Primary Health Centers Research Articles

Standardisation of Blood Pressure Measurement Among Patients Attending an Urban Primary Health Centre: A Quality Improvement Initiative

Standardisation of Blood Pressure Measurement Among Patients Attending an Urban Primary Health Centre: A Quality Improvement Initiative

Effect of the COVID-19 vaccination on feto-maternal outcomes: A prospective cohort study among Indian pregnant women

Background & objectives Studies on the effects of COVID-19 vaccination among pregnant women in Asian settings, more specifically in India, are scarce. The present study evaluated the feto-maternal outcomes among Indian pregnant women who received the COVID-19 vaccine. Methods A prospective cohort study was undertaken among 430 pregnant women from two primary health centres (PHC) in Chandigarh, India during 2021-2022. The feto-maternal outcomes evaluated in the study included abortions, live birth/stillbirth, term/pre-term/post-term delivery, mode of delivery (normal vaginal/caesarean section/forceps), birth weight and intrauterine growth retardation. Results Of the 430 study participants, 295 pregnant women received COVID-19 vaccines, with an uptake rate of 68.6 per cent. Majority of vaccinated women (280- who completed the study) were in their second trimester (133, 47.5%), while 92 (32.9%) were in their third, and 55 (19.6%) were in their first trimester when they were enrolled in the study. Neonatal intensive care unit (NICU) admission was significantly lower among the vaccinated pregnant women, while other feto-maternal and neonatal outcomes were similar between vaccinated and unvaccinated pregnant women. Interpretation & conclusions The findings of this study suggest COVID-19 vaccination in pregnant women in India might be safe, in terms of feto-maternal outcomes

Assessment of the quality of malaria surveillance and laboratory services for diagnosis in three districts of Gujarat state, India

ObjectivesSurveillance is the backbone for the control of malaria and its elimination. In the state of Gujarat, situated in the western region of India, some of the districts reported a high annual blood examination rate (ABER) for malaria. Therefore, a study was conducted to identify the underlying reasons for the increase in the ABER for malaria.MethodsPlanned investigations were carried out in three of the state districts, scrutinizing records of malaria forms and other epidemiological data collected during health worker surveillance, assessment of laboratory services, and rapid fever surveys.ResultsThe rate of fever ranged from 8 to 57% in the primary health centers that were surveyed. Analysis of epidemiological data revealed that malaria parasite positivity was more from passive than active surveillance. Increased ABER was accounted for by multiple factors, including blood slides collected during the mass survey and contact smears, which were included in the ABER and not mentioned separately. Blood slides prepared for the migrant population were included in the ABER, but the migrant population was not counted while calculating the ABER.ConclusionThe ABER in villages surveyed varied from 1.6 to 78%, which is mainly due to indiscriminate preparation of blood slides, i.e., without fever symptoms. Addressing the key gaps identified in data recording may aid in channeling the limited resources efficiently, thereby progressing toward malaria elimination. Adequate surveillance activities, along with systematic data recording, will enable timely, informed decision-making for the effective allocation of resources, ultimately supporting malaria elimination efforts in the state.

Assessment of patient knowledge and perceptions towards orthodontic treatment in the Aljouf Region, Saudi Arabia: a cross-sectional study

Background In orthodontic treatment, it is most important to assess the patient’s perspective of malocclusion because these perceptions are fundamental to determining the patient’s demands and level of treatment satisfaction. This study was done to assess the knowledge and perception of residents of the Aljouf Region of Saudi Arabia seeking orthodontic treatment. Furthermore, we determined the factors associated with the patients’ knowledge and perception of orthodontic treatment. Methods This cross-sectional study was conducted using a pre-tested and validated questionnaire among patients seeking orthodontic treatment who were registered at King Abdulaziz Hospital, Sakaka, and primary health centers. We identified the associated factors using binomial logistic regression analysis. Finally, we applied Spearman’s correlation test to identify the correlation between knowledge and perception. Results A total of 282 individuals participated in the current study, of which 53.3% were female and 46.1% were male. About one-third (36.9%) of patients had a low level of knowledge, 35.5% had a medium level of knowledge, and 27.7% had a high level of knowledge regarding orthodontic treatment. A total of 20.6% had low perceptions, 42.9% had medium perceptions, and 36.5% had high perceptions of orthodontic care. A significant correlation was found between age and gender, knowledge (p = 0.001), and perception (p = 0.040). Moreover, we observed a positive correlation between knowledge and perception (Spearman’s rho = 0.297, p = 0.001). Conclusion People in Aljouf have poor knowledge and medium perception regarding orthodontic treatment. We recommend that the concerned authorities make a health educational plan for the patients seeking orthodontic treatment.

Nutritional education on health beliefs, metabolic profiles, and quality of life among high-risk pregnant women for gestational diabetes mellitus: a randomized controlled trial.

In recent years, nutrition has become increasingly important in treating and managing gestational diabetes mellitus. The Health Belief Model (HBM) is a conceptual framework in health behavior research used in some medical research. The present study aimed to evaluate the effect of glycemic index training based on the HBM on metabolic indicators and pregnant women's health-related quality of life. In this open-label, parallel-controlled randomized trial, 90 pregnant women from primary health centers in Iran were recruited and randomly assigned to either the intervention group or the control group, using a block randomization method with a block size of six. The intervention group underwent 12 weeks of nutritional education on the glycemic index and load of foodstuff. The control group only received routine health care. Valid and reliable questionnaires included demographic and prenatal information, physical activity, three days of food records, quality of life (SF-12), and HBM constructs. Fasting blood samples were taken at baseline and end of the study, to assess fasting blood glucose (FBS), fasting insulin, hs-CRP, and lipids. Eighty-four pregnant women with an age mean of 30.12 ± 4.35 completed 12 weeks of intervention. At baseline, there were no significant differences between groups in the HBM subscales (P > 0.05). However, within the intervention group, there was an increase in perceived susceptibilities (mean change 1.45 ± 4.21; P = 0.03) and cue to action (mean change: 1.22 ± 3.38; P = 0.02). In the adjusted model, the General Health subscale of Quality of Life showed a significant increase in the comparison between groups (mean change 13.69 ± 29.83 vs. 0.00 ± 29.58; P = 0.04). Additionally, the adjusted model revealed a notable difference between the groups in serum hs-CRP level, (mean change -0.877 ± 3.47 vs. -0.067 ± 3.40; P = 0.01) and triglyceride level (mean change - 55.24 ± 111.21 vs. 40.92 ± 142.01; P = 0.001). However, in the adjusted model, the total cholesterol levels increased between groups (mean change 22.75 ± 66.17 vs. 30.12 ± 61.33; P = 0.01) at the end of the study. There was no significant difference in glycemic indices (P > 0.05). Participation in a nutrition education program might positively impact nutritional beliefs, behaviors, and some biochemical indicators among pregnant women. Future studies with larger sample sizes and longer follow-ups are warranted.Trial registration number: IRCTID: IRCT20190227042858N1. Registration date: 2019-07-18.

A cluster randomised controlled trial investigating the efficacy of family-centred obesity management program in primary care settings: A study protocol.

The study aims to test the efficacy of a family-centred healthy lifestyle program in primary care health centres among children with overweight or obesity, evaluating the results at 3, 6, and 9 months post-intervention. A single-blind, randomised controlled cluster study where participants will be blinded to group assignment to reduce bias will be followed. The intervention comprises a 6-month program with intensive and maintenance behavioural therapies, including dietary modifications and guidelines for physical activity, administered by a multidisciplinary team. Participants will be assigned to an intervention group or a treatment-as-usual control group. Primary health centres in Seeb Wilayat, serving densely populated areas and willing to participate, will be included. Randomisation will be conducted at the cluster level to improve recruitment efficiency. A sample size calculation will ensure adequate power to detect significant differences. Ethical approval is granted and informed consent/assent will be obtained from all participants. The proposed study focusses on testing the efficacy of a family-centred healthy lifestyle program in primary care centres through a controlled, randomised study. Successful outcomes could lead to informed interventions, improvements in the health system, policy recommendations, positive community impacts, information on behavioural therapies, and improved long-term health outcomes for affected children and their families. This study will contribute to the literature by providing a culturally sensitive and evidence-based solution to a pressing public health issue, which can be adapted to similar contexts in Oman and beyond.

Diagnostic accuracy of TB screening tests in a prospective multinational cohort: Chest-X-ray with computer-aided detection, Xpert TB host response, and C-reactive protein.

Accessible, accurate screening tests are necessary to advance tuberculosis (TB) case finding and early detection in high-burden countries. We prospectively screened adults with ≥2 weeks of cough at primary health centers in the Philippines, Vietnam, South Africa, Uganda, and India. Participants received chest-X-ray, Cepheid Xpert TB Host Response (Xpert HR) testing, and point-of-care C-reactive protein (CRP) testing (Boditech). Chest-X-ray images were processed using CAD4TB v7, a computer-aided detection algorithm. We assessed diagnostic accuracy against a microbiologic reference standard (sputum Xpert Ultra, culture). Optimal cut-points were chosen to maximize specificity at 90% sensitivity. Two-test screening algorithms were considered, using 1) sequential negative serial screening (positive defined as positive on either test) and 2) sequential positive serial screening (positive defined as positive on both tests). Between July 2021 and August 2022, 1,392 participants with presumptive TB had valid index tests and reference standard results, and 303 (22%) had confirmed TB. In head-to-head comparisons, CAD4TB v7 showed the highest specificity at 90% sensitivity (70.3% vs. 65.1% for Xpert HR, difference 95% CI 1.6 to 8.9; 49.7% for CRP, difference 95% CI 17.0 to 24.3). Three two-test screening algorithms met WHO target product profile (TPP) minimum accuracy thresholds and had higher accuracy than any test alone. At 90% sensitivity, the specificity was 79.6% for Xpert HR-CAD4TB [sequential negative], 75.9% for CRP-CAD4TB [sequential negative], and 73.7% for Xpert HR-CAD4TB [sequential positive]. CAD4TB achieves TPP targets and outperforms Xpert HR and CRP. Combining screening tests further increased accuracy. NCT04923958.

Stress, Anxiety, and Depression During Pregnancy: A Survey Among Antenatal Women Attending Primary Health Centers

Background/Objectives: Maternal mental health problems such as stress, anxiety, and depression (SAD) in antenatal women are major public health challenges. This study aimed to determine the levels of SAD in antenatal women and associate the selected variables with them. Methods: A cross-sectional study was conducted in selected primary health centers (PHC) in Al-Ahsa, Saudi Arabia. The pregnant women were selected using systematic randomization, and their SAD levels were assessed using the perceived stress scale (PSS), the state anxiety scale (SAS), and the patient health questionnaire (PHQ-9), respectively. Linear regression was used to associate factors related to stress, anxiety, and depression. Results: Out of 346 antenatal women, 4% had a high level of stress and 27.2% had a moderate level of stress. Regarding the level of anxiety, 2.6% of them had high anxiety, and 32.9% had moderate anxiety. Around 32 (9.2%) women had moderate depression, and 4 (1.2%) had severe depression. The mean score of SAD was 11.99, 28.88, and 4.73, respectively. A linear regression proved that there was an association between stress and age, occupation, gestational age (GA), gravida, para, abortions, and social support (SS) (p < 0.05). Anxiety was associated with age, GA, gravida, para, abortions, past obstetrical complications, and SS (p < 0.05). Depression was related to age, education, occupation, para, abortions, past obstetrical complications, and SS (p < 0.05). Conclusions: Due to the prevalence of SAD in pregnancy, the screening of these conditions and awareness creation about the associated factors can help to identify potential risks earlier and prevent maternal and fetal complications.

Evaluation of Hypertension-Related Knowledge, Medication Adherence, and Associated Factors Among Hypertensive Patients in the Aljouf Region, Saudi Arabia: A Cross-Sectional Study

Background and Objectives: Hypertensive patients’ knowledge and adherence to prescribed medicines are critical in managing their condition, as poor adherence may lead to adverse cardiac and cerebrovascular events. The present study assessed hypertension-related knowledge and medication adherence among hypertensive patients attending primary health centers (PHCs) in the Aljouf Province, Saudi Arabia. Materials and Methods: Using a cross-sectional design, we conducted this survey on 390 patients. Self-reported hypertension knowledge was assessed using the Hypertension Knowledge Level Scale (HK-LS), and medication adherence was determined using the Hill–Bone Medication Adherence Scale. We used binomial regression analysis (adjusted with other variables) to find the associated factors of medication adherence. Results: This study found that nearly half (49.2%) of the participants had inadequate knowledge, and poor medication adherence was noted in 40.8% of the participants. We found a positive correlation between HK-LS and the Hill–Bone Medication Adherence Scale scores (Spearman’s rho = 0.312, p = 0.002). Medication adherence was significantly associated with job status (private sector (ref: public sector, adjusted odds ratio [AOR] = 2.02, 95% CI = 1.18–3.62, p = 0.005)), living in an urban region (ref: rural, AOR = 3.61, 95% CI = 1.85–5.72, p = 0.002), and duration since diagnosis of more than 5 years (ref: ≤1 year, AOR = 3.53, 95% CI = 2.36–4.95, p = 0.001). Conclusions: The present study findings indicate that there is still a critical gap in managing hypertension at the PHCs in this region, and this may lead to poor health outcomes among the patients and burden the healthcare system. Hence, continuous patient education and targeted counseling are recommended for those with poor medication adherence.

Intravenous iron sucrose when administered to moderately anemic pregnant women raises the hemoglobin concentration and replenishes body iron at 6 months

ABSTRACT Introduction: Intravenous iron sucrose (IVIS) is a rapidly acting, safe, and effective treatment for moderate anemia among pregnant women. The effectiveness of IVIS at 6 months post IVIS infusion was unknown. We, therefore, assessed the mean increase in hemoglobin concentration and body iron replenishment status at 6 months after the last dose of IVIS infusion. Methods: The study was conducted in 28 villages served by two primary health centers in district Faridabad, Haryana. The participants (n = 129), when originally recruited in 2020, were all moderately anemic (hemoglobin level 7.0 to 9.9 g/dL) pregnant women in either the second or third trimester of pregnancy. Their iron deficiency was calculated by Ganzoni’s formula with additional allowance of 500 mg of depot iron. The calculated deficit was rounded off to the nearest 100 mg. The dose of IVIS was 300 mg of iron diluted in 300 ml of normal saline administered intravenously every third day till the full calculated dose was administered. In this study, we collected the follow-up blood specimen 6 months after the last dose of IVIS and measured the hemoglobin concentration, C-Reactive protein (CRP), and serum ferritin level. Hemoglobin concentration was measured using an automated hematology analyzer (Sysmex XS-1000i). Serum ferritin and CRP were measured by enhanced chemiluminescence immunoassay and the enzymatic heterogeneous, sandwich immunoassay method, respectively (VITROS ECiQ, Ortho Clinical Diagnostics, New Jersey, USA). Results: The mean [standard deviation (SD)] duration of time elapsed since the administration of the last dose of IVIS infusion was 6.4 (0.9) months. The mean (SD) hemoglobin level at the time of original recruitment (baseline) was 8.7 ± 0.8 g/dL. The mean (SD) increase in the hemoglobin concentration at 6 months follow-up was 3.2 [95% confidence interval (CI): 3.0–3.4)] g/dL. The median [interquartile range (IQR)] serum ferritin level (ng/mL) at follow-up was 28.1 (12.7, 61.5). A total of 10.2% of the participants had a raised (>10 mg/L) CRP level. Adjusting for CRP level and based on serum ferritin level, the proportion of participants who were iron-deficient was 35.3%. The proportion of participants who had any degree of anemia was 70.5%. Conclusion: Administration of IVIS infusion was effective in raising the mean hemoglobin concentration and in replenishing the body iron reserve at 6 months post infusion.

Diagnostic accuracy of DIPSI criteria for diagnosing gestational diabetes mellitus in Puducherry

ABSTRACT Context: Gestational diabetes mellitus (GDM) is a major concern in recent years. During pregnancy, it is difficult to consume 75 g of glucose in the fasting state as pregnant women may experience symptoms such as vomiting. The Diabetes in Pregnancy Study Group India (DIPSI) criterion requires a single prick in the non-fasting state to collect the sample for diagnosing GDM. Aims: This study aimed to assess the diagnostic accuracy of DIPSI criteria compared to the WHO criteria for GDM diagnosis. Settings and Design: A community-based cross-sectional study was conducted among pregnant mothers attending the primary health centers in Puducherry from August 2022 to November 2022. Methods and Material: A total of 384 samples were selected, and 75 g of anhydrous glucose was given after 8 hours of overnight fasting. Both fasting and postprandial venous blood sugar levels were measured to determine the prevalence of GDM as per the WHO 2013 criteria. After 2 days, GDM was diagnosed among all study participants based on the DIPSI criteria. Further analysis was done. Results: The prevalence of GDM was 14.1% and 12.8% per the WHO 2013 and DIPSI criteria, respectively. In comparison to the WHO 2013 criteria, DIPSI had 79.63% sensitivity, 98.18% specificity, 87.76% positive predictive value, and 96.72% negative predictive value. The results of kappa statistics showed that there was almost perfect agreement between the WHO 2013 criteria and DIPSI criteria. Conclusions: The present study shows that the DIPSI criteria can be used to screen and diagnose GDM as there is no need for overnight fasting. The blood glucose value can be measured easily with a single prick, which is comfortable for both pregnant women and treating doctors.

Birth Preparedness & Complication Readiness Among Pregnant Women in A Rural Area of North Karnataka - A Community - based Cross - sectional Study

Introduction: Globally, approximately 810 women die daily from preventable causes related to pregnancy and childbirth. Birth Preparedness and Complication Readiness improves the use and effectiveness of key maternal and newborn health services, by reducing the phases of delays in receiving these services. This study assessed the knowledge, attitude & practice regarding BPCR among rural antenatal women in Belagavi. Material & Methods: A community - based cross – sectional study was conducted from 1st January to 31st December 2019 among 400 pregnant women in the rural field practice area of a Primary Health Centre, Belagavi. Pre – validated and tested questionnaire from Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) was used for the interview. Data was analyzed using SPSS 25.0 trial version. Results: The BPCR index was 47.1 %. Positive association with being well prepared were found among women from upper and middle socio-economic status, multigravida, those ≥ 34 weeks of gestational age and those who availed their first antenatal care in the first trimester. Conclusion: Nearly three – fourth of the rural pregnant women were well prepared for birth, highlighting the need for continued efforts to enhance BPCR among diverse groups.

Relationship between proxy behavior in clinic attendance and disease control among persons with hypertension and diabetes at a rural primary health center: A cohort analysis in South India

ABSTRACT Aims: Among persons with hypertension and diabetes on treatment for at least 1 year at the Rural Health Centre (RHC) noncommunicable disease (NCD) clinic, 1. To determine the control status for hypertension and diabetes. 2. To assess the relationship between proxy behavior for collection of medications and the control status. Settings and Design: Rural Health Centre, Ramanathapuram, Puducherry, India; record-based retrospective observational study. Methods and Material: The study employed a universal sampling of 396 eligible persons with diabetes and hypertension who had been on medication for over a year at the RHC NCD clinic and had recorded blood pressure and glucose values within the last 4 months. Case sheets of these patients were retrieved from the Medical Registration Department, and data from the past 12 months were collected and analyzed to assess proxy behaviors and absenteeism. Statistical Analysis Used: Data were entered from the case sheets in Epicollect5 and analyzed using Stata v17. Results: Among hypertensive patients, 48.01% were aged 60 and above, with 55.63% being female. Fifty-six percent of hypertensive patients had their condition controlled. For diabetic patients, 40.88% were aged 45–59 years, with 59.75% being female. Only 18.24% of diabetic patients had their condition controlled. The multivariable analysis examined factors associated with the control status of hypertension and diabetes. Those aged 30–44 (aRR: 1.47, 95% CI: 1.01–2.15) and 45–59 (aRR: 1.37, 95% CI: 1.03–1.82) had a higher risk of uncontrolled hypertension compared to those aged 60 and above. Gender did not show significant associations with hypertension control status. Regarding attendance status, patients who had both proxy and missed visits (RR: 1.46, 95% CI: 1.02–2.07) had a higher risk of uncontrolled hypertension. There was also a significant association with patients having more than three proxies (aRR: 1.51, 95% CI: 1.10–2.17) exhibiting a higher risk of uncontrolled hypertension. Absenteeism status showed that those absent for 1–3 visits had a higher relative risk (RR: 1.37, 95% CI: 1.03–1.82) of uncontrolled hypertension compared to those with no absenteeism. Conclusion: Proxy behavior affects the control status of persons with hypertension and diabetes. A longitudinal study is warranted to assess the relationship between proxy visits and control status.

Prevalence of anxiety disorders among visitors at a military primary health center in UAE

ABSTRACT Background: Anxiety disorders are common. However, individuals suffering from anxiety disorders often do not seek treatment. These disorders impose a high individual and societal burden, especially on military personnel and their families, and place a significant burden on healthcare systems as care is often sought from primary care physicians rather than specialized professionals. This study was undertaken to determine the prevalence and correlates of anxiety among visitors at a Military Primary Health Center. Results: Anxiety disorders were high in our study population. Generalized Anxiety Disorder (GAD) was the most common, while social phobia was less prevalent. 72.5% were 18-40 years old and 63.5% were males. 68% were military personnel, 23% were military personnel family, and the rest were retired. The most common symptoms were sleep disturbances (60.4%), irritability (55%), and restlessness (51.4%). GAD, specific phobia, and panic disorder were more likely in divorced people, and chronic diseases were more likely in people suffering from GAD. Conclusions: The prevalence of anxiety disorders was considerably higher among visitors at a Military Primary Health Center due to the high stress levels and occupational difficulties associated with an unstable social and family life. Counseling services and follow-up of diagnosed cases should be available at the primary health care level for improved healthcare delivery by the primary care or family health physicians.

Knowledge, attitude, and practice of Iraqi pregnant women about maternal risk factors

Maternal risk factors can lead to adverse pregnancy outcomes. These include extreme maternal age, short inter-pregnancy intervals, lack or inadequate prenatal care, smoking, and obesity. Good knowledge, positive attitude, and safe practice of women about these risk factors are important in improving pregnancy outcomes. To assess knowledge, attitude, and practice of pregnant mothers attending primary health centres, a cross-sectional study was conducted with 200 randomly selected pregnant women attending the Al-Qudus Family Medicine Primary Health Centre for antenatal care during the period June 2022 to February 2023. Direct interviews of the participants was carried out to obtain data using a structured questionnaire, and the data were tabulated and analyzed using SPSS software The mean age was 22.5 years, 78% of whom knew pregnancy beyond 35 years increases complication; 77% agreed that low maternal educational level has bad effect on pregnancy; 63% were aware of the bad effects of short interpregnancy intervals; while almost all women agreed that smoking has bad effect on pregnancy. About 82% had attitude of planning for pregnancy and frequent antenatal care visits; more than half had regular doctor visits with folic acid supplementation; while three quarters of the women took information from their families and relatives and half from doctors. We conclude that pregnant women in Al-Qudus Family Medicine Health centre, Iraq, have moderately to good knowledge of maternal risk factors.

Assessment of brand awareness and marketing techniques of health services by users of primary health centres in Indonesia

Community health centres are of great importance in the context of disease prevention and health promotion. Nevertheless, the number of individuals who utilise health centres for preventive care is significantly lower than those who seek treatment for existing illnesses. The objective of this study was to provide insights into innovative marketing strategies and brand awareness to enhance the utilisation of primary health services. A cross-sectional study was conducted with a randomly selected sample of 249 respondents who visited the health centre in 2023. The results of the survey indicated that the majority 62% of respondents had been informed about the healthy people mall innovation programme by the health centres. The most prevalent method of communication regarding the healthy people mall innovation program was through direct promotion by health centre health workers, as reported by 39% of respondents. This indicates that direct promotion remains a pivotal strategy for introducing the healthy people mall initiative. The healthy people mall plays a crucial role in prompting individuals to prioritize their healthcare services.

The effectiveness of information, education, and communication (IEC) methods on food safety and hygiene among food vendors during Ramadan

Background: During Ramadan 2023, only 4.7% of the 104 snack and food outlets in Jakarta, Indonesia, at the Cilandak District Primary Health Center met hygiene and sanitation standards. The inspections involved supervising cleanliness, implementing HACCP (Hazard Analysis & Critical Control Point), and counseling on the implementation of health and food safety practices. Purpose: To evaluate the impact of information, education, and communication (IEC) methods on food safety and hygiene practices among street food vendors during Ramadan. Method: A quantitative design with a quasi-experimental approach, an information, education, and communication (IEC) methods on food safety and hygiene for food vendors during the month of Ramadan consisting of one group. The study had two steps: first, it inspected food outlets before and after an educational intervention using a health environment inspection (eIKL PaJan) form; secondly, it tested food samples using a rapid test. Three outlets were randomly selected from each of the five sub-districts, and the data was analyzed using a paired T-test. The level of statistical significance was set at an alpha level of 0.05. Results: Fifteen "takjil" snack vendors were evaluated, and most had non-conformity scores. The highest non-conformity scores were due to hand hygiene issues and lack of knowledge about food safety. After the intervention, the mean score of knowledge about safe food handling increased from 57.5 to 75.9, with p<0.001 indicating an increase in awareness of food safety perceptions. Of the fifteen food samples tested, six showed the presence of formalin in the rapid test. However, subsequent testing at the laboratory revealed that the samples were free of formalin. Conclusion: Our study highlights a significant public health concern: enhancing awareness can bolster the safety, cleanliness, and knowledge of snack food outlet proprietors. This could positively affect the economy, human resource quality, and health through the implementation of food security practices.

Atrial fibrillation, prevention and rehabilitation in a primary healthcare setting. A feasibility study

Abstract Background Atrial fibrillation (AF) often influences daily life with symptoms like palpitations, dyspnoea, fatigue, fear and anxiety. Research show that patients with AF benefit from prevention and rehabilitation interventions. However, evidence is scarce and mainly hospital-based, and it is unknown whether the transition to the primary healthcare sector gives the same positive results. In 2019, a Danish primary care Health Center and the cardiology department at the local hospital completed a multidimensional prevention and rehabilitation intervention for patients with AF. Purpose To investigate the feasibility of delivering a multidimensional prevention and rehabilitation intervention for patients with AF in a primary care Health Center. Methods This study was a mixed-methods, non-randomized, intervention, feasibility study. A convergent mixed-methods design was used, and results were illustrated in side-by-side joint displays. Patients were included at a Hospital AF clinic referring to the Health Center. The prevention and rehabilitation intervention consisted of risk factor management, patient education, physical activity and yoga. Two patient-reported outcomes measures (PROMs) were used, the HeartQoL measuring health-related quality of life (HRQoL) and the Hospital Anxiety and Depression Scale (HADS) measuring symptoms of anxiety and depression. Data were collected at baseline (T0), at end of intervention (T1), and at two-months follow-up (T2) and analysed descriptively. Focus group interviews were analysed thematically and covered experiences of participating, needs and preferences, outcomes and feasibility of collecting PROMs. The reporting was guided by the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot and feasibility trials. Results 43 patients (53% women; median age 66 (range 52-81) years) completed the intervention. Table 1 shows that HRQoL increased, and symptoms of anxiety and depression decreased. These results maintained at follow-up. Figure 1 shows the qualitative themes. Patients experienced being understood and supported by health professionals and peers. They thought it difficult to know what their needs were. However, some patients had specific preferences for interventions. For changes in outcomes, the patients identified that gaining tools and knowledge about the disease from the interventions helped. It was feasible to collect PROMs during the intervention and finally, the patients had an attention to what comes next, when finishing the intervention in the primary care setting. Conclusion It was feasible to deliver a multidimensional prevention and rehabilitation intervention for patients with AF at a primary care Health Center. HRQoL increased and symptoms of anxiety and depression decreased. The patients experienced being supported and gaining tools and knowledge to handle AF. Future large randomized controlled trials must confirm these results.

Child COVID-19 rates and migrant status: A quantitative study in the Lisbon area (Mar 2020-Jun 2022)

Abstract Introduction According to OECD data, immigrant children were over-represented among COVID-19 cases compared to non-immigrant children. However, evidence is missing on whether their migrant status is associated with testing positive for COVID-19. Therefore, we aimed to estimate COVID-19 positivity rates among children residing in five municipalities of the Lisbon metropolitan area, Portugal, and to analyze migrant status as a determinant of health. Methods We conducted a prospective cross-sequential cohort study with 989 children born in 2015, 2018, and 2020 (48.5% non-immigrants; 51.5% immigrants). Sociodemographic data were collected through interview-based questionnaires, and the child’s birth weight and gestational age were obtained from the primary health center’s information system (SClinico). COVID-19 test results (conducted between March 2020 and June 2022) were obtained from the national surveillance system (SINAVE Lab) and categorized into two primary outcomes: ever positive for COVID-19 (yes/no) and positivity frequency for COVID-19 (count). Robust and standard Poisson regressions were used to estimate the association between primary outcomes and demographic, socioeconomic, and clinical variables. We estimate relative risks (RR) and prevalence ratios (PR) with 95% confidence intervals. Results The positivity rate is lower for immigrant children (12% vs 17%). Compared with non-immigrant, and adjusting for other factors, immigrant children are 52% less likely to be ever positive for COVID-19 (PR = 0.482; IC 95%: 0.392-0.594), and the estimated number of positive tests is 54% lower (RR = 0.456; IC 95%: 0.362-0.574). Conclusions Being an immigrant is a protective factor against testing positive for COVID-19, aligning with the well-known immigrant paradox. These results underscore the need for further research into the immunological profiles of this population and are crucial for guiding strategies to manage emerging public health crises. Key messages • Immigrant children living in the Lisbon metropolitan area may have a protective factor against testing positive for COVID-19, consistent with the well-known immigrant paradox. • Understanding COVID-19 positivity rates and associated factors in children is crucial for guiding effective strategies to manage and mitigate emerging public health crises.

General Practitioner Availability and Accessibility in Serbia Before and During the Pandemic

Abstract Background During the COVID-19 pandemic in Serbia, state-owned primary health centres’ general practitioners (GPs) served as the first point of care for adults (the population aged 19 years and older) and gatekeepers of the health system. The study highlights changes in the overall availability, accessibility, and workload of GPs during the pandemic. Methods We used routine health facility data at the national level to describe the changes in GPs over the past three years, before the pandemic (2017-2019) and during the pandemic (2020-2022). Specifically, we looked at the total number of GPs, the percentage of specialists, the average number of citizens per GP, the services used per capita, the average number of visits per GP, and the leading causes of morbidity. Results The study found a decrease in the total number of GPs in both periods (before: -10%, during: -9%) and in the number of specialists (before: -2%, during: -3%). During the pandemic, the average number of citizens per GP varied. In 2022, the average number of visits per GP decreased noticeably to 3557 GPs, of which 37% were specialists. In the same year, each GP received 6661 annual visits and served 1509 citizens on average. However, these figures exhibit considerable regional and geographical differences. Circulatory and respiratory diseases were the most common reasons for visiting a GP (about 14% and 13% of all visits, respectively). Up to 10% of all visits resulted in either a diagnosis of external factors that influence health status or in ill-defined symptoms, clinical and laboratory findings. Conclusions This study’s findings underscore the critical reductions in availability, accessibility, and workload of general practitioners in the Serbian public sector and emphasize the importance of strengthening the primary healthcare system to better respond to future challenges. Key messages • Public health officials should prioritize the development of effective strategies and policies that focus on improving the quality and accessibility of primary health care services in Serbia. • A greater investment in general practice is necessary to ensure it can effectively meet the population’s needs during health emergencies.