Primary Health Care Facilities Research Articles

Prevalence of depression and associated symptoms among patients attending primary healthcare facilities: a cross-sectional study in Nepal

BackgroundDepression is a prevalent mental health condition worldwide but there is limited data on its presentation and associated symptoms in primary care settings in low- and middle-income countries like Nepal. This study aims to assess the prevalence of depression, its hallmark and other associated symptoms that meet the Diagnostic and Statistical Manual (DSM-5) criteria in primary healthcare facilities in Nepal. The collected information will be used to determine the content of a mobile app-based clinical guidelines for better detection and management of depression in primary care.MethodsA total of 1,897 adult patients aged 18–91 (63.1% women) attending ten primary healthcare facilities in Jhapa, a district in eastern Nepal, were recruited for the study between August 2, 2021, and March 25, 2022. Trained research assistants conducted face-to-face interviews in private spaces before the consultation with healthcare providers. Depression symptoms, including hallmark symptoms, was assessed using the validated Nepali version of the Patient Health Questionnaire (PHQ-9).ResultsOne in seven (14.5%) individuals attending primary health care facilities in Jhapa met the threshold for depression based on a validated cut-off score ( > = 10) on the PHQ-9. The most commonly reported depressive symptoms were loss of energy and sleep difficulties. Approximately 25.4% of women and 18.9% of men endorsed at least one of the two hallmark symptoms on the PHQ-9. Using a DSM-5 algorithm (at least one hallmark symptom and five or more total symptoms) to score the PHQ-9, 6.3% of women and 4.3% of men met the criteria for depression. The intra-class correlation coefficient for PHQ-9 total scores by health facility as the unit of clustering was 0.01 (95% confidence interval, 0.00-0.04).ConclusionDepression symptoms are common among people attending primary healthcare facilities in Nepal. However, the most common symptoms are not the two hallmark criteria. Use of total scores on a screening tool such as the PHQ-9 risks overestimating the prevalence and generating false positive diagnoses. Compared to using cut off scores on screening tools, training health workers to first screen for hallmark criteria may increase the accuracy of identification and lead to better allocation of treatment resources.

Approaches for prevention of mother-to-child transmission of HIV services during coronavirus disease 2019

Background: During the coronavirus disease 2019 (COVID-19) pandemic, there was a reduction in access to prevention of mother-to-child transmission (PMTCT) of human Immunodeficiency virus (HIV) services globally, yet this programme is critical for reducing paediatric HIV incidence. To minimise the impact of COVID-19 and prevent disruptions to the PMTCT service provision, innovative strategies had to be developed and implemented.Aim: The study aimed to describe the approaches that were developed and utilised during the COVID-19 pandemic in enhancing PMTCT services in Tshwane primary healthcare facilities.Settings: Three primary healthcare facilities that were providing PMTCT services during the COVID-19 pandemic located in the Tshwane district, Gauteng province, South Africa.Methods: The study is part of a larger study that focused on the experiences of healthcare workers who were rendering PMTCT services during the COVID-19 pandemic. An interpretative phenomenological analysis (IPA) design was employed to gain insight into the experiences of 16 purposively sampled healthcare workers who were providing PMTCT services during the pandemic in Tshwane district facilities. In-depth individual audio-recorded interviews were conducted with study participants, following a semi-structured interview guide. Data analysis was performed using an IPA framework.Results: Three superordinate themes emerged: strategies utilised for providing care, community-based initiatives, and support systems to enhance the PMTCT service access.Conclusion: Strengthening community-based initiatives and support systems is important for the enhancement of the PMTCT programme during and beyond the pandemic.Contribution: Community-based initiatives are critical in continuity of PMTCT services, reducing HIV incidence, under-five child morbidity and mortality particularly during emergency situations.

The role of perceived quality of care on outpatient visits to health centers in two rural districts of northeast Ethiopia: a community-based, cross-sectional study

BackgroundPatients who have had a negative experience with the health care delivery bypass primary healthcare facilities and instead seek care in hospitals. There is a dearth of evidence on the role of users’ perceptions of the quality of care on outpatient visits to primary care facilities. This study aimed to examine the relationship between perceived quality of care and the number of outpatient visits to nearby health centers.MethodsA community-based cross-sectional study was conducted in two rural districts of northeast Ethiopia among 1081 randomly selected rural households that had visited the outpatient units of a nearby health center at least once in the previous 12 months. Data were collected using an interviewer-administered questionnaire via an electronic data collection platform. A multivariable analysis was performed using zero-truncated negative binomial regression model to determine the association between variables. The degree of association was assessed using the incidence rate ratio, and statistical significance was determined at a 95% confidence interval.ResultsA typical household makes roughly four outpatient visits to a nearby health center, with an annual per capita visit of 0.99. The mean perceived quality of care was 6.28 on a scale of 0–10 (SD = 1.05). The multivariable analysis revealed that perceived quality of care is strongly associated with the number of outpatient visits (IRR = 1.257; 95% CI: 1.094 to 1.374). In particular, a significant association was found for the dimensions of provider communication (IRR = 1.052; 95% CI: 1.012, 1.095), information provision (IRR = 1.088; 95% CI: 1.058, 1.120), and access to care (IRR = 1.058, 95% CI: 1.026, 1.091).ConclusionsService users’ perceptions of the quality of care promote outpatient visits to primary healthcare facilities. Effective provider communication, information provision, and access to care quality dimensions are especially important in this regard. Concerted efforts are required to improve the quality of care that relies on service users’ perceptions, with a special emphasis on improving health care providers’ communication skills and removing facility-level access barriers.

Development of practical emergency simulation training in primary health care: Lessons learnt

Emergency care in the primary health care setting is often sub-optimal leading to physician stress and adverse patient outcomes. Formal training opportunities in the management of emergency management are limited in public-sector facilities. Two family physicians conducted emergency simulation drills at primary health care facilities to address this need. The multi-disciplinary team at these facilities were involved, and each drill was followed by reflection and feedback. The drill evolved over an 18 month period, and the simulations as well as the feedback process were reviewed and improved. Reported benefits included improved skills and confidence, teamwork and sharing of information. Staff appreciated the support and the opportunity to review emergency equipment and drugs. Recommendations based on the experience gained and the outcomes of the simulation training include that the feedback is just as important as the simulations and that clinicians need to be trained in order to facilitate simulations successfully.

Frontline health workers’ experiences of providing care for people living with non-communicable diseases during the COVID-19 pandemic in Ghana: a qualitative study

BackgroundThe COVID-19 pandemic has significantly impacted frontline health workers. However, a neglected dimension of this discourse was the extent to which the pandemic impacted frontline healthcare workers providing non-communicable diseases...

When the smoke gets in your lungs: short-term effects of Indonesia’s 2015 forest fires on health care use

BackgroundThe forest fires that ravaged parts of Indonesia in 2015 were the most severely polluting of this century but little is known about their effects on health care utilization of the affected population. We estimate their short-term impact on visit rates to primary and hospital care with particular focus on visits for specific smoke-related conditions (respiratory disease, acute respiratory tract infection (ARTI) and common cold).MethodWe estimate the short-term impact of the 2015 forest fire on visit rates to primary and hospital care by combining satellite data on Aerosol Optical Depth (AOD) with administrative records from Indonesian National Health Insurance Agency (BPJS Kesehatan) from January 2015–April  2016. The 16 months of panel data cover 203 districts in the islands of Sumatra and Kalimantan before, during and after the forest fires. We use the (more efficient) ANCOVA version adaptation of a fixed effects model to compare the trends in healthcare use of affected districts (with AOD value above 0.75) with control districts (AOD value below 0.75). Considering the higher vulnerability of children’s lungs, we do this separately for children under 5 and the rest of the population adults (> 5), and for both urban and rural areas, and for both the period during and after the forest fires.ResultsWe find little effects for adults. For young children we estimate positive effects for care related to respiratory problems in primary health care facilities in urban areas. Hospital care visits in general, on the other hand, are negatively affected in rural areas. We argue that these patterns arise because accessibility of care during fires is more restricted for rural than for urban areas.ConclusionThe severity of the fires and the absence of positive impact on health care utilization for adults and children in rural areas indicate large missed opportunities for receiving necessary care. This is particularly worrisome for children, whose lungs are most vulnerable to the effects. Our findings underscore the need to ensure ongoing access to medical services during forest fires and emphasize the necessity of catching up with essential care for children after the fires, particularly in rural areas.

The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study

ObjectivesIn middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China.MethodsData were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians’ communication skills on healthcare quality and patient satisfaction.ResultsThe findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians’ knowledge and other factors, demonstrated positive associations between physicians’ communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training.ConclusionThis study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.

Procurement process and shortages of essential medicines in public health facilities: A qualitative study from Nepal.

Ensuring access to essential medicines remains a formidable challenge in Nepal. The specific reasons for the shortage of essential medicines within Nepal have not been extensively investigated. This study addresses challenges associated with access to essential medicines, procurement process difficulties, and functionality of inventory management systems at different levels of public health facilities. Fifty-nine semi-structured in-depth interviews were conducted with health managers and service providers at provincial and local levels in six randomly selected districts of Bagmati province, Nepal. Interviews were audiotaped and transcribed verbatim, and the results were analyzed using the inductive approach and were later mapped within the four domains of "Procurement of essential medicines". The major barriers for the effective management of essential medicines included delays in the procurement process, primarily locally, leading to frequent stock-out of essential drugs, particularly at the health post level. Additionally, challenges arise from storage problems, mainly due to insufficient storage space and the need to manage additional comorbidities related to COVID-19. Other identified challenges encompass the absence of training on logistics management information systems, a lack of information technology resources in primary health facilities, inadequate qualified human resources to operate the IT system, and insufficient power backup. Moreover, unrealistic demand estimation from the service points, inadequate transportation costs, and manual inventory management systems further contributed to the complex landscape of challenges. This study identified procurement delays as the primary cause of essential medicine shortages in Bagmati Province, Nepal. We recommend implementing comprehensive procurement guidelines, collaborative training, and dedicated budgets to address this issue. Improving the procurement and inventory management process in low-resource settings requires a well-trained workforce, suitable storage spaces, and enhanced coordinated administrative tiers within health facilities at different levels to ensure the year-round availability of essential medicines in these settings.

V6 vein-preserving superior segmentectomy: A potentially preferable option

ObjectiveThe increasing identification of pulmonary nodules has led to a growing emphasis on segmentectomy. Nevertheless, the surgical process for segmentectomy is complex and optimizing segmentectomy is a critical clinical concern. This study aimed to evaluate the safety and short- and long-term efficacy of V6-preserving superior segmentectomy. MethodsWe performed a retrospective analysis of patients who underwent thoracoscopic superior segmentectomy at our hospital between January 2019 and June 2020. Eligible patients were categorized into an V6 vein-preserving segmentectomy (VVPS) group and a Non V6 vein-preserving segmentectomy (NVVPS) group depending on the preservation of V6. Primary outcome measures encompassed the evaluation of surgical safety (surgical margins, 3-year overall survival, and disease-free survival), whereas secondary measures included postoperative complication rates, operative time, estimated intraoperative blood loss, length of hospital stay, and associated costs. ResultsThe analysis included a final cohort of 78 patients. In the NVVPS group (n = 43), 95.3 % of patients exceeded the tumor diameter, and no positive surgical margins were observed. The 3-year overall survival (OS) and disease-free survival (DFS) rates for the NVVPS group were 95.3 %, with no significant differences in OS (p = 0.572) and DFS (P = 0.800) compared with the VVPS group. Additionally, the median total hospitalization cost for the NVVPS group was 41,400 RMB (IQR, 38,800–43,400), which was significantly lower than that of the VVPS group, showing statistical significance (P < 0.05). No statistically significant differences were observed in the incidence of postoperative complications and length of stay between the two groups (P > 0.05). ConclusionV6-preserving superior segmentectomy is a secure and optimized surgical alternative. Its streamlined procedure facilitates easier adoption in primary healthcare facilities, rendering it a superior choice for superior segmentectomy.

Febrile disease modeling and diagnosis system for optimizing medical decisions in resource-scarce settings

Febrile diseases are highly prevalent in tropical regions due to elevated humidity and high temperatures. These regions, mainly comprising low- and middle-income countries, often face challenges related to inadequate medical infrastructure and a lack of skilled personnel for accurately diagnosing febrile diseases. Distinguishing one febrile illness from another posed a significant challenge, adding to the complexity of accurate diagnoses. This study developed a multi-symptom multi-disease model to address this challenge, leveraging exploratory data analysis of patient datasets from field studies and the expertise of medical practitioners specializing in tropical diseases. The research investigated the most effective modeling approach for differentiating among 11 febrile illnesses that are prevalent in Nigeria using three intelligent techniques: Extreme Gradient Boost (XGBoost), Fuzzy Cognitive Map (FCM), and Analytic Hierarchy Process (AHP). Comparative analysis demonstrates that AHP surpassed the others, achieving a precision of 84%, recall of 83%, and an F1-score of 84%. Consequently, the AHP technique was integrated into the development of “Febra Diagnostica,” an app aimed at enhancing febrile disease diagnosis in resource-constrained settings. The app was then deployed and utilized in select Nigerian states, offering scalability and empowering frontline health workers in primary health facilities. Febra Diagnostica featured user-friendly interfaces, automated diagnosis and treatment suggestions, streamlined referrals, and provisions for further investigations. Encryption, access control, and multi-factor authentication were some of the security and privacy considerations in the app which gained acceptance from medical experts and adapted to regulatory and ethical policies for smart healthcare systems.

Develop a web-based system using the Naïve Bayes algorithm to predict asphyxia neonatal

Introduction: Most cases of perinatal asphyxia are caused by conditions unrelated to labor. When asphyxia occurs during childbirth, it is usually caused by an obstetric emergency that was not detected during pregnancy. It is essential to prevent asphyxia by identifying the incidence of asphyxia during pregnancy. Several studies have been conducted to identify asphyxia problems developing by predictive models. However, there has been no development of a system for predicting birth asphyxia during pregnancy and carried out in primary health facilities.Purpose: Develop a web-based system using the Naïve Bayes (NB) algorithm to predict asphyxia neonatal using a dataset of antepartum risk factors in primary health facilities.Methods: This study employed research and development, which consists of 4 stages, namely literature study, development stage, expert validity, and trial.Results: A system that health workers in primary health facilities can use to predict asphyxia neonatal and recommend referrals for determining the place of childbirth has been successfully created. The system performance test predicted asphyxia neonatal with all NB evaluation values reaching more than 98%, and the prediction accuracy in the respondent test included in the High Accuracy category (MAPE value 9.06%).Conclusion: The development of a web-based system using the NB algorithm has been proven to be able to predict asphyxia neonatal and can be implemented for health workers as an effort to anticipate delays in handling cases of asphyxia neonatal because of the predicted results along with recommendations for focusing mothers with the risk of babies born asphyxia to find out possible childbirth places.

Comparing the Implementation of Different Diabetic Retinopathy Screening Models in Primary Health Care Settings in Northern India: Pragmatic Three-Arm Observational Study

Introduction: Early screening is recommended to prevent vision impairment (VI) and blindness globally due to diabetic retinopathy (DR). We aim to analyze the factors influencing the implementation of DR screening models in primary healthcare facilities. Methods: A pragmatic three-arm observational study will be conducted in the district of Mohali in Punjab, India. The study will compare three equal-sized groups with type 2 diabetes mellitus (T2DM) at age 30 and above. The T2DM participants and healthcare providers (HCPs) will be interviewed to identify the barriers to retinal examinations in primary healthcare settings. The study includes a comprehensive economic evaluation to determine the cost-effectiveness of implementing different DR screening models in primary health settings. The present study will use the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance), to assess the implementation of two DR screening interventions and the extent of variation in outcomes. Qualitative and quantitative data collected from participants and research team observations will be examined to report on the five RE-AIM domains. Discussion: A screening program should ensure early detection and referral for DR treatment before it results in irreversible vision loss. However, understanding the problems of accessing DR screening and estimating the cost-effectiveness of such programs in a primary health setting is important before allocating public health resources.

Assessment of Primary Laboratory Facilities for Rural Health Care Preparedness in Osmanabad District, India

Government of India has provided Indian Public Health Standards to improve rural health care services and health status, but still rural laboratory is a cause of concern. This study is performed to understand the laboratory facility-level gaps that need to be addressed to improve the public primary health centres (PHCs) present in rural areas. The laboratory assessment is performed for governance, financing, resources and services, and results are validated with the PHC laboratory performance. The current assessment shows critical gaps in the facilities regarding governance, services, resources and financing required for the laboratory services at the rural primary health care level. Governance and services need to be strengthened the most, followed with sustained availability of resources and financing. Poor health status in rural areas necessitates public health response based on health systems. Therefore, health system preparedness in the form of laboratory services is essential in primary health care facilities.

“I just cannot take medication for the rest of my life”: Non adherence Towards Diabetes Treatment

Diabetes is a rapidly growing health challenge and potential epidemic across the low-and-middle-income countries. In primary health care settings, the management of diabetes is mainly by providing hypoglycemic drugs and lifestyle change. The level of adherence and compliance to the therapy is a critical element in glycaemic control. In developed countries, adherence to long-term therapies in the general population is around 50% and is much lower in developing countries. A specific trend of non compliance and non adherence towards medication was seen in patients coming to a rural primary health care facility in India. Several beliefs regarding non adherence were identified in such patients which are - Beliefs about chronic diseases in general, beliefs about long term drug intake, behavior towards diabetes medication, peers observations and switching between different treatments. There is a need to identify specific reasons for non compliance and/or non adherence so that more focused behavioral change strategies can be made for patients of chronic diseases. 

Maternal and child health care access to skilled delivery services among Ghanaian rural mothers

IntroductionMost new-born babies are born at home in rural communities which is not new phenomenon due to lack of access to primary healthcare services and trained skilled health attendants, exposing mothers and children to a high risk of labour complications. The purpose of this study was to better understand factors influence rural women's access to primary health care and skilled delivery services as well as their reasons for using or not using maternal health care and skilled delivery services.MethodsThe study employed a social survey design with a quantitative approach to data analysis. Cluster Sampling was used, possibly based on rural communities, to efficiently collect data from different geographic locations. Simple random sampling individuals from each cluster ensures that all eligible individuals have an equal chance of being included in the study. This enhances the representativity of the sample. A total of 366 mothers were selected from four rural communities in the North East Region of Ghana. The choice of sample size considered factors like the study's objectives, available resources, and the desired level of statistical power. Data was primarily gathered through the administration of a questionnaire to the respondents. Factors considered for achieving representativity include, geographic representation, accessibility, healthcare infrastructure and healthcare professionals’ attitudes.FindingsThe study found that distance to health centres limits women's access to skilled delivery services. Lack of primary health facilities in the rural communities hamper maternal and child care services delivery. The attitude of health care professionals determines a mother’s utilisation of maternal health care and skilled delivery services.ConclusionThe study contributes to the limited research on maternal health services and their impact on mother and child health in the study area. This study is one of the first to investigate into maternal health care as a key predictor of mother and child health in the study area. The study's theoretical lens was the Andersen and Newman Health Behavioural Model theory, which supports the explanation of distance, lack of primary health centres, attitudes and lack of skilled personnel to the non-utilisation of maternal and health services in rural communities. The study recommended that primary healthcare facilities and trained health professionals should be a priority of government in rural communities to promote maternal and child healthcare.

A mixed methods study examining the impact of primary health care financing transitions on facility functioning and service delivery in Kenya: a study protocol

Background Kenya has experienced several health financing changes that have implications for financing primary healthcare (PHC). These include transitions from funding by two key donors (the World Bank and the Danish International Development Agency (DANIDA)) and the abolishment of conditional grants that were earmarked for financing primary healthcare facilities. This protocol lays out study plans to evaluate the impact and implementation experience of these financing changes on PHC facility functioning and service delivery in Kenya. Methods/design A sequential mixed methods design will be applied to address our research objectives. Firstly, we will perform a document review to understand the evolution of policy changes understudy. Second, we will conduct an interrupted time series analysis across all 47 counties in Kenya to assess these financing changes' impact on health service utilization in all public primary healthcare facilities (level 2 and 3 facilities). Data for this analysis will be obtained from the Kenya Health Information System (KHIS). Third, we will carry out in-depth interviews with health financing stakeholders at the national, county, and health facility levels to examine their perceptions of the experiences with these changes in health financing. Discussion This mixed methods study will contribute to evidence on the sustainability of financing primary healthcare in low and middle-income countries facing financing changes and donor transitions.

Impact of COVID-19 on essential healthcare services at the primary healthcare level in Armenia: a qualitative study

BackgroundThe COVID-19 pandemic has presented significant global healthcare challenges, particularly impacting the continuity of essential health services in low- and middle-income countries. This study investigates the impact of the COVID-19 pandemic on the utilization and provision of essential health services in Armenia.MethodsWe employed a conventional qualitative study design, conducting semi-structured in-depth interviews (n = 17) within public and private primary healthcare (PHC) facilities in Armenia in 2021. Our study participants encompassed physicians providing specialty services in PHC facilities (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular visitors to PHC facilities (e.g. adults with chronic diseases, parents of children), and policymakers. Thematic analysis was conducted, yielding five emergent categories: mobilization and organization of PHC services during COVID-19; PHC visits during COVID-19; worsening of chronic conditions due to the decline in PHC visits; problems with routine childhood vaccinations; and patient-provider communication challenges.ResultsThe number of in-person visits to PHC facilities declined due to adaptations in service delivery, imposed lockdown measures, and the public’s fear of visiting healthcare facilities. Maternal and child health services continued with no major disruptions. PHC providers deliberately limited the number of maternal and child visits to essential antenatal care, newborn screenings, and routine childhood immunizations. Still, children experienced some delays in vaccination administration. The pandemic resulted in a notable reduction in follow-up visits and monitoring of patients with chronic conditions, thereby exacerbating their chronic conditions. Phone calls were the primary method of patient-provider communication during the pandemic.ConclusionsThe COVID-19 pandemic has had a profound impact on the delivery and utilization of essential healthcare services at PHC facilities, especially for those with chronic conditions who needed continuous care. Unified national-level guidance and technical capacity are needed to direct the provision of essential services at the PHC level, promote effective health communication, and implement digital platforms for the uninterrupted provision of essential care during public health emergencies.

Self-management challenges of adults with type 2 diabetes mellitus in Ekurhuleni district primary health care facilities amid COVID-19 lockdown.

Self-management is highly recommended in managing type 2 diabetes mellitus (T2DM). Amid the coronavirus disease 2019 (COVID-19) lockdown, many restrictions were imposed, which might have affected the continuum of care and self-management. However, little is known about how people with T2DM experienced self-management during COVID-19 lockdown within the primary health care (PHC) facilities. The study explored and described the self-management challenges of adults with T2DM in Ekurhuleni PHC facilities amid COVID-19 level 5 and 4 lockdowns. The study was conducted in three community health centres in Ekurhuleni which are rendering PHC services. A phenomenological, qualitative, exploratory, and descriptive design was utilised. Purposive sampling was used to select adult patients with T2DM. Data were collected telephonically between July 2022 and August 2022 using semi-structured interviews. Inductive content analysis was used to analyse data. Two themes emerged from the interviews, namely, uncontrolled blood glucose levels and financial challenges. The patients with T2DM experienced uncontrolled blood glucose levels and financial challenges during the COVID-19 lockdown. Guidelines to improve self-management programmes during restrictions are needed to promote good health during future pandemics to prevent complications and mortality. The telehealth model can be designed to monitor chronic patients at home during lockdown as a two-way communication.Contribution:More knowledge and insight into self-management and health promotion of patients with T2DM was provided by this study. Increased training needs arose for PHC nurses in managing and monitoring patients.

A mixed methods study on continuity and care coordination based on the obstetric near miss approach.

The near-miss approach assumes that mothers facing life-threatening conditions such as severe pre-eclampsia and postpartum haemorrhage share common risk factors. Among these women, those who survive (near-miss cases) can offer insights into the determinants, providing valuable lessons for understanding underlying factors. To investigate elements of continuity and coordination leading to obstetric near misses. A major referral hospital and its referral pathway in Kenya. Explanatory sequential mixed-methods design. Near-miss survivors had lower continuity and coordination of care indices during antenatal visits (COCI = 0.80, p = 0.0026), (modified continuity of care index [MCCI] = 0.62, p = 0.034), and those with non-life-threatening morbidity in the first trimester were more likely to experience a near miss (aOR = 4.34, p = 0.001). Facilities in the western region had a higher burden of near misses compared to the Eastern region. Qualitatively, three deductive themes were identified: sequential coordination, parallel coordination and continuity, along with factors classified as access. In mixed integration, poor continuity indices were explained by quality of interpersonal relationships and woman centredness. Poor coordination was explained by inadequate teamwork between providers in referring and referral facilities and between primary health facilities and the community. Higher near-miss rates in the western region resulted from differences in human and physical resources. Promoting woman-centred care, teamwork, improving communication and introducing innovative coordination roles like case and care managers can enhance continuity and coordination of maternal healthcare. This study contributes to our understanding of the challenges of continuity and coordination in maternal healthcare in resource-poor settings by applying the WHO operationalisation of continuity and coordination using mixed methodology.

High uptake of COVID-19 vaccines among healthcare workers in urban Uganda.

The aim of the study was to describe the facilitators, barriers to and level of uptake of COVID-19 vaccines among healthcare workers in primary healthcare facilities in an urban setting in Uganda. We conducted a cross-sectional study among HCWs in private and public health facilities in Entebbe municipality between July 2021 and August 2021. Data was collected using a structured questionnaire that was shared, via an online link, to consented participants. Uptake of the vaccines among healthcare workers was analysed as proportions, and logistic regression was used to analyse barriers and facilitators to uptake of COVID-19 vaccines. The study enrolled 360 participants, with 61.7% (n = 222) females. A total of 236 (65.6%) healthcare workers had received at least one dose of COVID-19 vaccine, with higher uptake among females 64% (n = 151). Age above 40 years (OR 2.16), working in a government healthcare facility (OR 3.12), participating in COVID-19 vaccine related activities (OR 4.62), and having tested for SARS-COV-2 (OR 3.05) increased the odds of having been vaccinated. Working in small roadside clinics reduced the odds of being vaccinated by almost 70%, while HCWs in government health services were 3.1 times more likely to have been vaccinated. History of having cared for a COVID-19 patient and having a positive SARS-COV-2 test result did not influence the uptake of the vaccines in the study population. Vaccine uptake among HCWs was close to the World Health Organisation (WHO) recommended uptake of 70% by mid-2022.