducted eight focus groups with L&D providers (n = 36) and nurse-midwifery students (n = 12). We conducted surveys with 60 L&D providers assessing HIV stigma (fear of acquisition, extra precautions and attitudes) and self-efficacy in caring for WLHIV. Qualitative findings were complemented by survey data to provide a comprehensive understanding of providers' attitudes and experiences. Providers expressed fear of HIV acquisition when caring for WLHIV. Almost all providers noted that they used extra precautions with WLHIV; 97% used double gloves and 39% avoided touching WLHIV with bare hands, even when there were no bodily fluids. Most providers had positive attitudes towards WLHIV. Almost all rejected the idea that HIV was a punishment for bad behaviour, but 44% thought their patients might not be careful about infecting others. Qualitative data suggested providers worried that patients' reluctance to disclose their HIV status could raise the risk of occupational exposure. Provider self-efficacy in normal birth was lower when caring for a woman with HIV compared with care for women who are HIV-negative but did not differ significantly in other situations. This study showed that providers had generally low-stigmatising attitudes towards people living with HIV but feared occupational exposure, leading to avoidance of necessary patient contact. Training on clinical and interpersonal skills, coupled with evidence-based care for women with HIV during childbirth, could benefit both providers and patients. The study is reported following the Good Reporting of a Mixed-Methods Study (GRAMMS) checklist. Patients and the public were not involved in this research.

Ritshidze’s community-led monitoring system as a source of information on health system responsiveness in South Africa

Ritshidze is a large-scale community-led monitoring (CLM) system in South Africa, which has been conducting quarterly surveys of patient experiences at &gt;400 primary healthcare facilities and community sites since 2019. This in-practice piece examines the data collected and publicly reported by Ritshidze, to highlight its role as an independent, complementary source of information on primary healthcare performance. It argues that CLM has significant potential to enhance health system responsiveness. We provide an overview of the data collection system, involving close to 500 data points organised into seven domains, and then focus on two sets of indicators that illustrate the utility of the monitoring and reporting system. The indicators selected are a set that assesses patient time spent at a facility (as a proxy for waiting times), illustrating both the depth and the breadth of the Ritshidze database; and the length of HIV prescriptions (‘length of medicine refill’), as an indicator of the improvements in responsiveness of the health system to the needs of patients. Integrating CLM data into formal health system monitoring and evaluation frameworks could enhance the responsiveness of the health system to patients and communities, one of the key overall objectives of the district health system.

Assessing clinical associate students’ views on learning opportunities and involvement during primary health care placements: a mixed methods study in Tshwane

BackgroundThe training model for Clinical Associates (Clin-As), initially centered on district hospitals, has increasingly involved primary healthcare (PHC) facilities over the past few years. This study explore and compare the perceptions and experiences of Clin-A students regarding learning opportunities and involvement during hospital and clinic rotations.MethodologyThis cross-sectional mixed-methods study involved two primary data collection techniques: the administration of the validated medical education instructional questionnaire (MedIQ) questionnaire and the facilitation of focus group discussions.ResultsA total of 74 Clin-A students participated in the quantitative study, including 20 s-year students from 2022, 35 s-year students from 2023, and 19 third-year students from 2023. The only statistically significant difference was noted in follow-up care, where student involvement was significantly higher in clinics (M = 3.39) compared to hospitals (M = 2.96), with a t-value of 2.933 (p = 0.002). For learning opportunities, the highest mean difference was observed in ‘participation in patient education’, where clinics (M = 4.38) had a higher mean than hospitals (M = 3.96), but without statistically significance (t = 1.715, p = 0.089). Students perceived better learning diversity and proficiency development in clinics (M: 3.91, SD: 1.31; M: 4.18, SD: 1.203) compared to hospitals (M: 4.00, SD: 1.489; M: 3.97, SD: 1.385). Clinics generally outscored hospitals, especially in involvement in patient education, chronic illness, and procedures. Ten students attended two focus group discussion: one with 2023 third-years (n = 5) and one with 2023 s-years (n = 5). Students valued clinics for skill development and patient journey exposure but faced challenges such as feeling like employees, disrupted learning from frequent rotations, patient overcrowding, and poor communication between the program and healthcare staff.ConclusionThis study underscores the importance of primary healthcare settings in Clin-A training, demonstrating that clinics provide learning opportunities and involvement in patient care comparable to hospitals. To address challenges such as high workload areas where students feel like employees, insufficient teaching, lack of staff awareness, limited learning in low-volume clinics, and disrupted rotations requires, structured rotations, enhanced preceptor training, and improved communication between programs and clinical sites are essential.

Water Quality in Primary Healthcare Facilities (PHCFs) and its effects on universal health coverage (UHC)

Water Quality in Primary Healthcare Facilities (PHCFs) and its effects on universal health coverage (UHC)

Outcome and management of children with chest indrawing pneumonia at primary health care settings in Pakistan: an observational cohort study.

Pneumonia is a major cause of childhood mortality in Pakistan. In 2019, the Government of Pakistan revised the national Integrated Management of Childhood Illness (IMCI) chart booklet, following the World Health Organization's recommendation for outpatient management with oral antibiotics of children aged 2-59 months with chest indrawing pneumonia. We aimed to assess the outcomes of children aged 2-59 months with chest indrawing pneumonia in programme setting of Pakistan. This was a prospective observational cohort study in three primary health care facilities in Thatta district, Sindh province. We screened children aged 2-59 months who presented with cough and/or difficult breathing, and recruited those classified with chest indrawing pneumonia according to the IMCI tool. from December 2022 to March 2024. The primary outcome was to assess the case fatality ratio. The secondary outcomes were to calculate the prevalence of antibiotic use, hospital admissions and treatment adherence among these children during the current illness. We followed up on day 15 after enrolment to assess outcomes. 456 children with chest indrawing pneumonia met the study's enrolment criteria. Two (0.4%) died. Four (0.9%) were lost to follow-up and excluded from the analysis. According to parental/caregiver reports, among 452 children followed up on day 15, 435 (96.3%) were cured, 12 (2.7%) did not improve and two (0.4%) worsened and were hospitalised. All patients were treated with oral antibiotics. Oral amoxicillin was prescribed and used by 282 (62.4%) and 236 of those (83.7%) adhered to five or more days of oral amoxicillin treatment. Oral cefixime was prescribed and used by 114 children (25.2%). Our findings support using the IMCI protocol for treating chest indrawing pneumonia without danger signs in children aged 2-59 months with oral antibiotics on an outpatient basis. It can potentially reduce childhood pneumonia deaths, increase access to treatment, improve treatment coverage, reduce referrals and reduce costs for the health system and families in resource-limited settings. ISRCTN: 12687253.

The prevalence trends of Trichomonas vaginalis infection among women in Jingzhou, central of China, 2019–2023

BackgroundTrichomonas vaginalis (T. vaginalis) is one of the most prevalent sexually transmitted infections globally, with significant regional variations in its prevalence. This study aimed to examine the epidemiological characteristics of T. vaginalis infection in Jingzhou, Hubei Province, China.MethodsTo obtain the prevalence of T. vaginalis infection among age groups and different years, a total of 115,775 patients from 2019 to 2023 were included in this study. Two detection methods including immunochromatographic assay and wet mount microscopy were used to detect the pathogens in vaginal swabs samples including T. vaginalis with other vaginal pathogens, such as Candida albicans (C. albicans) and Gardnerella Vaginalis (G. vaginalis).ResultsThe overall prevalence of T. vaginalis in Jingzhou was 3.41%, demonstrating a decreasing trend from 2019 to 2023, with a particularly significant decrease during the COVID-19 pandemic in 2020–2022 (P < 0.001). The highest positive rate of T. vaginalis was observed in the 45–54 years age group (4.87%), while the lowest rate was observed in the 25–34 years age group (2.37%). The prevalence of T. vaginalis in pregnant women (0.83%) was lower than that in non-pregnant women (1.87%), with a statistically significant difference (P < 0.001). T. vaginalis had co-infection with other pathogens (2.76%) compared to single infection (0.65%), and the most common co-infection pattern was T. vaginalis and G. vaginalis (2.09%). The results showed that there was relative high consistency (Kappa: 0.841) between the immunochromatographic assay and wet mount microscopy method for the detection of T. vaginalis. Additionally, elevated leukocyte levels were associated with a higher prevalence of T. vaginalis.ConclusionThe overall infection rate of T. vaginalis was 3.41%, showing a decreasing trend in prevalence in Jingzhou from 2019 to 2023. The prevalence was the highest in the 45–54 years age group. The study suggested that the immunochromatographic assay should be widely implemented as a screening method for T. vaginalis in primary healthcare facilities.