Primary Health Care Level Research Articles

Comparative Analysis of Methods of Audiological Screening of the Adult Population: Global and Kazakhstani Experience

Hearing impairment is currently recognized as the most prevalent sensory impairment and one of the leading causes of disability worldwide. It is estimated that one in five people on Earth has at least minimal hearing loss, and more than 5% of the population has disabling hearing loss. There are many methods for screening detection of hearing impairment, and the most common ones are mobile applications, recognition of whispered speech, a portable audiometer, questionnaires, the speech intelligibility test in noise, and others. Nevertheless, the “gold standard” for hearing testing has been and remains the method of pure-tone threshold audiometry. The purpose of this review is to study the currently available literature, analyze ongoing research in the field of audiological screening of adults, study the cost-effectiveness of ongoing screening activities, study the situation in Kazakhstan, and the possibility of using these screening methods in Kazakhstan. We selected 25 full-text articles that met the following criteria: the 2018-2023 time interval, adult population, screening methods, effectiveness, and article language (English, Russian, Kazakh). Conclusions. Despite a sufficient number of hearing screening methods, their sufficient reliability, sensitivity, and specificity, and their obvious cost-effectiveness in comparison with the costs of rehabilitation of hearing impairments, none of the hearing assessment methods are included in the National Screening Program for examining adult population in any country in the world. In Kazakhstan, a screening test of hearing function using a one-question survey, the HHIA/HHIE questionnaire, a study of whispered speech at the primary health care level, and also the use of a mobile version of a hearing test as a hearing self-diagnosis are applicabl

Are social determinants associated with depression among married women of reproductive age? A mixed methods study from urban slums of Islamabad, Pakistan.

Depression among married women of reproductive age is on the rise in Pakistan, owing to post-COVID-19 phase, super-inflation, increasing poverty, deteriorating law and order situation and perpetuating the uncertain political situation in the country. This study aimed to investigate the factors associated with depression among married women of reproductive age in Pakistan, using a mixed methods approach. The quantitative phase utilized the Urdu version of the Patient Health Questionnaire-9 (PHQ-9) to assess depression among 340 married women. Twelve women with higher scores on the PHQ-9 were selected for in-depth interviews in the qualitative phase. The quantitative analysis revealed a higher prevalence of depression among women with poor socioeconomic status, lower educational levels, larger family sizes, and recent deaths in the family. In the qualitative phase, the main themes identified were the impact of social conditions, such as societal expectations and gender roles, the influence of medical conditions on mental health, financial difficulties, the stress associated with caring for a larger number of children, and the emotional burden of recent deaths in the family. This study highlights the importance of addressing depression among married women of reproductive age in Pakistan. It is crucial to focus on early diagnosis and prompt treatment to mitigate the adverse effects of depression on the affected individuals and their families. Targeted interventions should consider the social determinants of depression, including improving socioeconomic conditions through safety nets, providing mental health support at the primary health care level, and addressing the specific health issues and needs of women in the reproductive age group. A multi-pronged approach and health system's thinking can reduce the burden of depression among women, ultimately enhancing their overall well-being, productivity and quality of life.

Upotreba antibiotika i antivirotika u lečenju pacijenata obolelih od COVID-19 u Kovid ambulanti Doma zdravlja Golubac

Introduction: There were 13 protocols for the COVID-19 infection treatment in Serbia. All protocols emphasize the importance of not giving antibiotics routinely, especially in patients who were treated at the primary healthcare level. Use of antibiotics was widely spread in the treatment of COVID-19 patients, all around the world. Objective. We aimed at examining the incidence, type, and combination of used antibiotics and antivirals in COVID-19 patients. Method: Observational retrospective cross-sectional study on the prescription of antibiotics and antivirals in patients who were treated in the COVID clinic of the Golubac Primary Healthcare Center in the period from 7/17/2020. until 10/31/2022. The data were obtained from the electronic health records of the participants. The sample consisted of 2709 respondents. The variables we used were sex and age. We used the statistical package SPSS17 for data processing. For statistical methods, we used descriptive statistics frequency (%) and, the X2 test. Results: The research included 2,709 patients. In total, 1590 people were prescribed antibiotics. Concerning the total number of patients, examined in the COVID clinic, this represents 58.7%. The highest percentage of patients who were prescribed an antibiotic was in the period November 2020 - May 2021. Depending on the study period, cephalosporin and azithromycin are the most frequently prescribed antibiotics (70-89% of the total number of prescribed antibiotics). The most commonly prescribed antibiotic combination is a cephalosporin-fluoroquinolone. Conclusion. The use of antibiotics in the treatment of COVID-19 patients was higher than recommended in the protocols and guidelines.

Prevalence of depression and anxiety among older persons residing in Thoubal district, Manipur

ABSTRACT Background: Among the elderly population, the most common psychiatric conditions include depression and anxiety, which often go untreated or unrecognized, owing to the lack of knowledge and misperceptions about these conditions. Timely identification and treatment improve the quality of life of the elderly. As community studies were scarce in Manipur, the present study was undertaken. Aim of the Study: This study aims to assess the prevalence of depression and anxiety among older persons residing in Thoubal district, Manipur. Materials and Methods: A descriptive cross-sectional study was conducted among 352 older persons, aged 60 years and above residing in a rural area of Thoubal district of Manipur in India for 1 year. The elderly subjects were selected randomly by lottery method. The validated Manipuri translation of the Geriatric Depression Scale-15 short version and the Geriatric Anxiety Scale-10 were used to assess depression and anxiety. Data analysis was done using SPSS version 26 for Windows. Results: The overall prevalence of depression was 102 (29.0%), of which 65 (18.5%), 31 (8.8%), and 6 (1.7%) had mild, moderate, and severe depression, respectively. Gender, age, marital status, no income, presence of chronic illnesses, and substance use were significantly associated with depression. The overall presence of anxiety among respondents was 91 (25.9%), out of which 59 (16.8%), 27 (7.7%), and 5 (1.4%) were mild, moderate, and severe, respectively. No income, presence of chronic illnesses, and substance use were significantly associated with anxiety. During binary logistic analysis, a higher risk of developing depression was found in females, widows/widowers, unemployed, no income, and elderly with diabetes and alcohol use, whereas the elderly with hypertension, both hypertension and diabetes, and tobacco use had a higher risk of developing anxiety. Conclusion: The results confirmed that there is a high prevalence of depression and anxiety among the rural elderly population. There is a need to improve geriatric mental health-care services including timely screening, monitoring, and implementing preventive programs at the primary health-care level.

Opšti principi hitnog zbrinjavanja trovanja u ambulanti lekara opšte medicine - izazovi i prepreke

Introduction. Timely recognition of acute or chronic poisoning, as well as the pharmacodynamic mechanisms and pathophysiology of poisoning, is of the utmost importance in the general practice office. Objective. We aimed to find out the rate of awareness and education of primary healthcare physicians on necessary measures in the case of poisoning treatment. Method. Physicans working in general practice in the Republic of Serbia were sent an electronic questionnaire ''Urgent poisoning treatment in the general practice office''. The questionnaire had 13 questions referring to the physician's practical experience. Results. The rise of medication, product, and biological substance poisoning rate was registered at the primary healthcare level in the last five years and it went from 0,14 to 0,21. Poisoning with non-medical substances is on the steep decline, from 0,30 to 0,19 per 1000 inhabitants. We followed the experience of general physicians (GPs) from outpatient clinics, concerning the cases of acute and chronic poisoning, by examining the questionnaire which showed 71,43% of GPs met with this condition. Physicans were more likely to be met with accidental poisoning (41,07%), while (21,43%) were met with multiple intentional poisonings. A larger percentage of these cases (44,65%) were treated on-site. About the existence of the National Poisoning Control Center knew 53,57% of physicans and 58,93% were familiar with detoxication measures. Additional expertise in the area of poisoning is necessary in the opinion of 75% of physicians. Discussion. Poison intake, in different ways, into a body, may cause a patient's death if not recognized on time, at the initial encounter in the general physician's office. Conclusion. Awareness and education of the GPs in the outpatient clinics, as well as, readiness to learn additional skills proved to be an important factor in taking care of poisoned patients who call on their GPs first. Continuous education is a necessary measure for the improvement of healthcare quality in the treatment of acute and chronic poisoning.

Service readiness for the management of non-communicable diseases in publicly financed facilities in Malawi: findings from the 2019 Harmonised Health Facility Assessment census survey

IntroductionNon-communicable diseases (NCDs) are rising in low-income and middle-income countries, including Malawi. To inform policy-makers and planners on the preparedness of the Malawian healthcare system to respond to NCDs, we...

Effectiveness of smartphone otoscope in management of ear ailments at primary healthcare level

Background: To work out efficacy of smartphone otoscope for managing ear ailments at primary healthcare level. Methods: Prospective study carried out at a co-located primary care clinic and secondary referral facility. With this plan, the PHC was equipped with a smartphone otoscope for diagnosing common ear problems. The doctor then forwarded patient's ear imaging to the referring hospital's otolaryngologist. The otolaryngologist reviewed the history to make remote diagnosis before providing the PHC provider with recommendations for treatment. Information on patients' demographics, outpatient diagnoses, symptom durations, affected side, treatments received, and outcomes was collected. This information was used to determine whether or not a smartphone otoscope may be used to improve healthcare for patients suffering from common ear illnesses without sending them to more specialized facilities. Results: 150 patients were enrolled; 53.3% were male and 46.7% female. Participants aged between 3 and 83 years, with a mean of 44.6. Eighty-two (48%) of the cases presented with left ear, sixty (40%) with right ear, and eighteen (12%) for both sides. The typical course of ear infection lasted 6.5 (2, 15) days. Out of 150 patients, 33 (22%) were deemed cured, 117 (78%) demonstrated improvement in symptoms. The technique was praised by primary care physicians, who said they learned more about otolaryngology. Conclusions: The ability of primary care physicians to manage common and straightforward ear ailments is greatly enhanced by the use of smartphone otoscopes. Thus, improving patient satisfaction and the strain on medical facilities.

Educational training in disease management for persons providing peer support to patients with type 2 diabetes and arterial hypertension at the primary healthcare level.

Introduction: Good metabolic control of a patient with type 2 diabetes (T2D) and arterial hypertension (AH) requires continuous monitoring of patient's health and associated diseases, where lifelong education and support represent key factors in patient empowerment and successful self-management. This is a task beyond the capabilities of healthcare professionals in Slovenia, which could be solved with engagement and cooperation of partners outside the healthcare system. Therefore, appropriate organisation, training and functioning of lay persons, who will provide peer support, can significantly contribute to improved integrated care in patients with T2D and AH. In this way trained peer supporters will voluntarily share their knowledge, experiences and support to other patients with the same chronic disease without linguistic nor cultural barriers.
 Aim: The aim of our pilot study was to determine the acceptability, effectiveness and feasibility of educational training in disease management for persons providing peer support to patients with T2D and AH at the primary healthcare level in Slovenia. 
 Methods: This study is a part of an ongoing international research project SCUBY (SCale Up diaBetes and hYpertension care). Our pilot study started with recruitment of 36 patients with T2D and/or AH. Participants were educated in a total of 15 hours of group and individual training by nurses with special skills. Before and after completing the training, participants filled out questionnaires including sociodemographic and clinical data, knowledge about T2D and AH, Appraisal of Diabetes Scale and Theoretical Framework of Acceptability.
 Results: 31 patients (21 women and 10 men) successfully completed structured educational training in management of their T2D and AH and became trained peer supporters. Their average age was 63,9 ± 8,9 years, they were treated for T2D on average of 14,3 ± 11,7 years and for AH on average of 7,9 ± 8,1 years. Compared to the knowledge at the time of entering the research, their knowledge about T2D (p<0,001) as well as about AH (p=0,022) increased significantly. The impact on the quality of life with T2D was insignificantly better (p=0,146). The participants rated training as highly acceptable in all 7 domains of acceptability; the total mean score on a 5-point scale was 4,44 ± 0,52. 
 Conclusions: Educational training in disease management for peer supporters proved to be highly acceptable, effective and feasible, which indicates a great potential for successful implementation of peer support for patients with T2D and AH at the primary healthcare level in Slovenia. Active role of trained peer supporters will lead to the development of a new form of cooperation and collaboration between patients, their family members, informal caregivers in local community and healthcare professionals.

Hypertension cascade across three healthcare systems and in relation to the level of implementation of the integrated care package of hypertension

Introduction: Primary health care (PHC) systems across the globe are struggling to produce an effective response to the rising burden of disease related to Type 2 Diabetes (T2D). However, effective T2D care at the PHC level – the ‘Integrated Care Package (ICP)’– exists and is cost-effective. Further, there is evidence that this integrated care package ((1) structure) leads to improved care processes (2), to health care responsive to people’s needs and eventually to better health outcomes (3). There is however a clear need for an assessment framework to enable countries to evaluate their progress towards integrated care for T2D.
 We aim to test an assessment framework incorporating these 3 elements: (1) a tool to assess the degree to which the T2D care provided corresponds to the ICP for T2D (structure); (2) cascades-of-care to visualize and detect the ‘leakages’ at each separate step of the care continuum (process and outcomes of T2D care); and (3) a contextualization of (1) and (2) in order to explain why the implementation of specific ICP elements has or has not led to the expected outcomes. This framework will be tested in 3 countries with different PHC approaches, namely Slovenia, Belgium and Cambodia.
 Methods: A mixed methods design is used. First, information about the level of ICP implementation is collected using the ICP Grid at the health care facility level. Secondly, patient level data is used to build de T2D cascades-of-care: we rely on representative survey data (5000 individuals) in Cambodia, on health insurance (+ laboratory) data in Belgium and routine data in Slovenia. Where feasible, we used ICP scores as explanatory variables explaining the drops in the cascade. Thirdly, expert consultations and stakeholder interviews were used to contextualize the findings.
 Results: The ICP grid scores showed considerable variations in the implementation of the ICP for patients with T2D between Belgium, Slovenia, and Cambodia – with Slovenia consistently reporting the highest scores. However, important in-country variations were observed for Belgium and Cambodia indicating that specific initiatives have resulted in higher levels of integrated care. In terms of T2D care process and outcomes, the country cascades-of-care display similar profiles with the biggest drops at the ‘diagnosis’ and ‘under control’-bars. The qualitative data on the health system clearly demonstrate that the context can hamper (1) the construction of the cascades (i.e. in Belgium and Cambodia due an absence of a routine monitoring system) and (2) the linking of the ICP grid data with the cascade-of-care data (i.e. in Cambodia where the private sector takes up a large proportion of T2D care).
 Conclusions: The developed framework offers a promising strategy to assess (1) the progress made in ICP implementation in PHC for T2D as well as (2) its impact on the T2D care process and outcomes. As such, the framework offers policy makers and stakeholders a tool to monitor T2D care and adapt specific elements where required. The study, however, also indicated severe challenges in collecting the required data which also limited the cross-country comparability of the produced outcomes.

Quality of life of elderly users of long-term health care in and outside the institution

<p><strong>Introduction. </strong>Long-term care is series of health and social care services provided at home or in an institutional environment to people with reduced functional capacity. Even though it is known that the quality of life (QoL) of elderly is on a lower level when compared to younger people, there is a small amount of information about QoL of long-term health care patients. The aim of our study was to determine the difference in QoL, depression, anxiety and stress of longterm health care users placed in and outside the institution.</p> <p><strong>Methods.</strong> This cross-sectional study included 100 long-term healthcare users, divided in two groups. First group consisted of 50 respondents from primary level of health care and second group consisted of 50 residents of nursing home. The research was conducted in the period from June to July 2022. A general socio-demographic questionnaire, SF-36 health questionnaire for estimating the QoL and the scale of depression, anxiety and stress (DASS-21) were used as instruments in this study.</p> <p><strong>Results. </strong>Respondents who were institutionalized had significantly lower values of domains and summary scores of QoL compared to respondents whose health care took place outside of institutions, where the difference was observed in physical health summary score (37.67±6.20% vs. 50.39±10.74%, p<0.001), and the mental health summary score (44.87±11.82% vs. 51.83±16.01%, p =0.015). Respondents who received long-term health care institutionally had significantly (p=0.011) more mild anxiety (12%) and moderate anxiety (34%) compared to respondents who received long-term health care outside the institution (4% vs. 14%).</p> <p><strong>Conclusion. </strong>Our results showed that residents of nursing home had significantly worse physical and mental functioning, as well as more frequent occurrence of anxiety symptoms compared to users of longterm health care placed outside institutions, in home environment.</p>

Design and techno-economic evaluation of hybrid renewable energy system for an Upazilla Health Complex (UHC) in Bangladesh

Upazilla Health Complex (UHC) offers the primary level health care facilities for rural communities. Every day thousands of patients come here for health care. The Health complex needs 24 hours electric supply. The national Grid cannot provide continuous electricity supply. Rural areas face various disturbance such as load shedding, blackouts problems and bad weather situation. In this paper, we report on the techno-economic assessment of net metering based On-grid photovoltaic system for Kaunia Upazila Health Complex in Rangpur District, Bangladesh. The analysis is based on the grid-connected photovoltaic system without battery storage. The HOMER software is used to obtain the overall analysis and the load study is carried out by HOMER powering tools. It suggests that the selected health complex requires a 34 kW PV system. The system’s net present cost (NPC) and the levelized cost of energy (COE) are $35,524 and $0.048 respectively. In this proposed system, renewable energy provides 99% of the total power requirements, while the generator and grid provide only 1%. The system produces 53,736 kWh a year of electricity where the system’s surplus electricity is 3226 kWh per year which can be sold to the national grid using a net-metering system.

Research Trends in Motivation and Weight Loss: A Bibliometric-Based Review

Obesity is a complex disease that, like COVID-19, has reached pandemic proportions. Consequently, it has become a rapidly growing scientific field, represented by an extensive body of research publications. Therefore, the aim of this study was to present the research trends in the scientific literature on motivation and weight loss. Because traditional knowledge synthesis approaches are not appropriate for analyzing large corpora of research evidence, we utilized a novel knowledge synthesis approach called synthetic knowledge synthesis (SKS) to generate new holistic insights into obesity research focusing on motivation. SKS is a triangulation of bibliometric analysis, bibliometric mapping, and content analysis. Using it, we analyzed the corpus of publications retrieved from the Scopus database, using the search string TITLE-ABS-KEY((obesity or overweight) and “weight loss” and motiv*) in titles, keywords, and abstracts, without any additional inclusion or exclusion criteria. The search resulted in a corpus of 2301 publications. The United States of America, the United Kingdom, and Australia were the most productive countries. Four themes emerged, namely, weight loss and weight-loss maintenance through motivational interventions, lifestyle changes supported by smart ICT, maintaining sustainable weight with a healthier lifestyle, and weight management on the level of primary healthcare and bariatric surgery. Further, we established that the volume of research literature is growing, as is the scope of the research. However, we observed a regional concentration of research and its funding in developed countries and almost nonexistent research cooperation between developed and less-developed countries.

Treatment gap for mental and behavioral disorders in Punjab.

There is no data on the treatment gap and health care utilization for mental disorders from Punjab. The present study reports on the same by using the data collected during the National Mental Health Survey. Multisite, multistage, stratified, random cluster sampling study conducted in four districts, namely Faridkot, Moga, Patiala, and Ludhiana (for urban metro areas). Data were collected from October 2015 to March 2016. Mini International Neuropsychiatric Interview 6.0.0 and Adapted Fagerstrom Nicotine Dependence Scale were used to diagnose mental and behavioral disorders and tobacco use disorder, respectively. Pathways Interview Schedule of the World Health Organization was applied to persons having any disorder to assess treatment gap and health care utilization. Exploratory focused group discussions (FGDs) were conducted to understand the community perceptions regarding mental and behavioral disorders. The treatment gap for mental and behavioral disorders was 79.59%, and it was higher for common mental disorders than severe mental disorders and higher for alcohol and tobacco use disorders as compared to opioid use disorders. The median treatment lag was 6 months. Only seven patients out of 79 were taking treatment from a psychiatrist, and the average distance traveled by the patient for treatment was 37.61 ± 45.5 km. Many attitudinal, structural, and other barriers leading to high treatment gaps were identified during FGDs in the community, such as stigma, poor knowledge about mental health, deficiency of psychiatrists, and distance from the hospital. Vertical as well as horizontal multisectoral integration is required to reduce the treatment gap and improve healthcare utilization. Increasing mental health literacy, providing high-quality mental health services at the primary-healthcare level and human resources development are the need of the hour.

Clinical Audit for Integration of Communicable and Non-Communicable Diseases at the Primary Health Care Level in Tanzania.

Poor quality of health care services remains an important challenge in health care delivery systems. Here, we validate clinical audit tools and describe audit results of selected clinical standards related to communicable disease (CD) and non-communicable disease (NCD) integration at the primary health care level. A multi-methods approach, including a retrospective cohort and cross-sectional design, was deployed concurrently at Health Centres. Separate evaluators assessed the Health Centres using an audit tool and the inter-rater/inter-observer reliability was estimated. The extent of adherence to clinical standards was measured in proportions for: infection prevention control, tuberculosis (TB) diagnosis including advanced TB/Human Immunodeficiency Virus (HIV), the diagnosis of chronic lung diseases, and the bidirectional screening and clinical management of TB and Diabetes Mellitus (DM). The inter-rater reliability for the clinical audit tools based on 130 individuals' charts was 99.5% (CI:99-100). The total estimated maximum score for infection prevention control was 114 and on average health centres scored 42 (37%). Only 3 (4%) of 80 individuals' medical charts with unexplained productive cough were evaluated for TB. None of the 24 individuals with HIV infection medical charts had vitals measured and only 6 (25%) patients with advanced HIV had a TB test performed, whereas 4 (17%) had a cryptococcal antigen test, and 1 (4%) had a chest radiograph. Also, 24 patients' chart from documented HIV negative with chronic cough had no records of spirometry or peak flowmeter or a chest radiograph. However, a diagnosis of asthma and chronic obstructive pulmonary disease as made in 17 (71%) and 7 (29%), respectively. TB was confirmed for 102 patients among whom only 12(12%) were screened for DM. The DM clinics had no TB presumptive registers. Patients with TB/DM (n=2) had a glycated haemoglobin (HbA1c) measurement done and received appropriate management. The developed clinical audit tools were reliable and could contribute to quality measurement for metrics-related integration of CD and NCD in Tanzania. Further investigations will determine if the clinical audit tools widely used in cycles can improve the quality of care in health care delivery systems.

Quality of antenatal care in primary health care in Brazil: a latent class analysis

Abstract Background Adequate antenatal care (ANC) is fundamental in preventing maternal and neonatal mortality. Developing indicators for assessing the ANC quality in Primary Health Care (PHC) is essential. Objective To characterize subgroups of quality of care with respect to ANC at the PHC level in Brazil. Methods We conducted a cross-sectional study with data from the first Brazil’s National Program for Improving Primary Care Access and Quality (PMAQ-AB) Cycle (2011–2012). A total of 16 566 PHC teams participated in the first cycle of the PMAQ-AB, corresponding to 49.6% of the teams active across Brazil, distributed across 69.3% of Brazilian municipalities. To assess the quality of ANC, six indicators were defined: ‘Group of medicines,’ ‘Protocols and patient flows,’ ‘Record-keeping practices,’ ‘ANC routine tests,’ ‘Protocols for early detection of pregnant women and ANC provision,’ and ‘Identification and ANC of low/high-risk pregnancies.’ Latent Class Analysis (LCA) was carried out to characterize the quality of care provided by PHC teams according to these six indicators. Results ‘Identification and ANC of low/high-risk pregnancies’ indicator had the highest percentage of teams providing adequate care (39.5%), while ‘ANC routine tests’ had the lowest percentage (16.8%). The LCA identified three classes, and 20.5% of PHC teams had the probability of belonging to the class denominated ‘High adequacy.’ Conclusion Using a national PHC-level dataset, we evaluated PHC teams’ ANC adequacy through six indicators. Brazilian PHC teams consistently show weaknesses across these indicators, particularly in essential care. This approach can guide global initiatives to evaluate the quality of ANC.

Demand and supply analysis for maternal and child health services at the primary healthcare level in Nigeria

BackgroundThe low demand for maternal and child health services is a significant factor in Nigeria's high maternal death rate. This paper explores demand and supply-side determinants at the primary healthcare level, highlighting factors affecting provision and utilization.MethodsThis qualitative study was undertaken in Anambra state, southeast Nigeria. Anambra state was purposively chosen because a maternal and child health programme had just been implemented in the state. The three-delay model was used to analyze supply and demand factors that affect MCH services and improve access to care for pregnant women/mothers and newborns/infants.ResultThe findings show that there were problems with both the demand and supply aspects of the programme and both were interlinked. For service users, their delays were connected to the constraints on the supply side. On the demand side, the delays include poor conditions of the facilities, the roads to the facilities are inaccessible, and equipment were lacking in the facilities. These delayed the utilisation of facilities. On the supply side, the delays include the absence of security (fence, security guard), poor citing of the facilities, inadequate accommodation, no emergency transport for referrals, and lack of trained staff to man equipment. These delayed the provision of services.ConclusionOur findings show that there were problems with both the demand and supply aspects of the programme, and both were interlinked. For service users, their delays were connected to the constraints on the supply side.

Introduction of telemedicine technologies based on artificial intelligence into practice of providing outpatient care for medical examination

To date, the main focus in the implementation of medical activities is focused on the organization of outpatient care for the population. It is at the level of primary health care, where it is possible to carry out primary prevention measures and the formation of a healthy lifestyle, these issues should be given special attention when providing medical care to the population. One of the main tasks of modern healthcare is to reduce the number of chronic non-communicable diseases of the adult population using modern tools of early preclinical diagnostics. To date, one of the most promising areas that have a significant impact on modern healthcare is digital telemedicine technologies based on artificial intelligence. They can be confidently attributed to the most popular and rapidly developing groups of services developed for primary health care for the purpose of primary diagnostics. Nevertheless, no matter how fast information technologies develop, the opinions of experts in the subject area remain relevant, which significantly enrich the results of the expert opinion.

Biliary atresia: The profile, management and outcome of patients treated at a tertiary hospital in central South Africa

Background. Biliary atresia (BA) is an obstructive inflammatory disease of the bile ducts. Without intervention, the disease rapidly progresses to liver cirrhosis and fibrosis, with end-stage liver failure and death occurring within the first 3 years of life. It is the most common indication for liver transplantation (LT) in the paediatric population. The management of BA in South Africa (SA) faces multiple challenges, such as late referrals and socioeconomic burdens, with suboptimal outcomes. Objectives. To determine risk factors and shortcomings that are detrimental to the outcome of the paediatric patient population by reviewing the profile, management and outcome of patients with BA treated at Universitas Academic Hospital Complex (UAHC), Bloemfontein, SA. Methods. This was a retrospective analytical record review of all patients diagnosed with BA and treated at UAHC from 1 January 2009 to 31 December 2019. Results. In total, 67 patients were included; 74.6% were female, and 86.6% were black Africans. Most (62.7%) had isolated BA. A Kasai portoenterostomy (KPE) was performed in 32 patients (47.8%). Of 5 patients referred for LT evaluation, 2 received a transplant. Of 55 patients with known outcomes, 5.5% (n=3) survived and 94.5% (n=52) died after receiving a KPE or palliative treatment. Of the 3 patients who were alive at the end of the study period, 1 had a KPE and 2 had LTs. Conclusion. Late presentation, cholangitis and cessation of bile flow after an initial successful KPE, and socioeconomic challenges are issues of concern and had a detrimental influence on the outcome of BA in our study population. Implementing screening measures and education programmes at the primary healthcare level is essential to diagnose and refer BA patients timeously. Establishing support systems to assist socioeconomically disadvantaged patients will enable them to qualify for LT.

Strengthening Health System and Community Mobilization for Sickle Cell Disease Screening and Management among Tribal Populations in India: An Interventional Study

Sickle cell disease (SCD) affects 5% of the global population, with over 300,000 infants born yearly. In India, 73% of those with the sickle hemoglobin gene belong to indigenous tribes in remote regions lacking proper healthcare. Despite the prevalence of SCD, India lacked state-led public health programs until recently, leaving a gap in screening and comprehensive care. Hence, the Indian Council of Medical Research conducted implementation research to address this gap. This paper discusses the development and impact of the program, including screening and treatment coverage for SCD in tribal areas. With a quasi-experimental design, this study was conducted in six tribal-dominated districts in three phases – formative, intervention, and evaluation. The intervention included advocacy, partnership building, building the health system’s capacity and community mobilization, and enabling the health systems to screen and manage SCD patients. The capacity building included improving healthcare workers’ skills through training and infrastructure development of primary healthcare (PHC) facilities. The impact of the intervention is visible in terms of people’s participation (54%, 76% and 93% of the participants participated in some intervention activities, underwent symptomatic screening and demanded the continuity of the program, respectively), and improvement in SCD-related knowledge of the community and health workers (with more than 50% of net change in many of the knowledge-related outcomes). By developing screening and treatment models, this intervention model demonstrated the feasibility of SCD care at the PHC level in remote rural areas. This accessible approach allows the tribal population in India to routinely seek SCD care at their local PHCs, offering great convenience. Nevertheless, additional research employing rigorous methodology is required to fine-tune the model. National SCD program may adopt this model, specifically for community-level screening and management of SCD in remote and rural areas.

Risk factors for cardiovascular diseases: the focus on primary prevention.

Views on the etiopathogenesis of atherosclerosis are subject to evolution. In addition to the classic well-known risk factors, new ones related to mental state, social life and environment are being discovered. Both acute and chronic stress stimulate inflammatory processes. Due to the change in lifestyle and eating habits, the accumulation of risk factors in childhood is an increasing problem. Knowledge of risk factors allows for effective primary prevention of cardiovascular diseases. The effectiveness of prevention increases when the activities cover the largest possible part of the society, and access to a doctor is easy. Therefore, government programs are being implemented offering patients easier access to diagnostics of cardiovascular diseases at the level of primary health care, which enables faster identification of people at the greatest cardiovascular risk. Easier access to primary care and a good doctor-patient relationship improve patient compliance. In this situation, the importance of the family doctor as a key link in the diagnosis, prevention and treatment of cardiovascular diseases is increasing.