Primary Health Care Centers Research Articles

A patient-reported questionnaire for evaluating utilization of the National Essential Public Health Service Program in China among older adults with hypertension and diabetes

ObjectivesThis study aimed to develop a patient-reported questionnaire to assess service utilization and patient satisfaction among older adults with hypertension and diabetes in primary health-care centers operating under China’s National Essential Public Health Service Program (NEPHSP).MethodsThe questionnaire’s item pool was constructed on the basis of a logic model. A cross-sectional survey was conducted in three provinces of mainland China between November and December 2019. The questionnaire was evaluated using Cronbach’s alpha coefficients and confirmatory factor analysis (CFA) to refine items and assess internal consistency, construct validity, convergent validity, and discriminant validity.ResultsThe final questionnaire adopted a second-order factor model comprising three domains: essential services for all older adults, follow-up services for older adults with hypertension or diabetes, and patient satisfaction assessment. Through a two-step refinement process, nine factors encompassing 29 items were selected, including elements such as “health records and health education,” “blood pressure/glucose monitoring,” and “health education in follow-up.” Cronbach’s alpha coefficients indicated excellent reliability, with values of 0.899 and 0.906. The 29-item instrument had robust model fit for both hypertension and diabetes cohorts. The fit indices for the hypertension model included a Bollen–Stine bootstrap chi-square to degrees of freedom ratio (χ2/df) of 1.78, root mean square error of approximation (RMSEA) of 0.03, and goodness-of-fit index (GFI) of 0.97. Similarly, for the diabetes model, the fit indices were a Bollen–Stine bootstrap χ2/df ratio of 1.38, RMSEA of 0.02, and GFI of 0.97. CFA revealed factor loadings ranging from 0.516 to 0.940 for the hypertension model and from 0.504 to 0.943 for the diabetes model. All three first-order factors were significantly correlated with each other (p < 0.01), and their correlation coefficients were lower than the square root of the average variance extracted. The models demonstrated strong structural validity, convergent validity, and discriminant validity.ConclusionA valid and reliable questionnaire for evaluating service utilization and patient satisfaction among older adults with hypertension and diabetes in primary health-care center was developed in China. This instrument will serve as a practical tool for patient-reported assessments within the NEPHSP framework at primary health-care centers.

Enhancing Family Readiness to Prevent Relapse in Individuals with Severe Mental Disorders in Indonesia

Objective: Effective relapse prevention for individuals with severe mental disorders requires understanding the role of psychosocial factors in readiness-relapse. This study evaluates the impact of family support, motivation, coping mechanisms, and experience on readiness-relapse. Methods: A correlational study was conducted with 150 respondents from three primary healthcare centers in Kebumen Regency, Central Java, Indonesia. Participants were selected using proportional random sampling and completed validated questionnaires. Data were analyzed for validity, reliability, normality, and hypothesis testing using T-tests and F-tests. Results: Motivation was identified as a significant predictor of readiness-relapse (p =0.0001), demonstrating its crucial role in preventing relapse.

Potentially inappropriate medications for geriatric patients in Bahrain: prevalence, predictors, and implications for practice

BackgroundThe global increase in the older adult population necessitates a comprehensive understanding of medication management to mitigate the risks associated with potentially inappropriate medications (PIMs). These medications are of particular concern due to their association with adverse drug reactions, increased hospitalization, and increased healthcare costs. This study aimed to determine the prevalence and risk factors associated with PIM use among older adult patients attending primary health care centers in Bahrain.MethodsThis cross-sectional study was conducted in 2022 in 27 primary healthcare centers across Bahrain. The study included patients aged 65 years or older. A computer based simple random sample was obtained, and the Beers criteria 2023 was utilized to assess medication appropriateness. Anonymous data was retrieved from electronic medical records and analyzed via univariate, and logistic regression analyses.ResultsAmong the 595 older adult patients studied, the average age was 71.7 years, with 54.5% (n = 324) being female. Most of the patients were married (70.8%, n = 421). More than half of the patients (51.3%, n = 305) received at least one PIM, with gliclazide (37%, n = 113), pantoprazole (29.8%, n = 91), and rabeprazole (27.9%, n = 85) being the most prevalent prescribed PIM. Univariate analyses revealed that PIM rates were significantly higher among females (p = 0.001) and patients with comorbidities such as diabetes mellitus (p < 0.001), essential hypertension (p < 0.001), and hyperlipidaemia (p < 0.001). Logistic regression analysis revealed that age (OR = 1.09, p < 0.001), female sex (OR = 1.645, p = 0.012), and diabetes mellitus (OR = 1.696, p = 0.029) were significant predictors of PIM use.ConclusionThis study highlights the significant burden of PIM use among older adult patients in Bahrain, with more than half of the participants receiving at least one PIM. These findings underscore the urgent need for targeted interventions, particularly among female patients, those with chronic conditions such as diabetes mellitus, and patients taking five or more medications. These insights contribute to the broader understanding of geriatric pharmacotherapy and offer a foundation for policy development aimed at optimizing medication safety in aging populations.

Predictors of stages of adoption of colorectal cancer screening among adults attending primary healthcare centers in Turkey

BackgroundDespite the proven effectiveness of colorectal cancer (CRC) screening in reducing mortality, adherence rates for fecal occult blood testing (FOBT) and colonoscopy remain low among Turkish adults. This study aimed to assess the stages of adoption of CRC screening behaviors, identify the factors influencing adoption, and examine the perceived benefits and barriers to screening.MethodsA cross-sectional study was conducted in Istanbul’s Anatolian region from May to June 2022, involving 498 adults aged 50–70 years. Multistage cluster sampling was used to select 20 primary healthcare centers. A structured questionnaire was administered to assess sociodemographic characteristics, health perceptions, knowledge of colorectal cancer (CRC) screening, and readiness for screening based on the transtheoretical model. The benefits and barriers to screening were evaluated using the Turkish version of “The Instruments to Measure CRC Screening Benefits and Barriers.”ResultsThe participants (mean age: 59.10 ± 5.71 years) showed greater recognition of colonoscopy (68.7%) than FOBT (39.8%). Most participants were in the precontemplation stage for FOBT (58.6%) and colonoscopy (63.9%). Perceptions of benefits were associated with education, employment, income, health status, familial CRC history, and screening knowledge (p < 0.05). Perceived barriers were linked to lack of knowledge and provider recommendations (p < 0.05). The participants in the precontemplation stage reported fewer benefits and more barriers compared to those in advanced stages (p < 0.05).ConclusionsColonoscopy is more widely recognized than FOBT among the Turkish adult population; however, a significant proportion remains in the precontemplation stage for screening. Perceptions of benefits and barriers are influenced by sociodemographic factors, health status, and CRC knowledge. Interventions addressing these barriers and raising awareness could improve CRC screening uptake and help reduce the disease burden.

Socio-Cultural Influencing Factors Among Mothers Knowledge About Immunization Dropout of Children Under Five Years at Rural and Urban Area: A Comparative Study

Background: Vaccination of children is a vital part of worldwide health systems because it is the most successful and cost-effective preventive clinical service for children's health and for the maintenance of public health. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease. The aims: to identify the Socio-cultural factors influencing immunization dropout among mothers of children under five years, and to compare between the rural and urban area with regards to the factors influencing immunization dropout among children under five years Methods: A cross-sectional descriptive study design, conducted in Babylon province from October 4, 2023, to July 1, 2024. Non Probability " convenience " sample of (303) mothers who have children under five years were selected from unit of immunization at primary health care centers (PHCCs), from Babylon province. Result of the study: Overall, urban mothers had good knowledge about immunization, whereas rural mothers had poor knowledge, and the comparison between mother’s Socio-cultural- knowledge Influencing of Immunization Dropout of both group (urban and rural) the recorder mean score shows high significant differences between the responses. Conclusion &amp; recommendation: Most mothers in both groups received information about childhood immunization from healthcare workers. The findings revealed that overall assessment of mothers live in urban had good knowledge about immunization, whereas rural mothers had poor knowledge. Regarding to the recommendation, develop and expand SMS reminder systems to improve vaccination adherence. Conduct future studies on a larger sample and at a national level to improve postnatal care services.

Nourishing insights: Exploring how primary healthcare practitioners’ eating habits influence diet counseling approaches in Qatar

Background: Physicians have the potential to significantly impact their patients’ health habits through effective lifestyle counseling. To influence patient behavior, physicians themselves need to practice healthy habits. The aim of this article was to investigate dietary patterns among primary healthcare practitioners (PHPs) in Qatar and their impact on related counseling practices with patients. Methods: We conducted a cross-sectional survey among PHPs working at the primary healthcare centers in Qatar in 2020–2021 using a self-administered questionnaire adapted mainly from the World Health Organization’s (WHO’s) Stepwise survey. Institutional ethical approval was obtained before the start of the study. Results: Of 511 PHPs, a total of 306 participated in the survey. The majority were 41–50 years old (51.4%), males (58.1%), and non-Arabs (55.8%). Approximately three-quarters (75.1%) of PHPs did not meet the WHO recommendations for fruit and vegetable intake. Of the patients, 58.2% were counseled on a healthy diet and weight management. Using logistic regression, we found that gender is the only independent predictor of meeting the WHO recommendations for fruit and vegetable intake, with females more likely to meet the recommendations than males (adjusted OR 2.9, 95% CI: 1.35–6.27, p = 0.007). Linear regression analysis showed that PHPs’ consumption of fast food and sweets on one day or less per week was significantly associated with an approximately 20% increase in the percentage of their patients counseled on diet (p = 0.012). PHPs found that lack of time and language barriers extremely limited their counseling practices. Conclusion: The majority of primary healthcare providers do not adhere to the WHO guidelines on fruit and vegetable consumption. Physicians’ lifestyle behaviors can have a significant impact on their patient counseling practices. Implementing PHP-focused lifestyle interventions and providing behavioral support can help align physicians’ personal dietary habits with counseling practices, ultimately improving patient care outcomes.

Equity of National Essential Public Health Services (NEPHS) in Mainland China, 2019: a cross-sectional study based on the NEPHS database

BackgroundChina’s National Essential Public Health Service (NEPHS) Program was launched in 2009 to deliver population-based public health and individual health management services to all residents at 800,000 primary health-care centers nationwide. This study assessed NEPHS utilization data and evaluated usage inequities using comprehensive nationwide data.MethodsA cross-sectional study was conducted, selecting 16 indicators (out of 18) from 12 service packages to evaluate inequity. These included 4 indicators for services provided to all residents and 12 for pregnant women, new mothers, children aged 0–6 years, and patients with hypertension, diabetes, severe mental disorders, or tuberculosis. Data on service utilization and target populations for these indicators across the 31 provinces and 453 cities in mainland China were obtained from the NEPHS database and management platform for the period January 1 to December 31, 2019. Service utilization rates and bias-corrected bootstrap confidence intervals (CIs) were calculated to determine utilization. Inequities were assessed using the Gini coefficient and Sitthiyot-Holasut composite inequality index at the national and provincial levels, and the Theil index was employed to decompose overall inequity into within-region and between-region subgroups.ResultsThe NEPHS collected health records for 88.25% of China’s permanent residents (95% CI: 79.23%–98.82%). The nationwide vaccination coverage rate was 97.44% (95% CI: 91.33%–99.91%). Newborn visit and child health management rates for children aged 0–6 years were 92.08% (95% CI: 74.85%–98.34%) and 90.87% (95% CI: 82.49%–98.47%), respectively. At the national level, NEPHS service utilization in 2019 was generally equitable, with Gini coefficients below 0.4 for the 15 indicators. Potential large equity gaps were observed in the provision of health education services in Shanghai [Gini coefficient = 0.358 (95% CI: 0.219, 0.444)], Inner Mongolia [Gini coefficient = 0.370 (95% CI: 0.073, 0.440)] and Xinjiang [Gini coefficient = 0.457 (95% CI: 0.217, 0.502)]. Additionally, the utilization of family planning education and sanitation inspection services also indicated potential large and severe equity gap in 13 provinces. The Theil indices revealed that inequities primarily existed within rather than between regions. Province-level results indicated perfect equity in health record management and vaccination coverage, while several provinces showed potential equity gaps in health education and family planning services. Potential equity gaps were also observed in health management services for patients with hypertension and diabetes, particularly in Beijing, Hunan and Xinjiang.ConclusionsThis study provides evidence for health planning in China’s primary health sector and guidance for analyzing equity in national health programs similar to the NEPHS Program.

Psychometric properties of the Persian version of the treatment satisfaction questionnaire for medication (TSQM) among Iranian hypertensive patients.

This study aimed to evaluate the psychometric properties of the Persian version of the TSQM-14 in patients with hypertension in Iran. This cross-sectional study was conducted among hypertensive patients referred to primary healthcare centers in Kerman City between January and February 2021. Cronbach's alpha and total-item correlation were used to evaluate internal consistency, while the Intraclass Correlation Coefficient (ICC) was employed to assess test-retest reliability. Construct validity was examined using structural equation modeling (SEM), known-groups validity, and convergent validity. A total of 319 participants took part in the study, with a mean age of 56.7 years (SD = 13.0), and 57.7% (n = 184) were female. The Cronbach's alpha and ICC values of the TSQM-14 for the composite scales were 0.83 and 0.91, respectively, indicating good reliability. The SEM indices for TSQM-14 demonstrated adequate model fit, with χ² = 118.9 (P ≤ 0.001), CFI = 0.96, RMSEA = 0.07, TLI = 0.95, and NFI = 0.91. The mean (standard deviation (SD)) scores of the composite scale for patients in the uncontrolled group (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) and the controlled group were 50.2 (SD = 6.6) and 47.6 (SD = 6.1), respectively (P = 0.021). Additionally, the Spearman correlation coefficient between the TSQM-14 scale and the MMAS-8 was 0.30 (P < 0.001), demonstrating a weak but significant correlation. This study demonstrated that the Persian version of the TSQM-14 has acceptable reliability, as well as construct and convergent validity, for assessing treatment satisfaction among hypertensive patients.

Interpretable time-series neural turing machine for prognostic prediction of patients with type 2 diabetes in physician-pharmacist collaborative clinics

Interpretable time-series neural turing machine for prognostic prediction of patients with type 2 diabetes in physician-pharmacist collaborative clinics

Exploring General Practitioner Work in Upper Austria: A Pilot Retrospective Observational Study Across Thirty Practices.

This study investigates the differences in patient care across various organisational forms of general practitioners (GPs) in Upper Austria. Data was collected from GPs across Upper Austria, examining patient demographics, prescription patterns, staff employment, services offered and the proximity of practices to hospitals. The variability in recording patient visit reasons was also analysed. Of the 30 participating GPs (Response Rate 5.1%), 17 worked in single practices, 7 in group practices, and 6 in PHC units. In our sample, single practices tend to prescribe more medications for chronic conditions. Group practices and PHC centres are more prevalent in areas with larger populations, offer online appointment bookings more frequently and employ more staff. The study also highlights variability in documenting patient visit reasons, emphasising the need for standardised documentation practices. The most common reasons for the patient to contact their GP, based on ICPC-2 categories, were general and non-specific, respiratory and locomotor problems, and the most common chronic diseases seen in the practice are cardiovascular, endocrine diseases and locomotor system problems. The most common therapeutic procedures were counselling and prescription of medication. Our study, the first of its kind, reveals significant insights into the variability and adaptability of general medicine outpatient practices in Upper Austria, highlighting the need for improved diagnosis coding at the primary care level.

Promoting lifestyle change through text messages to patients with hypertension: A randomized controlled trial in Swedish primary care.

We aimed to investigate whether health-promoting text messages sent to patients with hypertension in primary care could affect lifestyle habits, and if the Theory of Planned Behavior could be used to identify moderators of intervention effects. From September 2020 to December 2022, patients with hypertension were randomly selected from the patient register at 10 Swedish primary health care centers and randomized 1:1 to receive health-promoting text messages or treatment as usual (N=401). The intervention group received four text messages per week for six months. Self-reported measures of lifestyle habits were collected through a questionnaire at baseline and after six months. Predictors of behavioral change according to the Theory of Planned Behavior were collected through a baseline questionnaire. The data were analyzed according to the intention-to-treat principle. We compared lifestyle habits between the intervention and control groups at follow-up with adjustment for baseline measures through logistic regression analysis and analysis of covariance. The text message group had a statistically significant decrease in the proportion of participants with alcohol use above four standard drinks per week (OR 0.35, 95% CI 0.15-0.81), and in the proportion of participants being physically inactive (OR 0.60, 95% CI 0.37-0.98). The effect could not be explained or predicted by a pragmatic adaptation of the Theory of Planned Behavior. Health-promoting text messages could be offered to Swedish primary care patients with hypertension as part of the effort to improve their lifestyle habits.

Optimization of Type 2 Diabetes Patient Assistance Through Enhanced Telecoaching Capacity for Primary Healthcare Nurses in Kendari City

ABSTRACT Diabetes Mellitus (DM) is a health problem that requires a multidisciplinary approach, including the important role of community health center nurses. Telecoaching conducted by nurses has proven effective in improving glycemic levels in DM patients. This community service program aimed to enhance the capacity of primary healthcare center (puskesmas) nurses in providing telecoaching to Type 2 Diabetes Mellitus (DM) patients in the coastal areas of Kendari City. The program was designed to address the limitations in nurses' knowledge and skills while increasing the intensity of remote patient support for DM. A total of 10 primary healthcare nurses participated in the training, which covered telecoaching techniques, motivational interviewing, and the use of the Diabetes Mellitus Patient Health Assistance Application (DMPHAA). Evaluations assessed improvements in nurses' knowledge and skills, as well as reductions in the fasting blood glucose levels of DM patients. The results showed a significant increase in nurses' knowledge of telecoaching by 40.30% and a 52.76% improvement in telecoaching skills after the intervention. In addition, there was a 20.61% reduction in the fasting blood glucose levels of DM patients, demonstrating the program's effectiveness in helping patients manage their diabetes. Statistical tests showed significant results for all three variables with p&lt;0.05. This program demonstrated that telecoaching can be an effective solution for providing remote healthcare services, especially in areas with limited access. It is recommended that the sustainability of this program is integrated into the services of primary healthcare centers to improve diabetes management in remote regions. Keywords: Telecoaching, Diabetes Mellitus, Primary Healthcare Nurses, Blood Glucose, Community Service

Association of Possible Developmental Delays with Emotional and Behavioral Disorders, and Risk Factors in Children Under Six in Karachi, Pakistan: A Cross-sectional Study

Developmental delays refer to a child not reaching expected milestones. They are linked to various factors and, if unaddressed in early childhood, can lead to long-term consequences in adulthood. Objectives: To determine the association of developmental delays with emotional and behavioural disorders and other risk factors in children less than six years of age. Methods: This cross-sectional study was conducted at a primary healthcare center in a Karachi slum from October 2020 to July 2021. Using non-probability consecutive sampling, 425 participants (parents of children aged 1-5½ years) were selected. Data were collected using the validated Survey of Well-being of Young Children tool and analyzed in SPSS version 23.0. Logistic regression assessed associations between outcomes and risk factors. Results: Of 425 participants, 161 (37.9%) had possible developmental delays. No association was found with emotional/behavioural disorders (p=0.30). Binary logistic regression linked delays to male gender, uneducated parents, unemployed mothers, low income, domestic violence, and tobacco/drug exposure at home (p&lt;0.05). After adjustment, significant associations remained with the mother’s education (aOR=1.785, CI: 1.040-3.065, p=0.036), income (aOR=3.361, CI: 1.197-9.434, p=0.021), and domestic violence (aOR=2.603, CI: 1.055-6.423, p=0.027). Conclusions: It was concluded that the prevalence of developmental delays in slum-dwelling children is high. No association was found with emotional/behavioural disorders. Socioeconomic factors, such as the mother’s education.

Prevalence of gestational malaria among pregnant women attendiing anatenatal care in selected primary healthcare centres in Oluyole local government area of Ibadan, Oyo state, Nigeria

Prevalence of gestational malaria among pregnant women attendiing anatenatal care in selected primary healthcare centres in Oluyole local government area of Ibadan, Oyo state, Nigeria

Chronic pain - prevalence, demographic inequalities and healthcare utilisation: a primary care database analysis.

Chronic pain (CP) is an ill-defined condition, often under-recorded in primary care records. To determine prevalence, evidence of health inequalities, primary care consultation rates and healthcare utilisation costs of CP. Cross-sectional, retrospective study using anonymised primary care data from all GP practices in one inner-city London area. CP was defined on the basis of analgesic medication codes and novel inclusion of diagnostic codes for conditions known to be strongly associated with CP. CP prevalence and consultation rates were determined; comparisons were made with 31 other Long-Term Condition (LTCs). Consultation cost estimates were based on health care professional type and consultation mode. 358 889 adult patients were registered in sample practices, with continuous (12-month) health care records available for 327 800 (91.3%). CP prevalence was 18.6%; the second most prevalent LTC after anxiety at 21.4%. CP mean annual consultation rates were 15.3/patient, the highest LTC consultation rate. CP incurred the highest primary care consultation costs of any of the included LTCs. Age was the strongest predictor of CP, particularly in those aged≥60 years (Adjusted Odds Ratio (AOR): 9.32; 95% Confidence Interval: 8.83 to 9.84; compared to 18-39-year-olds). Much smaller AORs were found for ethnicity, social deprivation, gender and non-UK country of birth. CP represents the most demanding LTC, in terms of consultation rates and costs, managed in primary care. Yet there is considerable uncertainty about optimal management and alternatives to long term, high volume primary care consultation rates.

The effect of an intervention for organizing primary mental health care in Brazil: a study based on routine process indicators

BackgroundThe “Mental Health Care in Primary Health Care (PHC)” project (SMAPS, from Portuguese) was developed in six health regions from three Brazilian states. Considering the gap and relevance of monitoring and assessing mental health (MH) care in real-world settings using data from service records, this study aimed to evaluate the effect of SMAPS on indicators of MH care process in PHC, calculated from official records available in health services.MethodsThis is a pilot study conducted between January 2022 and September 2023. The sample comprised 18 PHC units in 14 municipalities, which were in one of the three Brazilian states that adhered to SMAPS and assigned to one of two groups: control and intervention (2:1). Secondary data were collected at two times using the same instrument to systematize the retrieval of aggregated data, which were extracted from management reports from PHC units or municipalities departments. Data analysis was performed using descriptive statistics at the PHC units or municipality level.ResultsThe rate of referrals to MH specialties per consultation with a MH classifications record seemed to decline in intervention and control group. The percentage of benzodiazepine medications delivered for PHC decreased from 16.1 to 11.3% in the intervention group municipalities but increased from 20.3 to 24.1% in the control group. An inverse pattern was observed for antipsychotic, anticonvulsant, and antidepressant medications (increased from 82.2 to 86.2% in the intervention group municipalities and declined from 77.6 to 74.4% in the control group). Despite this, analyzing the mean variation in MH care indicators, statistically significant differences between groups in distribution at the 5% level were not identified.ConclusionThe present pilot study points to possible effects of SMAPS for organizing MH care in PHC, especially regarding the referrals to specialty mental health care and the delivery of psychotropic medications. It contributes to the formulation of proposals for evaluating MH care based on data already available from records and reports from health services and emphasizes the need to improve the quality of MH care recording in PHC work routines.

Exploring the barriers to accessing antenatal care at the primary health care center level of a tertiary hospital in Lebanon: a qualitative study

BackgroundAccess to antenatal care (ANC) is vital for improving maternal and neonatal outcomes. However, barriers to ANC remain a challenge, particularly in resource-limited settings such as Lebanon. This study examines the barriers pregnant women in Lebanon face when accessing ANC at a primary healthcare center (PHCC) in a public tertiary hospital located in Beirut, Lebanon.MethodsThis qualitative study explored the perspectives of 17 pregnant women receiving ANC at the Rafic Hariri University Hospital (RHUH) PHCC. Semi-structured interviews were conducted to gather in-depth insights into their experiences with ANC services. Verbatim transcripts of the interviews were analyzed using an inductive-deductive thematic approach, identifying several barriers to ANC at the PHCC level. Levesque’s framework was used to identify key barriers to antenatal care across five dimensions of access, providing a structured approach to understanding challenges in service utilization at the study site.ResultsThe key barriers to accessing ANC services identified in the study include cultural influences, inadequate health literacy, and financial constraints, which delayed care-seeking and fostered mistrust between pregnant women and healthcare providers. Systemic inefficiencies such as long wait times, overcrowding, and poorly organized appointment processes further limited accessibility, while discrimination and communication barriers reduced engagement in care. Additionally, logistical challenges like time constraints, transportation issues, and staff shortages exacerbated by employee strikes, along with the ongoing economic crisis, affected both the affordability and quality of ANC services at RHUH.ConclusionImproving health literacy, streamlining service delivery, and enhancing patient-provider communication are key recommendations. Future efforts should focus on strengthening financial support, addressing logistical barriers, and regularly updating strategies to adapt to evolving challenges, ensuring equitable access to maternal care.

Recommendation to improve chronic kidney disease management guideline in primary healthcare, KwaZulu-Natal.

The prevalence of chronic kidney disease (CKD) is high in KwaZulu-Natal (KZN), especially in individuals with risk factors such as HIV, diabetes mellitus and hypertension. Despite existing guidelines, the study identified multifactorial gaps in implementing CKD management measures at the primary healthcare (PHC) level. This leads to late-stage diagnoses and increased burdens on tertiary institutions, as identified in institutional statistics. The study was therefore conducted in four different settings: a tertiary hospital in Durban and three PHC centres across KZN (two urban centres and one in a township). The study's objective is to describe the perceptions of healthcare professionals on the management of CKD, in the PHC setting in KZN, South Africa. A qualitative, exploratory design involving healthcare professionals was adopted. Purposeful sampling was used. Open coding and conventional content analysis were adopted to analyse data. Findings revealed three overarching themes: (1) knowledge and awareness about existing guidelines, (2) fragmented system and a lack of clear guidelines and (3) implications of clear guidelines on patient care. Participants demonstrated diverse awareness of guidelines, revealing a need for continuous education. Participants expressed needs for continuous education and clear guidelines. The study highlights an urgent need to bridge the knowledge gap and establish a cohesive healthcare system to address the growing CKD burden in KZN effectively.Contribution:The study emphasises the potential benefits of implementing clear guidelines to improve patient outcomes, early detection and appropriate interventions, thereby reducing the burden on tertiary facilities.

Predictors of hearing screening among residents of Saudi Arabia at primary healthcare settings in Riyadh: useful insights from a cross-sectional survey

BackgroundDespite the significant prevalence of hearing impairment and the devastating impact on the quality of life, screening patterns regarding hearing loss in adults are significantly reduced. It is necessary to identify the proportion of residents of Saudi Arabia which undergo for hearing screening and identify predictors of hearing loss. Therefore, we conducted this study to identify predictors of the hearing screening among residents of Saudi Arabia.MethodsA cross-sectional study was undertaken, and an electronic questionnaire was administered to 14,239 patients who visited primary health care centers. Primary health care centers were selected using a random sampling technique. Data was collected on hearing screening and other sociodemographic and behavioural factors along with other co-morbidities. We performed multiple logistic regressions to identify predictors that were significantly associated with hearing screening. We performed analysis using SPSS version 26.0 for Windows and reported adjusted odds ratios (AORs) with 95% CIs.ResultsThe sample consisted of 43.4% males and 65.3% married participants. Only 5.9% of the study participants reported going for hearing screening. Age (AOR: 1.01; 95% CI: 1.01, 1.02); higher education level (AOR: 2.46; 95% CI: 1.55, 3.92), full time employment (AOR: 1.36; 95% CI: 1.05, 1.75), part time employment (AOR: 1.54; 95% CI: 1.22, 1.94), good health status (AOR: 1.52; 95% CI: 1.17, 1.96), and Diabetes Mellitus (AOR: 1.37; 95% CI: 1.08, 1.72) were found to be strong predictors of hearing screening among residents of Saudi Arabia in Riyadh.ConclusionWe found a very low prevalence of hearing screening among residents of Saudi Arabia. Older age, educated, employed, people with good status health, and diabetic individuals were more likely to go for hearing screening. Health literacy sessions need to be carried out to raise awareness among residents of Saudi Arabia and more robust epidemiological studies need to be carried out to explore the reasons of low hearing screening in this population.

Assessment of the Level of Direct Health Facility Funding Awareness and Training among Staff of Primary Health Care Facilities in Plateau State

The study carried out an assessment of the level of direct health facility funding awareness and training among staff of primary health care facilities in Plateau State. Pragmatism research philosophy and descriptive cross-sectional design were used. The population of the study comprised of a total of 974 healthcare centres in Plateau State, out of which 851 are primary health care centres comprising of 1702 administrators and 25,111 staff. The sample of this study was drawn from the population of the study using Krejcie and Morgan technique. A sample of 642 was obtained based on 265 administrators and 377 staff. The study established that most of the primary healthcare created awareness about the direct health facility funding initiative among their staff. Interactive sessions were held in most of the facilities to educate staff about the direct health facility funding initiative, its components, principles and application. Experts in direct health facility funding administration were enlisted by the government and other stakeholders to train principal administrative and financial officers of primary healthcare facilities in Plateau State on how to implement the programme in various primary healthcare centres in Plateau State. The trainings were mainly carried out through workshop and seminars. It is recommended that more training should be provided to administrators of primary health facilities so as to equip them adequately on direct health facility funding administration. This will in turn improve the effectiveness of the direct health facility funding programme in primary healthcare facilities.