Primary Health Care Program Research Articles

Community participation in primary health care (PHC) programmes: lessons from tuberculosis treatment delivery in South Africa.

Currently, there is renewed interest in the role community participation can play in Primary Health Care (PHC) programmes such as the delivery of effective anti-TB treatment to patients in high-burden settings. To explore the feasibility of community participation in a high-burden Tuberculosis Control Programme and to establish how supervision of treatment by lay volunteers compares with other methods of tuberculosis treatment delivery in the Northern Cape province of South Africa. Prospective study involving 769 patients with confirmed pulmonary TB who were followed-up over a one-year period. Questionnaire interviews were also carried out with 135 lay volunteers participating in the TB programme. One-third of the TB patients in the study received their treatment from lay volunteers in the community. Treatment outcomes for new patients supervised from the community were found to be equivalent to those who received treatment through other modes of treatment delivery (RR=1.04[0.94-1.16], p=0.435). For the re-treatment patients, community-based treatment was found to be superior (RR=5.89[2.30-15.09], p<0.001), to self-administered therapy. Health care planners should consider community participation as a viable way of ensuring accessibility and effectiveness in PHC programmes. There is need for more research into ways of achieving sustainability in resource-limited but high disease burden settings.

Evaluation of Community Pharmacists' Involvement in Primary Health Care.

Objective: To evaluate the involvement of community pharmacists in primary health care; determine extent of the pharmacists' participation in curative and preventive services, as well as partially assess quality of the involvement. Methods: A 27-item self-completion questionnaire with 0.92 reliability was administered to 110 community pharmacists in Benin City, Nigeria. Data were collected on a scale that ranged from 27 to 135 with an assumed neutral point of 81 and statistically analysed. Results: Respondents scored 87.92 31.31, and over half (55%) were above the neutral point. This implies a slightly satisfactory but not significant involvement (p = 0.25447). Mean total rating on curative services was 92.6129.6, p = 0.0759 with 58% above the neutral point. Infectious diseases accounted for majority of the interventions. Involvement in preventive services was very poor. Only 31% scored above the neutral point with a rating of 65.6131.05, p = 0.2377. Quality of involvement was 94.7736.18 which was not significant (p = 0.2866). Majority of the respondents (94%) claimed they would be prepared to participate in further training on primary health care programme. Conclusion: Community pharmacists are marginally involved in the primary health care programmes in Benin City and are willing to improve on their performance. Continuing education on primary health care and incorporation of primary health care role of community pharmacists in the curriculum of pharmacy schools might be helpful. Keywords: Benin City, Community pharmacists, primary health care. Tropical Journal of Pharmaceutical Research 2002; 1(2): 67-74

Future health: coping with change.

WHO's Declaration of the "Health for All" (HFA) goal was pronounced in 1978 in Alma Ata, and it was planned that HFA would be achieved through primary health care programmes and approaches by 2000. However, it is now 2002 and despite the technological advancements in medicine, science, and ICT, Health for All is far from reality. Instead, more and more conflicts are emerging with lethal consequences, such as, bioterrorism, biological agent abuse, global-terrorism, and environmental destruction is occurring at a greater scale that we have witnessed before. We may have the latest technology and knowledge today, but ironically, we are using them to inflict more suffering and pain in the world. In the Asia-Pacific, the past 30 years has seen dramatic advancement and lifestyle changes. We are now paying a high price for such progress in terms of risk factors to the health of the population, such as, ageing diseases, obesity, smoking, diabetes, hypertension, and related conditions. The social, political, economic and environmental factors appeared to have deterred and negated WHO's HFA goal to attain basic human rights and health care for all. The HFA will not be achieved in the future if we do not learn from history and start taking measures now.

Dietary patterns and dental caries in nursery school children in Nairobi, Kenya.

To determine the dietary patterns and the prevalence of dental caries among nursery school children in Nairobi. A cross-sectional study. Nursery schools in Nairobi, Kenya. Three hundred and four nursery school-children (149 males and 155 females) aged 3-5 years were assessed in 1997. There was a high consumption of fruits, vegetables and milk on a daily basis. There was also a high consumption of snacks both at home and at school. About 96% of the children had been breastfed, while 41% had been bottle-fed. The prevalence of dental caries was high at 63.5% and a mean decayed, missing and filled teeth index (dmft) of 2.95, with the d-component comprising 96% of the total dmft. Only 1.3% of the children had filled teeth. Increasing age was the most predictive factor in dental caries. The high consumption of refined foods and snacks, as well as the high prevalence of dental caries raises a strong public health concern. It is recommended that dietary counselling and preventive oral health programmes should be initiated and the already existing ones strengthened and incorporated in primary healthcare programmes. There is also need for policy makers to come up with guidelines on advertisements promoting cariogenic snacks.

WHO Annual Report Devoted To Mental Health Issues

WHO Annual Report Devoted To Mental Health Issues

Gendering local knowledge: medicinal plant use and primary health care in the Amazon.

Local knowledge is becoming increasingly important in primary health care projects. However, these projects often incorporate local knowledge in an uncritical manner. One area where this is apparent is in the lack of attention paid to the gendered nature of local knowledge. I use one example, women's knowledge and use of medicinal plants in a low-income community in the Brazilian Amazon, to illustrate the links among authority, knowledge, and gender. In this article I argue that policy makers must pay attention to the relationships among authority, gender, and local knowledge and examine how the use of local knowledge in development strategies can affect existing (gendered) power relationships. Women's roles as managers of household health (which includes medicinal plant use) are a source of authority for them. Because of that, the way in which local knowledge is incorporated into primary health care programs can have a significant impact on women's authority.

Hypertension and its determinants among adults in high mountain villages of the Northern Areas of Pakistan.

We studied the prevalence and determinants of hypertension among adults in mountainous rural villages in the Ghizar district Northern Areas of Pakistan, an area that recently has undergone substantial economic development. We selected a stratified random sample of 4203 adults (age > 18 years) from 16 villages in Punial Valley of Ghizar district where the number of study subjects from each village was proportionate to the size of the village. We obtained blood pressure (BP) records by taking the mean of the second and third BP measurement, using a standard mercury sphygmomanometer, and assessed risk factors for hypertension in the study subjects. The mean +/- s.d. blood pressures (mm Hg) were 125 +/- 19 systolic and 80 +/- 12 diastolic in men and 125 +/- 22 systolic and 78 +/- 14 diastolic in women. The 125 +/- 22 systolic and 78 +/- 14 diastolic in women. The mm Hg, or systolic BP > or = 140 mm Hg or currently taking antihypertensive medication) was 15%, increasing from 4% in the 18-29 year age group to 36% among persons 60 years of age or older. The age-standardised prevalence of hypertension was 14% (12.5% among men and 14% among women). There was no significant difference in prevalence of hypertension in males, and in females. Multivariate analysis revealed that age, and higher body mass index (overweight and obesity) were independently associated with higher prevalence of hypertension. People with hypertension were more likely to have a first-degree relative with physician-diagnosed hypertension (OR = 1.90, 95% CI 1.49, 2). Hypertension is a significant health problem in rural northern Pakistan. The primary health care programme in the Northern Areas of Pakistan needs to address this problem, especially identifying people at risk.

Networking as a Means to Deliver Distance-Mode Health Education in Bangladesh

The provision of health education in a distance mode is very much a new approach in Bangladesh. Health education has been identieed as an important means for ensuring the health and hygienic consciousness of all citizens. Limitations of infrastructure and resource personnel are important problems for such educational programmes. This article focuses on two programmes, a Bachelor in Nursing programme and a Certiecate in Primary Health Care programme, that were developed and implemented by the Bangladesh Open University (BOU) through a distance-mode module. The use of electronic media delivery and the development of the continuing and extension health education offerings in distance mode have been successful. They provide access to global networking and to information on educational systems.

Improved indicators of infant mortality for integrated primary healthcare programmes.

Mortality and fertility rates are decreasing rapidly in many developing countries. It is argued that the indices commonly used as measures of these changes, i.e. infant mortality rate and fertility rate, ignore the interaction between mortality and fertility, and do not reflect their combined impact in lowering overall infant mortality. The paper proposes new indicators of infant mortality, termed fertility-adjusted infant mortality ratio (FIMR), age-specific, fertility-adjusted IMR (AFIMR), and total infant mortality ratio (TIMR) that are more sensitive to rapid demographic changes. These indicators include the combined effects of changes in both fertility and infant mortality rates on overall infant mortality in a region and appear to measure the effects of integrated health programmes better. Further, these conceptualize the mother-infant pair as an appropriate unit with which to monitor mortality, and may be used for guiding allocation of resources intended to lower infant mortality. The application and usefulness of these indicators have been illustrated, using one hypothetical example and empirical data from the maternal-child health and family-planning programme in Matlab, Bangladesh, as well as data from white and black population groups in the U.S.A. The results of these examples demonstrate that the new indicators are more sensitive than traditional measures when describing infant mortality, and may better reflect the perception in infant mortality status in the community.

Health for all in the United Arab Emirates

This paper reports on health for all in the United Arab Emirates. The current situation in the country regarding health for all and primary health care is described as well as the progress that has been made in this area. The main primary health care programmes and future activities are outlined.

Social Work in Primary Care

ABSTRACT A neighborhood primary health care program serving a socially and economically oppressed community, and a graduate school of social work have collaborated to create a social work student field work unit in a primary health care setting, to demonstrate emerging and innovative social work roles in an ever-increasing managed care environment. Patients with high levels of psychosocial stress make large demands on the primary care system and consume considerable laboratory and diagnostic treatment resources. Development of social services in primary care settings is a relatively new concept, however it has been clearly demonstrated that primary care physicians need the skills of social workers to handle the psychosocial and environmental aspects of illness. The principal goal was to demonstrate social work practice in a primary care health setting, utilizing practice research approaches. Validation of effectiveness was noted, as depression, anxiety, adjustment reactions (to name a few) were decreased, resulting in fewer physician visits, less somatization and improved compliance with medical and diet/nutrition regimens. The case examples and single subject data presented provide qualitative evidence, in the context of a natural experiment, for the profession to pursue this model further in both program development and research.

Weak Links in the Chain: A Diagnosis of Health Policy in Poor Countries

Recent empirical and theoretical literature sheds light on the disappointing experience with implementation of primary health care programs in developing countries. This article focuses on the evidence showing two weak links in the chain between government spending for services to improve health and actual improvements in health status. First, institutional capacity is a vital ingredient in providing effective services. When this capacity is inadequate, health spending, even on the right services, may lead to little actual provision of services. Second, the net effect of government health services depends on the severity of market failures—the more severe the market failures, the greater the potential for government services to have an impact. Evidence suggests that market failures are the least severe for relatively inexpensive curative services, which often absorb the bulk of primary health care budgets. A companion paper, available from the authors (seep. 219), offers a perspective on how government funds can best be used to improve health and well-being in developing countries. It gives an alternative view of appropriate public health policy, one that focuses on mitigating the characteristic market failures of the sector and tailoring public health activities to the government's ability to deliver various services.

Guest Editorial

The Second International Primary Health Care 2000 Conference drew together leading policy makers and experienced practitioners from Canada, the United Kingdom, South Africa, New Zealand and all States of Australia to explore primary health care service models and programs emerging in response to the economic and social pressures of the twenty-first century.

The Experience of the Catholic Relief Services Community-Based Primary Health Care Programme

Summary This article documents the experience of Catholic Relief Services through its Community-Based Primary Health Care Program (CBPHCP) in Battambang, Cambodia, in the development of structures and systems of community and health centre co-management/co-financing. The article discusses the role of community health structures in the development of these systems and the relationship between health centre quality of service and community financing. Finally, future plans for expansion, challenges, and lessons learned from this process are presented.

Health Promotion Behaviors of Jordanian Women

Many developing countries are undergoing industrialization and modernization, which has produced both positive and negative implications for health. This study was designed to adapt a well-known health measure to an Arab-Muslim population and to derive health promotion data for primary health care program planning for women in Jordan. A convenience sample of 512 literate females in Jordan was recruited from community settings such as secondary schools (teachers), primary health care centers (nursing staff and patients), universities (faculty and staff), colleges, and office worksites using an Arabic translated version of the Health Promoting Lifestyle Profile (HPLP) instrument. Subjects scored highest on self-actualization, interpersonal support, and nutrition but scored lower on the exercise and health responsibility domains. Unmarried women, however, scored higher on exercise and stress management. These findings support the development of educational efforts to increase women's awareness of relationships between lifestyle and health for both themselves and for their families.

The societal value of vaccination in developing countries

The vaccination of children against childhood illnesses not only carries the obvious medical and economic benefits, but there exists numerous indirect and often far reaching added societal benefits. In developing countries, vaccination forms the basis of village operated primary health care (PHC) activities leading to a sustained PHC programme. Vaccination programmes provide an opportunity for the provision of other primary care services, as it can be the only recurring activity in primary care, that brings mother and child into contact with health services on a predictable and frequent basis. Vaccination leads to a direct and measurable reduction of child mortality rates and this has been proven to families and communities, resulting in families choosing to have fewer children. Vaccination becomes an opportunity for a higher standard of living as it encourages smaller families and in this way contributes to successes In family planning programmes. The vaccination of children has a great impact on the lives of women in developing countries as they are the principle carers of children. Protecting the lives of children directly through vaccination and through other PHC activities is a major strategy towards improving the lives of women as it liberates their time, energy and resources. The opportunity and provision of vaccination empowers women to protect their own health and that of their children through their own actions, giving an added psychological feeling of control and empowerment in their lives. Therefore, while vaccination services can be delivered alone, they are best delivered along with other services needed by children in their first year of life and by pregnant women: the persons who constitute the priority groups for primary health care services in the developing world. In addition to the monitoring of the growth of the child, the use of oral re-hydration to treat diarrhoea and the promotion of breast-feeding, these services may include malaria treatment and prophylaxis, and counselling with respect to child spacing, nutrition during pregnancy, weaning practices, and clean water and sanitation.

Iranian rural health workers (behvarz) and risk factors of childhood injury

The role of health professionals in childhood injury prevention has been recognized. This study aimed to assess the knowledge of and attitudes to childhood injury epidemiology and prevention of behvarz (rural health workers). A self-administered questionnaire was sent to 210 behvarz, randomly selected from rural areas of Khuzestan province. Many behvarz were not aware of the epidemiology of childhood injuries. However, they had positive attitudes towards all injury prevention activities. There was a positive correlation between their knowledge and attitude scores (P < 0.01). Childhood injury prevention programmes should be included in the training of behvarz and covered by primary health care programmes in the Islamic Republic of Iran.

Towards malaria control: the knowledge of health care providers about mosquito and malaria transmission.

To find out how much health care providers know about the transmission of malaria and the vector. A cross sectional study was carried out using a predesigned questionnaire which was self administered by the student to collect the necessary information for analysis. Live samples of mosquito larvae, drawn larva and adults were provided for the subjects to identify to assess their knowledge. The University of Benin Teaching Hospital and the School of Health Technology. 254 randomly selected Community Health Officers in training at the University of Benin Teaching Hospital and the School of Health Technology in Benin City, Edo State, Nigeria. Many of the students had no knowledge of the subject. The School's authorities were encouraged to include field practicals in their curriculum to improve the students' knowledge on mosquitoes and malaria transmission. Only (26.8%) and (18.1%) of the subjects could identify both drawn and live larvae respectively while (25.2%) identified the adult mosquito correctly. All the respondents knew that the mosquito transmits diseases but quite a few knew the diseases transmitted included malaria (55.3%), yellow fever (16.0%) and elephantiasis (10.7%) respectively. The knowledge of the students on the biology of mosquitoes and their role as the malaria vector was poor. The education of the subject on this important endemic disease is advocated to improve the quality of life of citizens and promote the primary Health Care Programme in Nigeria.

Mortality of urban and rural young children with cerebral palsy in Bangladesh.

Bangladesh has a high child mortality rate. However, little is known about the outcome for young children who have cerebral palsy (CP). Ninety-two children with CP with a mean age of 3 years 3 months at entry into the study were followed for up to 3 years as part of an intervention study. Eight children died: two of 49 (4%) from an urban area and six of 43 (14%) from a rural area. Extrinsic factors such as infections and drug reactions preceded all the deaths, but those who died were mostly severely malnourished and among the more severely disabled of the total group. Eighty-nine percent of rural children in the study were from low-income families. Intervention programmes for severely disabled children in developing countries must include primary health care and feeding programmes as well as rehabilitation services to address both the needs of the child and empowerment of the mother and the family.

Primary Health Care initiatives in colonial Kenya

Most contemporary development practitioners have only passing familiarity with development strategies employed by their predecessors, especially for programs that occurred during colonial periods. An examination of the colonial medical system of Kenya reveals that many of the strategies now employed in Primary Health Care programs were preceded by comparable programs administered by the colonial medical authorities. The colonial system did not include universal or egalitarian access to health care, nor were the programs ever adequate to remedy many of the major threats to health, but the lessons derived from a careful review of this period validate the appropriateness of many Primary Health Care approaches now promoted. In particular, the emphasis on decentralized, preventive medical services, the use of comprehensive immunization programs, concerted efforts at improvements in sanitation, and promotion of health education were important components of the colonial medical services, that effected positive changes in the health of indigenous populations. Examination of specific colonial programs should inform contemporary Primary Health Care policies.