Primary Health Care Practice Research Articles

Primary health care contributions to universal health coverage, Ethiopia.

Many global health institutions, including the World Health Organization, consider primary health care as the path towards achieving universal health coverage (UHC). However, there remain concerns about the feasibility and effectiveness of this approach in low-resource countries. Ethiopia has been implementing the primary health-care approach since the mid-1970s, with primary health care at the core of the health system since 1993. Nevertheless, comprehensive and systemic evidence on the practice and role of primary health care towards UHC is lacking in Ethiopia. We made a document review of publicly available qualitative and quantitative data. Using the framework of the Primary Health Care Performance Initiative we describe and analyse the practice of primary health care and identify successes and challenges. Implementation of the primary health-care approach in Ethiopia has been possible through policies, strategies and programmes that are aligned with country priorities. There has been a diagonal approach to disease control programmes along with health-systems strengthening, community empowerment and multisectoral action. These strategies have enabled the country to increase health services coverage and improve the population’s health status. However, key challenges remain to be addressed, including inadequate coverage of services, inequity of access, slow health-systems transition to provide services for noncommunicable diseases, inadequate quality of care, and high out-of-pocket expenditure. To resolve gaps in the health system and beyond, the country needs to improve its domestic financing for health and target disadvantaged locations and populations through a precision public health approach. These challenges need to be addressed through the whole sustainable development agenda.

Implementing nudges for suicide prevention in real-world environments: project INSPIRE study protocol

BackgroundSuicide is a global health issue. There are a number of evidence-based practices for suicide screening, assessment, and intervention that are not routinely deployed in usual care settings. The goal of this study is to develop and test implementation strategies to facilitate evidence-based suicide screening, assessment, and intervention in two settings where individuals at risk for suicide are especially likely to present: primary care and specialty mental health care. We will leverage methods from behavioral economics, which involves understanding the many factors that influence human decision making, to inform strategy development.MethodsWe will identify key mechanisms that limit implementation of evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health through contextual inquiry involving behavioral health and primary care clinicians. Second, we will use contextual inquiry results to systematically design a menu of behavioral economics-informed implementation strategies that cut across settings, in collaboration with an advisory board composed of key stakeholders (i.e., behavioral economists, clinicians, implementation scientists, and suicide prevention experts). Finally, we will conduct rapid-cycle trials to test and refine the menu of implementation strategies. Primary outcomes include clinician-reported feasibility and acceptability of the implementation strategies.DiscussionFindings will elucidate ways to address common and unique barriers to evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health care. Results will yield refined, pragmatically tested strategies that can inform larger confirmatory trials to combat the growing public health crisis of suicide.

Community health nursing courses in baccalaureate nursing programs in China: A descriptive study based on website information

ObjectiveTo survey current community health nursing (CHN) courses offered in baccalaureate nursing programs in the mainland of China from the perspective on information available on websites of colleges and universities. MethodsA descriptive research design was used. Data were collected from the official websites of colleges and universities providing baccalaureate nursing programs in the mainland of China. A checklist was applied to identify academic year, type of course, credit, and class hours for both theory and practice teaching of CHN courses including Community Nursing, Geriatric Nursing, Rehabilitation Nursing, and Health Education. The prescribed textbooks were consulted for teaching content. ResultsColleges (n = 16) and universities (n = 26) offering baccalaureate nursing programs with accessible online information for curriculum setting were recruited. The results showed that most of the accessible educational institutions (92.86%) have offered three to four investigated CHN courses. Community Nursing, Geriatric Nursing and Rehabilitation Nursing are generally offered to juniors, while Health Education is offered in half of these institutions in different academic years. Community Nursing is mainly offered as a required course with 2 credits, while Geriatric Nursing, Rehabilitation Nursing and Health Education are provided as elective courses with fewer credits. Around half of the institutions have practice hours for Community Nursing, Geriatric Nursing and Rehabilitation Nursing courses. However, the proportion of practice hours in the courses is generally less than 50%. The teaching content focuses on clinical care competencies instead of complementary competencies. ConclusionIt was revealed that CHN education in China is still in its infancy from website information of colleges and universities. CHN courses should be included in curriculum design, and teaching reforms and innovations should be taken to prepare nursing students to practice in primary health care and community settings.

COVID-19, Obesity, and Undernutrition: A Major Challenge for Latin American Countries.

In March of 2020, the World Health Organization declared the SARS‐Cov2 2019 (COVID‐19) outbreak a global pandemic after documenting community scale transmission in every region, including Latin America. The risk factors associated with severity of disease include older age, diabetes, hypertension, cardiovascular and lung diseases, and immune suppression. Additional evidence strongly suggests that obesity is also a risk factor for severe forms of COVID‐19 disease, while other types of malnutrition increase the risk of hospitalization from influenza‐like diseases, regardless of the causative agent of the illness (1). Although detailed data are not yet available on the impact of under nutrition in the evolution of COVID‐19, given the known inflammatory response caused by this condition, it is reasonable to expect a suboptimal immune response and higher risk of severity, as found with obesity (2).

Knowledge of General Practitioner Doctors and Midwives Who Has and Has Not Attended Neonatal Resuscitation Course Has No Significant Difference

Introduction: Infant death is most prominent in the neonatal period. The success of neonatal resuscitation practice has many contributing factors. One of which is the health workers’ knowledge of the Neonatal Resuscitation Program (NRP) algorithm. Therefore, it is necessary to conduct studies to evaluate the health workers’ knowledge of the Neonatal Resuscitation Program who are educated in neonatal resuscitation course and has taken part in Neonatal Life Support practice in primary health care (PHC) Objective: This study aims to analyze the knowledge of general practitioners and midwives who has or has not attended in neonatal resuscitation course in Surabaya PHC Methods and Materials: this research is descriptive, cross-sectional research. All Basic Emergency Obstetric and Newborn Care (BEmONC) PHC in Surabaya which are Jagir PHC, Banyu Urip PHC, Medokan Ayu PHC, Tanah kali Kedinding PHC, Tanjungsari PHC, Balongsari PHC, Sememi PHC, Simomulyo PHC is included in this research from 2018 to 2019. A nine-item questionnaire referenced from The Textbook of Neonatal Resuscitation 7th Edition is given to ten respondents in each BEmONC PHC. Results and Discussion: from the total sample of 78 respondents, 32 (41,0%) receive a high score, 20 (25,7%) receive a middle score, and 26 (33,3%) receive a low score. The data shows that there is no significant score difference between respondents who has or has not participate in the NRP course (p=0,419). Conclusion: There is no correlation between difference knowledge midwives and general practitioners who had and had not attended neonatal resuscitation training at basic emergency obstetric and newborn care in public health center Surabaya.

Effectiveness of an educational manual to promote infant feeding practices in primary health care

Abstract Background Breastfeeding and adequate complementary feeding in the first years of life provide short- and long-term benefits for child health. However, breastfeeding and adequate complementary feeding prevalence's are low. In Brazil, the Estratégia Amamenta e Alimenta Brasil (EAAB) aims to improve the quality of the assistance provided by primary healthcare teams to ultimately improving infant feeding practices in the Brazilian population. In primary healthcare units, continuing education in breastfeeding and complementary feeding is facilitated by EAAB tutors. A Manual to Support EAAB Tutor (the Manual) was developed following a problem-based learning methodology. This study aimed to evaluate the effectiveness of using the Manual by analyzing exclusive breastfeeding and complementary feeding indicators. Methods A before and after study was conducted at primary healthcare units in Embu das Artes, Brazil. The intervention consisted in the use of the Manual by EAAB tutors who performed some comprehensive training activities with healthcare teams, in a period of 8 months. Subjects consisted of mothers of infants under one year of age attended at primary healthcare units. 561 mothers before and 598 mothers after intervention were interviewed about breastfeeding and complementary feeding practices. Multivariate analysis was performed using Poisson multilevel regression to test the hypothesis. Results Lack of minimum food diversity (before 62.9%; after 50.3%) and lack of food adequacy (before 77.5%; after 63.3%) decreased significantly. Regression analysis confirmed that infants after the intervention had lower prevalence of inadequacy of complementary feeding. While the intervention did not show significant association with exclusive breastfeeding, it showed association with the improvement of complementary feeding practices. Conclusions The Manual is a continuing educational strategy that improved complementary feeding practices in primary health care. Key messages The use of a continuing education strategy grounded on a problem-based learning methodology was effective to produce improvements in complementary feeding practices in primary health care. The 'Manual to Support EAAB Tutor' consists of a tool that has the potential to be adapted for different contexts and easy to disclose to all EAAB tutors in the country.

Cognitive impairment in a primary healthcare population: a cross-sectional study on the island of Crete, Greece

ObjectivesCognitive impairment is known to have a significant impact on the quality of life of individuals and their caregivers, yet it is often underdiagnosed. The objective of this study is...

Antimicrobial use practices and resistance in indicator bacteria in communal cattle in the Mnisi community, Mpumalanga, South Africa.

Surveillance of antimicrobial use and antimicrobial resistance is a critical component of the “Global Action Plan” to tackle antimicrobial resistance. However, there is a paucity of such surveillance in communal farming areas in South Africa. This study investigated knowledge and antimicrobial use practices by cattle farmers and antimicrobial resistance levels of indicator bacteria in cattle in a rural communal farming area in South Africa. Seventy (70) farmers were interviewed at five cattle inspection sites using structured questionnaires. Rectal swabs were collected from apparently healthy cattle (n = 100) for culture of Escherichia coli and Enterococcus species, and antimicrobial susceptibility testing using broth microdilution. The farmers indicated predominantly using tetracyclines. Although 42% of the farmers indicated hearing about antimicrobial resistance, none of them clearly understood what it involves. Seventy‐nine (79) E. coli and 71 Enterococcus species were isolated with E. faecium being the dominant species among the Enterococcus isolates. E. coli isolates were resistant to colistin (16%; 13/79), chlortetracycline (8%; 6/79) and amoxicillin (8%; 6/79). Enterococcus isolates were resistant to enrofloxacin (55%; 39/71) and amoxycillin (3%; 2/71). We observed knowledge gaps in prudent antimicrobial use practices and antimicrobial resistance among the farmers. Farmer tailored education programmes on primary animal health care and prudent antimicrobial use practices must be developed and implemented to improve antimicrobial stewardship among farmers with limited veterinary supervision. The level of colistin resistance detected among E. coli isolates from rural communal cattle in this study was unexpected and warrants further molecular investigation to check if the resistance is plasmid mediated.

Knowledge, Attitude and Practice Survey of the Recommended Infant Feeding Guidelines for HIV Positive Mothers by Primary Health Care Workers in Uyo, Nigeria

Background: Safe and appropriate feeding is a key intervention that can prevent mother to child transmission of HIV. This study aimed at determining the level of knowledge, attitude and current practice of primary health care (PHC) workers in Uyo of the recommended infant feeding guidelines for infants of HIV-infected mothers.
 Methodology: This was an analytical cross-sectional study carried out among 130 primary health care workers in 15 PHCs in Uyo metropolis, Akwa Ibom State, Nigeria. Data was collected using self-administered questionnaires in English and analyzed using the Statistical Package for Social Sciences (SPSS) version 25.0.
 Results: Nineteen (14.6%) and 111 (85.4%) respondents had a fair and poor level of knowledge of MTCT of HIV and infant feeding options respectively. One hundred and six (81.5%) and 100 (76.9%) respondents had received training on PMTCT of HIV and infant feeding counselling for HIV-infected mothers respectively. The majority of respondents exhibited positive attitude regarding infant feeding options for HIV exposed babies. One hundred and twenty (92.3%) considered it correct for an HIV-infected woman to breastfeed her baby and 125 (96.2%) considered breast milk alone adequate food for babies in the first 6 months of life. Predictor of negative attitude was lack of training on infant feeding counseling (OR 15, P=0.02, 95%CI 1.64-138.07). Most 107 (82.3%) cited exclusive breastfeeding with introduction of complementary feeds at 6 months as the most common method accepted by their clients.
 Conclusion: Gaps in the knowledge of PHC workers in Uyo on MTCT and Infant feeding options and practice were identified which can be addressed by qualitative training, effective monitoring and supportive supervision.

Factors Associated with Microalbuminuria in Non-Diabetic Hypertension Patients

The objective was to evaluate the factors associated with urinary albumin excretion (UAE) in non-diabetic hypertension (AH) patients in the context of Primary Health Care (PHC). The parameters investigated were per capita salt consumption, lipid and hematimetric profile, waist circumference and glomerular filtration rate (GFR) compared in individuals with microalbuminuria (MA) and without MA. BackWard multiple linear regression analysis was performed to estimate the influence of the analyzed variables on UAE. The prevalence of microalbuminuria was 21.9%, the mean GFR using the CKP-EPI formula was 65.04 and 60.89 mL/min/1.73m², respectively, among the groups without MA and with MA. Waist circumference and serum creatinine contributed in the explanation of 63.5% in the variation of excreted levels. The patients with AH with MA presented lower GFR, suggesting possible progression to renal disease. Screening for MA should be a frequent practice in PHC, especially in patients with H

Understanding patient satisfaction and loyalty in public and private primary health care.

Background: The quality of health centers, patient satisfaction, and loyalty are three key factors that enable health care providers to improve their services and cost-effectiveness. This study, therefore, aims to determine patient satisfaction and loyalty in public and private primary health care centers.Design and Methods: Data were obtained from a cross-sectional design of 1470 self-administered questionnaires and analyzed based on mean, standard deviation, and correlation coefficients.Results: The results showed respectively a strong and moderate correlation between patient satisfaction and loyalty in private (r=0.767) and public (r=0.54) primary health care centers, respectively. In addition, in both centers patients received adequate medical services, with social aspects as the least important factors affecting patient satisfaction.Conclusions: In conclusion, primary health care practices need to recognize the needs that influence patients’ satisfaction and loyalty, to improve the quality of their services.Significance for public healthPatient satisfaction affects all dimensions of healthcare services, including patient retention, which is the key factor that determines their return to the same center. The provision of high standard health services, staff motivation, and showing appreciation help to retain patients. It is important to determine the driving forces that influence patients’ choice to return for more services in order to implement effective strategies for maintaining their loyalty. This paper describes the correlation between patient satisfaction and loyalty in public and private primary health care.

Scientific literature on food and nutrition security in primary health care: A scoping review

ABSTRACT There is a growing interest in the scientific community regarding Primary Health Care practices aiming at assessing and addressing Food and Nutrition Security. The focus is usually on outcomes, instruments and effectiveness, with no concern regarding theories or concepts. We aimed to map the theoretical frameworks regarding practices towards Food and Nutrition Security in Primary Health Care and describe its conceptualisations based on Ludwik Fleck’s epistemological approach. We conducted a scoping review, including 14 databases. Within the 56 publications, the notion of Food and Nutrition Insecurity as a risk for health without further theorisations predominates. Other two minor theoretical frameworks coexist: Food and Nutrition Security as a social determinant of health and as the realisation of a human right. Few publications present Food and Nutrition Security conceptualisations. Of those who define it, there is great variability in the content and sources used. The most elaborated and homogenous conceptualisations are in the human rights group. This review exposes how the disputes surrounding a concept mostly built on policy and international relations penetrate the scientific field. When studying topics in the interface between science and health practices, notably those where controversies exist, researchers should explicitly express their theoretical and conceptual backgrounds.

Effectiveness of a hydrophobic dressing for microorganisms' colonization of vascular ulcers: Protocol for a randomized controlled trial (CUCO-UV Study).

AimTo determine the effectiveness of a hydrophobic dressing (Cutimed Sorbact®) against a silver dressing (Aquacel® Ag Extra) in the level of colonization of chronic venous leg ulcers. The secondary endpoints are health‐related quality of life, level of pain, and time to complete healing.DesignOpen randomized controlled trial, with blinded endpoint.MethodsPatients with chronic venous leg ulcers with signs of critical colonization will be randomized in a concealed sequence using computer software to receive one of the alternative dressings. A total of 204 participants recruited in Primary Health Care and nursing homes will be necessary to assure statistical power. Measures will include sociodemographic variables, wound‐related variables (area, exudate, and time to healing), level of pain, adverse effects, and health‐related quality of life. Smear samples will be collected from the ulcers and will be subject to DNA‐typing technique through polymerase chain reaction to obtain the level of colony‐forming units. Measures will be collected at baseline, 4, 8, and 12 weeks.DiscussionElevated levels of microorganisms prevent wound healing and favour its chronification. The main target when colonization is present is to reduce the bacterial load to levels that promote immune system mobilization. Hydrophobic dressings prevent the formation of biofilm in the wound by means of physical effect, so that the possibility of antimicrobial resistance is significantly reduced.ImpactCurrent evidence about the effectiveness of dressings to minimize venous leg ulcers colonization is very limited. Previous studies have important methodological flaws. This study will permit to obtain the effectiveness of hydrophobic dressings against silver dressings with a robust design based on conditions of routine clinical practice in Primary Health Care and nursing homes.

Self-reported Seasonal Symptoms and Diseases and Primary Healthcare Utilization Among Rural Elderly Women in Sylhet District, Bangladesh.

The physical health and conditions of elderly people are challenged by the adverse effects of seasonal variations in sub-tropical countries, including Bangladesh. Research to date does not feature the risk of seasonal changes for primary healthcare infrastructures and practices in supporting elderly women's care, especially in rural areas. This study aims to identify the health effects of seasonal variations that place increased risk of symptoms and diseases on rural elderly women, and to explore the determinants associated with the women's use of healthcare locally. Using a mixed-methods approach, audio-recorded semi-structured interviews including a short survey with sixty-five rural elderly women and eleven healthcare professionals were conducted. Quantitative data were analyzed in SPSS, and a thematic analysis of the qualitative data was facilitated by NVivo. Self-reported health history by rural elderly women identified the prevalence of three major seasonal symptoms: headache (28/43.1%), digestive disorder (27/41.5%), and physical pain (27/41.5%). The prevalence of three symptoms such as nausea, headache and digestive disorder varied significantly (p < 0.05) across the study villages. Of the women, the age group (60-70 years) recorded the highest number of cases (20), followed by age group (71-80 years/15), where the number of cases significantly varied across three seasons (p = 0.021). While 78.5% and 55.4% reported one and two symptoms/diseases respectively, the community clinic visits differed significantly (p = 0.011) among the seasons. The utilization of primary healthcare was low, and marginalization in using healthcare was underpinned by the health system, the poor living conditions of the women, and their reluctance to seek treatment. The findings suggest a need for policy solutions in promoting preventive measures and treatments by strengthening local clinics and on-going health education and training of staff and elderly women.

Quality Management System: Quality of Education, Science and Clinical Practice in Primary Care, Legislative and Regulatory Framework (Distance Learning Lecture)

The article presents modern data on the development of primary health care (PHC) and approaches to managing its quality, conceptі of quality, model of quality by A. Donabedian and WHO, the quality of structure, process and result of PHC, approaches to monitoring and improving quality. The regulatory framework and the results of reforming the PHC inUkraineare given, its impact on the quality of the PHC.The aim: is to provide basic concepts of quality of medical care and to explain the changes of quality of medical care in the process of reforming the healthcare system inUkraine.Materials and methods. A systematic review of the literature and legal documents, own experience and observations.Results. According to the WHO definition, primary health care is a providing treatment and prevention services at the local community level, usually by family doctors, patronage nurses, staff at local outpatient facilities, or other medical personnel. In the Astana Declaration of 2018, all countries of the world pledged to direct efforts and public investments to improve the quality of education, science and clinical practice of primary health care in order to ensure that all patients have access to the highest possible level of health. The creation of quality management systems for medical care is one of the priority areas of health care reform and determines both current and strategic prospects for the activities of any medical organization. According to the concept of A. Donabedian and WHO, quality is a multidimensional concept that consists of many components – safety, effectiveness, timeliness/optimality, efficiency/economy, fairness/equality, patient-orientation. In addition, quality is divided into three main components – the quality of the structure, process and result. The quality of the structure is the organizational aspects of the PHC – human and material and technical resources, legal support. The quality of the process is actually medical care itself, the implementation of diagnostic procedures in accordance with protocols and standards. The quality of the result – these are indicators that indicate what happens to the patient in the process of providing PHC. Monitoring the quality of PHC is carried out using indicators that can be developed and approved at the state or local levels. Quality improvement is described by the Deming Plan-Do-Check-Act cycle. When describing these concepts, legal documents on reforming the PHC inUkraine, international directives and a description of the impact of their implementation on the quality of the PHC inUkraine are indicated.Conclusion. Taking into account the reformation of the Ukrainian healthcare system, the recommendations of the world community and the transition to market relations, general practitioners – family doctors need to learn an additional skill in managing the quality of medical care.

The Use of Behavior Change Theories in Dietetics Practice in Primary Health Care: A Systematic Review of Randomized Controlled Trials

BackgroundBehavior change theories frameworks provide the theoretical underpinning for effective health care. The extent to which they are applied in contemporary dietetics interventions has not been explored. ObjectiveTo systematically review the evidence of behavior change theory-based interventions delivered by credentialed nutrition and dietetics practitioners in primary health care settings. MethodsMedline, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Embase, and Cochrane databases were searched for English language, randomized controlled trials before August 2019. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Eligible interventions included adults (aged ≥18 years) receiving face-to-face dietetics care underpinned by behavior change theories in primary health care settings with outcome measures targeting changes in health behaviors or health outcomes. Screening was conducted independently in duplicate and data were extracted using predefined categories. The quality of each study was assessed using the Cochrane Risk of Bias tool. The body of evidence was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Manual Conclusion Grading Table. ResultsThirty articles reporting on 19 randomized controlled trials met the eligibility criteria, representing 5,172 adults. Thirteen studies (68%) showed significant improvements for the primary outcome measured. Social cognitive theory was the behavior change theory most commonly applied in interventions (n=15) with 11 finding significant intervention effects. Goal setting, problem solving, social support, and self-monitoring were the most commonly reported techniques (n=15, n=14, n=11, and n=11, respectively). Most studies had a high (n=11) or unclear (n=8) risk of bias. There was fair evidence (Grade II) supporting the use of behavior change theories to inform development of dietetics interventions. ConclusionsInterventions delivered by credentialed nutrition and dietetics practitioners that were underpinned by behavior change theories and utilizing various behavior change techniques were found to have potential to be more effective at improving patient health outcomes than dietary interventions without theoretical underpinnings. Findings from this review should inform future primary health care research in the area of dietary behavior change. In addition, findings from this review highlight the need for stronger documentation of use of behavior change theory and techniques that map on to the theory within dietetics practice.

Primary healthcare implementation in practice: Evidence from primary healthcare managers in Ghana.

BackgroundPrimary healthcare (PHC) is a core part of healthcare in developing countries. However, the implementation of PHC since its inception in developing countries has been lethargic, inconsistent and marred by controversies.AimThis study investigates some of the controversies surrounding PHC implementation. It also examines how PHC is being implemented in Ghana as well as how the approaches adopted by PHC implementers influence PHC outcomes in developing countries.SettingThis study is set in Ghana and involves national, regional and district managers of PHC.MethodsA qualitative case study was used to gather information from 19 frontline PHC managers through semi-structured interviews. Interviews were recorded and transcribed. They were then qualitatively analysed using the thematic framework analyses approach.ResultsFindings uncover a lack of clear meaning of what PHC is and how it should be approached amongst key implementers. It also shows discrepancies between official policy documents and directives, and actual PHC practices. Findings also show a gradual shift from Alma Ata’s comprehensive PHC towards a more selective and intervention-specific PHC. Whilst donor and external stakeholders’ influence are the key determinants of PHC policy implementation, their support for vertical and other medicine-based interventions have gradually medicalised PHC.ConclusionThere is a need to pay more attention to understanding and addressing the gaps in PHC implementation and its inconsistencies. Furthermore, the role and control of donors and external development partners in PHC policy formulation and implementation, and their concomitant effects on community participation and empowerment, must be critically examined.

Factors affecting the use of herbal medicines in the universal health coverage system in Indonesia

Ethnopharmacological relevanceMedicinal plants play an essential role in primary healthcare practices in Indonesia, particularly in rural areas. While medicinal plants are broadly used in Indonesia, the country has made a commitment to healthcare services based on modern medicine through the provision of universal health coverage (UHC). Aim of the studyIn the context of the UHC system in Indonesia, we explore the utilization of medicinal plants in rural West Java by examining how herbal medicine use varies with socio-economic and demographic factors and whether herbal medicine use remains important when modern healthcare becomes available. Materials and methodsA total of 634 households in the two rural communities were randomly selected to participate in the survey. A semi-structured questionnaire was administered to a randomly selected adult in each household. ResultsHerbal medicine use prevalence was found to be 68% (431/634). Out of 549 total respondents with perceived illness, 40% (219/549) self-medicated with herbal medicines in the last six months. A total of 102 medicinal plant species belonging to 43 families were reported, each with their local names, medicinal use, and parts used. We found that herbal medicine use was significantly associated with the area of residence, age, education level and occupation, and was not correlated to gender or health insurance possession. ConclusionMedicinal plant remains a significant aspect of healthcare for rural communities in the West Java area. The presence of healthcare services under the UHC system is not a critical determining factor for treatment-seeking and may have less impact on the pervasive practice of herbal medicine use in rural areas.

Sexually transmitted infection and HIV/AIDS counseling practice in primary health care in the city of Montes Claros, Minas Gerais, Brazil, 2015-2016.

to investigate self-reported counseling practice of primary health care (PHC) professionals on sexually transmitted infections (STI) and HIV/AIDS in Montes Claros, MG, Brazil, 2015-2016. this was a cross-sectional study using a questionnaire answered by PHC physicians and nurses; their practice was classified as being adequate/inadequate based on the recommendations of Ministry of Health manuals; four thematic areas were investigated - counseling provision; prevention measures; risk behavior and vulnerability assessment; serological testing. 146 professionals participated (41.1% physicians; 58.9% nurses); only 25.7% of professionals reported adequate practices; the area with the highest proportion of inadequate self-reported practice was 'risk behavior and vulnerability assessment' (69.9%); physicians overall practice was more likely to be appropriate than that of nurses (OR=3.48 - 95%CI 1.57;7.70), especially for 'serological testing'. self-reported STI and HIV/AIDS counseling practices in PHC were found to be inadequate, revealing the need to intensify health professional awareness-raising/training.

Exploring factors improving support for vaccinations among Polish primary care physicians.

In Poland, primary care physicians are the most used and most trusted source of information on immunisation. We aimed to explore factors influencing support for vaccinations among physicians employed in the childhood immunisation programme, in order to inform education of healthcare workers and programme organization. In June-July 2017, we carried out a national cross-sectional survey of physicians working in randomly selected primary healthcare practices, and interviewed them by telephone. We assessed support for vaccinations using an ordinal scale (0–6) comprised of three equally weighted questions on the respondent support of the programme and vaccination of self and family. We also created a scale (0–3) based on correct answers to vaccination myths. We used ordered logistic regression to investigate factors independently influencing support for vaccinations, reporting the proportional odds ratios and 95% confidence intervals for one unit increase in the support score. Of 2,609 respondents contacted, we interviewed 500 (19%). The median vaccination support score (0–6) was 5 (IQR 2). After adjusting for other variables, we did not find significant effects of sex, medical specialty, adhering to recommendations, attending a conference in previous year, using non-scientific sources of information and self-assessed knowledge on vaccination support score. Age over 60 years, correctly addressing vaccination myths and use of one or more than one scientific sources of knowledge, significantly improved support for vaccinations (aOR = 1.97, 1.57, 3.09 and 2.68, respectively). We recommend to increase the amount, quality and accessibility of evidence-based educational materials for primary care physicians working with childhood immunisations.