Primary Health Care Facilities Research Articles

Effective integration of COVID-19 vaccination with routine immunization: A case study from Kinshasa, DRC

BackgroundIn response to the challenge of maintaining COVID-19 vaccination coverage amidst the pandemic, VillageReach, in collaboration with the Ministry of Public Health Prevention and Hygiene in Kinshasa, DRC, integrated COVID-19 vaccination with routine immunization services at two primary healthcare facilities. This initiative, launched in July 2022, represented the first of its kind in the DRC, aiming to assess the effectiveness and scalability of a multimodal vaccination approach. MethodsThrough a rapid appraisal involving key informant interviews and analysis of pre- and post-integration service delivery data, this case study explores the operational dynamics and outcomes of integrating COVID-19 and routine immunizations. ResultsResults demonstrated that the integrated approach not only maintained COVID-19 vaccine coverage but also significantly enhanced routine immunization uptake, particularly among under-immunized and zero-dose children. Overall, the vaccination sites, outreach, and integrated health facilities administered 229,983 (33 %) of COVID-19 vaccines in Kinshasa, of which 53 % were referred by community health workers. Additionally, 998 under-immunized children received routine immunizations, of whom 126 were zero-dose children. Key success factors included sustained community health worker engagement, neighborhood-specific strategies, accessible vaccination points, and robust data management. The findings suggest that such integrative strategies can effectively bolster immunization coverage in urban poor communities, offering valuable insights for similar initiatives in the DRC and beyond. ConclusionThis study advocates for sustained investment in innovative immunization models to strengthen primary healthcare systems post-pandemic.

Laryngopharyngeal reflux: knowledge, attitudes, and practices among primary healthcare physicians.

The aim of this study was to estimate the level of knowledge, attitudes, and practices regarding laryngopharyngeal reflux (LPR) among primary healthcare (PHC) physicians in Saudi Arabia. This quantitative cross-sectional study used an online-based questionnaire distributed to physicians in PHC facilities and hospitals in Saudi Arabia. The questionnaire consisted of four sections that provided data on demographics, knowledge, attitudes, and practices. Of the 473 physicians included in the study, one-third were unaware of LPR, and two-thirds were unfamiliar with the reflux symptom index (RSI). The most common sources of LPR knowledge were textbooks and literature (49.8%). The most recognised risk factor, symptom, and complication were high body mass index (75.8%), voice problems (82.4%), and laryngeal cancer (70.6%), respectively. The most recognised diagnostic and treatment options were laryngoscopy (73.5%) and lifestyle modifications (87.3%), respectively, while only 60.4% of participants recognised proton pump inhibitors as a treatment option. Most PHC physicians believed that LPR is underdiagnosed and that primary prevention and awareness among the general population need to be improved. One in three PHC physicians knew nothing about LPR, and two in three were unfamiliar with the RSI. More than half could not recognise all major symptoms of LPR, which might be a cause for concern, as recognising these symptoms is crucial for proper diagnosis. We recommend increasing the education of physicians about LPR, its signs and symptoms, and the RSI, all of which provide valuable clues for diagnosis.

Barriers to Follow-Up of an Abnormal Clinical Breast Examination in Uttar Pradesh, India: A Qualitative Study.

To understand key barriers to diagnostic follow-up for women with an abnormal clinical breast examination (CBE) at the primary care level in the Uttar Pradesh state in India. We also explored acceptability of mobile phones to address barriers to CBE follow-up for women. We conducted 28 semistructured in-depth interviews with 12 women with an abnormal CBE at the primary health facility who did not have diagnostic follow-up, four community health workers, nine health care providers from health facilities in rural and urban settings, and three state-level decision makers. Interviews were audiorecorded, transcribed verbatim, and translated from Hindi to English. Thematic analysis was conducted using Dedoose qualitative software. Themes were organized by multilevel barriers to follow-up. Key barriers to CBE follow-up included knowledge, fear, and stigma about breast cancer; women's health not being prioritized in the family; discomfort seeing male providers; and difficulty navigating the diagnostic facility. Despite community education and outreach efforts by community health workers (known as Accredited Social Health Activists), lack of awareness of breast cancer and the importance of follow-up for abnormal CBE remains a barrier to early detection. Despite widespread access to mobile phones, perceived acceptability varied among stakeholders regarding mobile phone use for breast health education and communication with clients. Knowledge, cultural, and health system barriers challenge women's ability to follow recommendations for diagnostic follow-up of an abnormal CBE. Multilevel and gender-responsive strategies are needed to address these barriers. Our results suggest that mobile phones could be used to further improve breast health awareness, patient navigation, and tracking, and further research is needed.

Effectiveness of a task-sharing collaborative care model for the detection and management of depression among adults receiving antiretroviral therapy in primary care facilities in South Africa: A pragmatic cluster randomised controlled trial

BackgroundHIV is characterised by high rates of comorbidity with mental health conditions including depression, as such, the detection and treatment of comorbid depression is critical to achieve viral load suppression. This study evaluated the effectiveness of a collaborative care intervention for depression among adults with comorbid depression symptoms receiving ART in primary health care (PHC) facilities. MethodsWe conducted a pragmatic cluster-randomised trial in 40 clinics in the North West province of South Africa. PHC clinics were stratified by sub-district and randomised in a 1:1 ratio. Participants were ≥ 18 years, receiving ART, and had depression symptoms indicated by Patient Health Questionnaire-9 (PHQ-9) score ≥ 9. Intervention clinics received: i) supplementary mental health training and clinical communication skills for PHC nurses; ii) workshops for PHC doctors on treating depression; and iii) lay counselling services. Using mixed effects regression models, we assessed co-primary outcomes of PHQ-9 response at 6 months (≥50 % reduction in baseline PHQ-9 score) and viral load suppression at 12 months (viral load<1000 copies/mL). ResultsThe intervention had no effect in PHQ-9 response (49 % vs 57 %, risk difference (RD) = −0.08, 95 % CI = -0.19; 0.03, p = 0.184) or viral load suppression (85 % vs 84 %, RD = 0.02, 95 % CI = −0.01; 0.04, p = 0.125). Nurses referred 4298 clinic patients to counsellors, however, only 66/1008 (7 %) of intervention arm participants were referred to counsellors at any point during the study. LimitationsThe highly pragmatic approach of this trial limited exposure to the counselling component of the intervention and referral to doctors for initiation of antidepressant treatment was extremely low. ConclusionThe trial showed no effect of a district-based intervention to strengthen collaborative care for depression. The trial revealed the extent of the treatment gap in the context of scaling up mental health services. Trial registrationClinicalTrials.gov (NCT02407691); Pan African Clinical Trials Registry (201504001078347).

Intravenous versus oral iron for anaemia among pregnant women in Nigeria (IVON): an open-label, randomised controlled trial

Oral iron for anaemia in pregnancy is often not well tolerated, with poor adherence. Iron administered intravenously might address these tolerance and adherence issues. We investigated the effectiveness and safety of intravenous ferric carboxymaltose versus oral ferrous sulphate on anaemia and iron deficiency among pregnant women in Nigeria. We did a multicentre, open-label, parallel, randomised controlled trial of pregnant women (aged 15-49 years) with haemoglobin (Hb) concentrations of less than 10 g/dL at 20-32 weeks' gestation from 11 primary, secondary, or tertiary health facilities in Nigeria (five in Lagos and six in Kano). Exclusion criteria included vaginal bleeding, blood transfusion or major surgery within the past 3 months, symptomatic anaemia, anaemia known to be unrelated to iron deficiency, clinically confirmed malabsorption syndrome, previous hypersensitivity to any form of iron, pre-existing maternal depression or other major psychiatric illness, immune-related diseases, such as systemic lupus erythematosus or rheumatoid arthritis, or severe allergic reactions. Participants were randomly assigned (1:1) by nurses and doctors using a web-based randomisation service to either receive a single dose of intravenous ferric carboxymaltose (20 mg/kg to a maximum of 1000 mg) or oral ferrous sulphate (200 mg; 65 mg elemental iron) three times daily until 6 weeks postpartum. The study was primarily unmasked. Primary outcomes were maternal anaemia (Hb <11 g/dL) at 36 weeks' gestation and preterm birth at before 37 weeks' gestation, with analysis by intention to treat in participants with available data. This study was registered at the ISRCTN registry on Dec 10, 2020 (ISRCTN63484804) and on ClinicalTrials.gov (NCT04976179) on April 7, 2021. Between Aug 10, 2021, and Dec 15, 2022, 13 724 pregnant women were screened for eligibility. 12 668 were excluded due to ineligibility for inclusion, and 1056 provided consent to participate and were randomly assigned to either the intravenous or oral administration groups. 527 were assigned to the intravenous ferric carboxymaltose group and 529 were assigned to the oral ferrous sulphate group. 518 in the intravenous group were assessed at 36 weeks' gestational age and after 518 deliveries, and 511 completed the 6 weeks postpartum visit. 513 in the oral ferrous sulphate group were assessed at 36 weeks' gestational age and after 512 deliveries, and 501 completed the 6 weeks postpartum visit. No significant difference was found in anaemia at 36 weeks (299 [58%] of 517 in the intravenous group vs 305 [61%] of 503 in the oral group; risk ratio 0·95, 95% CI 0·85-1·06; p=0·36), nor in preterm birth (73 [14%] of 518 vs 77 [15%] of 513; 0·94, 0·70-1·26; p=0·66). There were no significant differences in adverse events. The most common adverse events were diarrhoea (in six participants) and vomiting (in three participants) in the oral group and fatigue (in two participants) and headache (in two participants) in the intravenous group. Although the effect on overall anaemia did not differ, intravenous iron reduced the prevalence of iron deficiency to a greater extent than oral iron and was considered to be safe. We recommend that intravenous iron be considered for anaemic pregnant women in Nigeria and similar settings. Bill & Melinda Gates Foundation.

Evaluating the effects, implementation experience and political economy of primary healthcare facility autonomy reforms within counties in Kenya: a mixed methods study protocol

IntroductionThere is a growing emphasis on improving primary healthcare (PHC) services and granting frontline service providers more decision-making autonomy. In October 2023, Kenya enacted legislation mandating nationwide facility autonomy. There...

An ICT-enabled community oriented primary care intervention in mining communities during COVID-19 (2019–2022): perceived changes in the role and place of community health workers

BackgroundThis is a study of service provider perceptions of the place, role and practices of CHWs in a four-year, large-scale private sector funded, public service ICT-enabled COPC intervention with rural and remote mining communities. Like all South African communities, apart from large mining house employees and some contractors, most people use available public healthcare services and private traditional as well as limited allopathic private sector providers. In addition to the limitations of facility centred primary healthcare and a fragmented health care system, the many negative health effects of mining on the communities, go unattended.MethodsThis is a rapid, qualitative pragmatic study. Using site and participation convenience sampling, 37 semi-structured individual or group interviews were conducted with 57 stakeholders from 38 of the 135 intervention PHC facilities. Using a data driven, inductive approach, the results were analysed thematically in terms of perceived changes in the role and place of CHWs.ResultsCHWs registered 42 490 households and captured the demographic and social profiles as well as the health status of over 154 910 individuals using AitaHealth™. These data provided healthcare professionals and managers with knowledge about community demographics, at-risk groups and vulnerable individuals. The intervention changed the locational focus of CHW practice and expanded their scope of work and competencies in household comprehensive health education, advice and care. It led to a growth in community and professional confidence in CHWs as trusted members of mining community PHC teams and to more focused and efficient clinic work.ConclusionThis ICT-enabled COPC intervention adopted a comprehensive approach to healthcare delivery that started by including CHWs in PHC teams and locating them in communities. Inclusive and systematic continuous learning, clinically-led CHW service support and ICT-enabled information technology engendered trust in CHWs as competent PHC members, and grew community confidence in them and the PHC system as a whole. Although health, care and other professionals and workers valued the changes the intervention brought to their work as well as people’s lives in underserved and vulnerable mining communities, its sustainability is contingent on the vagaries of political will and financial commitment.

Assessment of the compliance with minimum quality standards by public primary healthcare facilities in Nigeria

Achieving universal health coverage (UHC) and the Sustainable Development Goals (SDG) by 2030 relies on the delivery of quality healthcare services through effective primary healthcare (PHC) systems. This necessitates robust infrastructure, adequately skilled health workers and the availability of essential medicines and commodities. Despite the critical role of minimum standards in benchmarking PHC quality, no global consensus on these standards exists. Nigeria has established minimum standards to enhance healthcare accessibility and quality, including the Revised Ward Health System Strategy (RWHSS) by the National Primary Health Care Development Agency (NPHCDA). This paper outlines the evolution of PHC minimum standards in Nigeria, evaluates compliance with RWHSS standards across all public PHC facilities, and examines the implications for ongoing PHC revitalization efforts. The study used a cross-sectional descriptive design to assess compliance across 25 736 public PHC facilities in Nigeria. Data collection involved a national survey using a standardized assessment tool focussing on infrastructure, staffing, essential medicines and service delivery. Compliance with RWHSS minimum standards was found to be below 50% across all facilities, with median compliance scores of 40.7%. Outreach posts had a median compliance of 32.6%, level 1 facilities 31.5% and level 2+ facilities 50.9%. Key findings revealed major gaps in health infrastructure, human resources and availability of essential medicines and equipment. Compliance varied regionally, with the North-west showing the highest number of facilities but varied performance across standards. The lessons learned underscore the urgent need for targeted interventions and resource allocation to address the identified deficiencies. This study highlights the critical need for regular, comprehensive compliance assessments to guide policy-makers in identifying gaps and strengthening PHC systems in Nigeria. Recommendations include enhancing monitoring mechanisms, improving resource distribution and focussing on infrastructure and human resource development to meet UHC and SDG targets. Addressing these gaps is essential for advancing Nigeria’s healthcare system and ensuring equitable, quality care for all.

Primary healthcare nurses' experiences in managing chronic diseases during COVID-19 in the North West province.

The World Health Organization, stated that the coronavirus disease 2019 (COVID-19) pandemic not only affected the socioeconomic well-being of millions but also had adverse effects on public health, particularly in the management of chronic diseases at the primary healthcare (PHC) level. What remained unknown was the experiences of professional nurses(PNs) working in PHC regarding this issue. The study aimed to explore and describe the lived experiences of PHC nurses in managing chronic diseases during the COVID-19 pandemic. The study was conducted in the North West province, South Africa. A qualitative descriptive phenomenological design was employed to collect and analyse data. Face-to-face interviews were conducted and audio recorded with 16 PNs from five high-volume PHC facilities selected purposively. The study's findings reveal four themes: suboptimal care for patients with chronic disease, a lack of resources, mental health challenges experienced by PHC nurses, and stigma and discrimination from both family and community members. The neglect of PHC and its frontline healthcare staff has impeded the mental health of PHC workers and the management of chronic diseases thus any progress made in reducing the burden of chronic diseases is likely to have regressed during the COVID-19 pandemic.Contribution:Policymakers should prioritise strengthening PHC by implementing integrated disease management policies, ensuring ethical clinical standards, providing supportive supervision, fair resource allocation and capacity building for PHC staff. In addition, addressing stigma and discrimination, and raising awareness among families and communities is crucial for future pandemics to effectively manage both chronic and infectious diseases.

Advanced cardiac life support in out-of-hospital cardiac arrest: A case study

Background: Public Health Center (PHC), especially in rural areas, is one of the primary healthcare facilities that have an important role in the chain of survival of out-of-hospital cardiac arrest (OHCA) patients. Despite of limited facilities, prehospital resuscitation can be performed by optimizing the available emergency facilities and infrastructure. Purpose: To provide a comprehensive overview of the resuscitation management of OHCA patients at a PHC in East Java Province in Indonesia. Method: Case study of a 43-year-old woman who was brought to PHC by residents after suddenly losing consciousness while working. The clinical condition when the patient arrived was unresponsive, no pulse, no respiratory effort, cold extremities, and oxygen saturation of 80%, the patient was medically diagnosed as OHCA. Results: Resuscitation organization was carried out by involving 1 doctor, 2 nurses, and 1 midwife. The patient was given basic life support (BLS) and Advanced Cardiac Life Support (ACLS) by optimizing diagnostic tools, airway, breathing, circulation, and available drugs. The patient successfully Return of Spontaneous Circulation (ROSC) after the third cycle and successfully reached the referral hospital to receive further life support. Conclusion: ACLS in the prehospital setting at PHC in Indonesia has a potential to be performed. Inter-professional collaboration, airway, breathing, and circulation optimization in providing BLS and ACLS on OHCA patients can increase the patient's chance of getting further care in the hospital.

Care-seeking pathways and treatment practices for snakebite in Odisha, India

PurposeSnakebites represent a pressing global public health concern, with India shouldering a disproportionate burden and often dubbed the "snakebite capital." Traditional and spiritual healing methods prevail in India, yet their efficacy and potential adverse health consequences warrant investigation. This study seeks to elucidate the perspectives of healthcare providers and caretakers regarding snakebite treatment practices, with a specific emphasis on traditional healing modalities.MethodsAn exploratory study was conducted among ten healthcare providers–five traditional and five modern treatment providers, two snake trappers/catchers and 120 snakebite victims or their caretakers across three districts of Odisha, India. Data were collected through in-depth interviews and analysed using content analysis.ResultsThe analysis revealed five main categories: various snakebite treatment practices, care-seeking pathways of victims, perspectives of patients and caretakers on treatment, traditional healers’ views on modern treatment, and allopathic doctors’ views on traditional treatment. Treatment practices observed included allopathic treatment, cold treatment, spiritual healing practices at temples, brass plate treatment, mantra enchanting, herbal treatment, and self-medication. Reasons for treatment delay included strong community beliefs in traditional healing, lack of control over irrational treatment by traditional healers, suboptimal care at primary and secondary healthcare facilities, and poor community literacy on snakebites.ConclusionsThe study emphasizes the need for improved snakebite preparedness strategies, community literacy, active involvement in prevention programs, and strong political commitment to control irrational treatment practices.

Primary Healthcare Physicians' Insufficient Knowledge Is Associated with Antibiotic Overprescribing for Acute Upper Respiratory Tract Infections in China: A Cross-Sectional Study.

Overuse of antibiotics in healthcare remains prevalent and requires urgent attention in China, particularly in primary healthcare (PHC) facilities. This study aimed to describe the patterns of antibiotic prescriptions for acute upper respiratory tract infections (URTIs) in PHC facilities in China and to investigate how PHC physicians' knowledge influences their antibiotic prescribing behavior. A cross-sectional survey linking physician questionnaire responses and their prescription data was conducted in Shaanxi Province, China. The proportions of URTI visits that received at least one antibiotic, combined antibiotics, and broad-spectrum antibiotics were the main outcomes reflecting antibiotic prescribing behavior. Multivariate mixed-effects logistic regressions were applied to analyze the relationship between PHC physicians' knowledge about antibiotics and their antibiotic prescribing behavior. A total of 108 physicians filled out the questionnaires between February 2021 and July 2021, and a sample of 11,217 URTI visits attended by these physicians from 1 January 2020 to 31 December 2020 were included in the analysis. The overall mean score of our respondents on the knowledge questions was 5.2 (total score of 10). Over sixty percent (61.2%; IQR 50.2-72.1) of the URTI visits received antibiotics. The percentages of URTI visits prescribed with combined and broad-spectrum antibiotics were 7.8% (IQR 2.3-10.2) and 48.3% (IQR 36.7-58.7), respectively. Third-generation cephalosporins were the most frequently used antibiotics. Physicians with lower antibiotic knowledge scores were more inclined to prescribe antibiotics (p < 0.001), combined antibiotics (p = 0.001), and broad-spectrum antibiotics (p < 0.001). Physicians' insufficient knowledge was significantly associated with antibiotic overprescribing. Professional training targeting physicians' knowledge of antibiotics is urgently needed to improve the rational use of antibiotics in grassroots healthcare facilities in China.

Adjusting for quality of care in primary health care utilization and benefits in Bihar, India: A Benefit Incidence Analysis

India’s public health policies prioritize the least wealthy and vulnerable. Additionally, for Primary Health Care (PHC) to achieve equitable health outcomes, all must receive high-quality care. This study determined equality of utilization and benefit incidence of PHC services across socioeconomic (SE) groups in Bihar, with and without adjusting for quality of care. It used secondary data from linked PHC facility and household surveys in Bihar that included information on PHC facility utilization, quality of care and household expenditure patterns. Lorenz curves and concentration indices were constructed to examine relative distribution of utilization and benefits from public sector PHC services by SE status, before and after adjusting for quality of care using quality weights. We found that relative distribution of public sector PHC utilization, total and net benefits was statistically no different from perfect equality. With quality weights, utilization and benefits of PHC facilities in Bihar were slightly more pro-rich but statistically no different from perfect equality. The wealthiest do not disproportionately benefit from public sector PHC facilities, but neither do the least wealthy.In conclusion, relative utilization and benefits of public sector PHC facilities were equally distributed across socioeconomic groups in Bihar. Benefits from public sector PHC facilities are not disproportionately concentrated among the least wealthy in the community. As the Ayushman-Bharat Health and Wellness Centers are strengthened to improve public sector PHC services, it would be important to target its benefits towards the least wealthy by ensuring services are accessible and amenable.

Self-care practices among professional nurses employed in primary health care clinics

Background: Professional nurses typically promote and advocate self-care practices to their patients to achieve better health outcomes, but rarely engage in these practices themselves.Methods: A qualitative, descriptive phenomenological approach was used in this study. Ten professional nurses employed in different primary health care facilities were purposively sampled. Semi-structured interviews were conducted to collect data, which were analysed using Colaizzi’s data analysis strategy, and data saturation was reached.Results: Two themes were identified. Theme 1: the participants expressed that internal and external factors compromised self-care practices, such as subconscious self-neglect, insufficient resources, and a depressed economy, which encouraged them to work extended hours. Theme 2: participants’ holistic well-being was compromised, as they neglected their mental well-being.Conclusion: Self-care practices among professional nurses seem unachievable. The extent of this population’s self-care neglect was evident during the coronavirus disease 2019 (COVID-19) pandemic when professional nurses globally gave of themselves relentlessly.Contribution: This is the first study conducted on the topic in the City of Ekurhuleni, and the findings will provide relevant stakeholders with a directive on what strategies, policies, and guidelines to develop and implement to make self-care practices attainable for professional nurses.

The current situation of health equity in underserved areas of Afghanistan.

In Afghanistan, providing universal health coverage (UHC) in accordance with the principles of the UHC declaration is challenging on two fronts: the geographic topography of the country and the prevailing gender dynamics within the local culture. We conducted a desk review of underserved areas in the context of health services by gathering and analyzing existing literature, reports, and data using a combination of keywords and phrases such as: "underserved areas," "healthcare disparities," "access to healthcare," and "health services." The primary data were derived from an analysis of underserved populations conducted by the World Health Organization (WHO) Afghanistan's Emergency Program, supplemented by information from in-country partners. In addition to other reports, this review focused on analyzing the geographical availability of primary healthcare (PHC) services by employing the guidelines set forth in the SPHERE framework. It also took into account the social dynamics within the Afghan population that may create barriers to equity in terms of demand and access to PHC services. Although there are a significant number of primary healthcare facilities in operation (4,242), they are unevenly distributed across different regions of Afghanistan, resulting in almost 25% of the population being underserved. The underserved population is nearly equally distributed between genders, with the majority residing in rural communities. Women of childbearing age represent 28% of the underserved population. Children under the age of five represent 16-18% of the underserved population in all regions, except in the western region, where they represent between 12 and 13%. Individuals over 60 years of age represent 1-3% of the underserved population across all regions. More than 50% of the population in the Central Highlands of Afghanistan is underserved, followed by the western and southern regions. Ghor province in the western region has the highest proportion of underserved populations, followed by Zabul province in the southern region. Afghanistan is currently experiencing a protracted humanitarian crisis, with millions of people living in poverty and lacking access to healthcare. This situation exposes them to serious risks such as disease epidemics, starvation, and maternal and child mortality. It is crucial to implement alternative strategies to reach the most affected populations and to increase funding for the delivery of healthcare services in Afghanistan.

Evaluation of Home Healthcare Services By Service Providers and Users

Background: On May 15, 2017, the Turkish Ministry of Health transferred the coordination and delivery of home healthcare services from primary healthcare facilities to hospitals. Objective:This study aims to find out what the patients, their families, and home healthcare providers think about this organizational change that has been made to the service delivery process. Methods: In the quantitative research, the survey created using the results of qualitative research was administered to 396 individuals, comprising 322 patients or their relatives and 74 medical staff members. The survey's reliability was assessed using Cronbach's alpha coefficient, its validity was assessed using exploratory and confirmatory factor analyses, and the t-test was used to test the hypotheses. Results: Following the transfer of home health service delivery and coordination from primary healthcare institutions to hospitals, it was found that visit frequency-satisfaction, equity, monitoring-evaluation, and socio-economic support were the dimensions in which patients and their relatives participated more than healthcare personnel. However, compared to patients or patient relatives, healthcare personnel participate more in the areas of access to services, personnel-financial support, and private sector-security support. Conclusions: According to these findings, it is noteworthy that both groups have a much higher level of participation in issues that directly concern them. Thus, it is believed that improving the problems that clients and staff find objectionable will enhance home health services. Keywords: Home care; healthcare providers; healthcare users; primary healthcare; hospitals

Diarrheagenic Escherichia coli in Stool Specimens Collected from Patients Attending Primary Healthcare Facilities in Ethiopia: Whole-Genome Sequencing-Based Molecular Characterization.

The diarrheagenic Escherichia coli (DEC) is the major cause of diarrheal diseases in Africa, including Ethiopia. However, the genetic diversity of E. coli pathotypes found in Ethiopia has not been studied well. This study aimed to characterize potential DEC belonging to enteropathogenic (EPEC), Shiga toxin-producing (STEC), enteroaggregative (EAEC), enterotoxigenic (ETEC), and enteroinvasive (EIEC) E. coli pathotypes from stool specimens of patients attending primary healthcare units (n = 260) in Addis Ababa and Hossana using whole-genome sequencing. Real-time PCR assays were used to identify DEC isolates belonging to EPEC, STEC, EAEC, ETEC, and EIEC pathotypes, which were then subjected to whole-genome sequencing on the Illumina platform. Twenty-four whole-genome nucleotide sequences of DEC strains with good enough quality were analyzed for virulence-associated genes (VAGs), antibiotic resistance genes (ARGs), phylogenetic groups, serogroups, and sequence types. The majority (62.5%) of DEC isolates belonged to the phylogenetic group B1. The identified DEC isolates belonged to 21 different serogroups and 17 different sequence types. All tested DEC isolates carried multiple VAGs and ARGs. The findings highlight the high diversity in the population structure of the studied DEC isolates, which is important for designing targeted interventions to reduce the diarrheal burden in Ethiopia.

Water, sanitation, hygiene, and waste management in primary healthcare facilities in war-torn Tigray, Ethiopia: implications for infection prevention and control

BackgroundWater, sanitation and hygiene (WASH) and infection prevention and control (IPC) are compromised during emergencies and in the post-conflict period. The IPC-WASH status of primary healthcare facilities in Tigray, Ethiopia, is not known. The aim of the study was to assess the IPC-WASH status of facilities in war-torn Tigray, Ethiopia. MethodsAs part of a cross-sectional study, data were collected from January to February 2024 in 32 randomly selected primary healthcare facilities using an electronic Open Data Kit (ODK) based on a questionnaire. A descriptive analysis was conducted to describe the IPC-WASH services. The analyzed data were compared with the Joint Monitoring Program (JMP) service ladders and presented in texts, figures and tables. ResultsNearly seven out of ten primary healthcare facilities had improved water sources, nine out of ten had latrines with limited sanitation facilities, and four out of ten had handwashing facilities. Eight out of ten facilities had no access to personal protective equipment, and most facilities surveyed had very limited waste management services, IPC capacity building and IPC committee. According to JMP service ladders, almost one in four primary healthcare facilities had basic water supply, one in ten had basic sanitation, basic hygiene and basic waste disposal. ConclusionsThe overall result of the study shows that access to IPC-WASH is low in primary healthcare facilities in war-torn Tigray, Ethiopia. Collaborative efforts to improve access to basic IPC-WASH facilities and IPC capacity building are essential to improve the quality of care.

Health System Structural Factors Associated with Use of Scorecard to Improve RMNCAH Performance Indicators in Public Primary Health Facilities in Kenya

Purpose: Researchers looked into how the structure of the health system affects the use of scorecards to boost reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Kenya's Kwale and Kilifi Counties' public primary health facilities. Specifically, this includes use of the RMNCAH indicators, trainings received on RMNCAH indicators, and factors associated with the utilization of the RMNCAH indicators. Materials and Methods: We conducted a cross-sectional study to gather quantitative data from 119 primary healthcare workers in chosen public primary facilities via one-on-one interviews. We collected data using tablets and the Kobo Collect app. Findings: The findings revealed that 89% of the selected facilities analyzed RMNCAH variables, whereas only 13% used scorecards at the time of the study. The study found that 75% of the facilities that used scorecards did not indicate the specific type of scorecard they received training on. Further research revealed a relationship between scorecard type and utilization (p&lt;0.001, χ2= 2.365), with 84% of facilities analyzing RMNCAH indicators on a monthly basis, focusing on immunization and family planning. However, 63% of healthcare workers rated the health system's structures as either low or poor. Only 11% of facilities had monitoring and evaluation budgets, yet 78% had RMNCAH indicator targets. While most public primary facilities analyze RMNCAH indicators, only a small percentage of these facilities use scorecards due to barriers such as limited training on different types of scorecards, a lack of monitoring and evaluation budget commitments, and poor structural components of the health system Implications to Theory, Practice and Policy: While facilities appreciate the availability of RMNCAH indicators, still the main focus is on immunization and family planning, hence the need for a more comprehensive monitoring of all RMNCAH indicators.

Association between malaria parasitemia with usage of insecticide-treated nets (ITNS) among pregnant and nursing mothers accessing Lokuwa Primary Health Care (PHC) facility, Mubi, Nigeria

Association between malaria parasitemia with usage of insecticide-treated nets (ITNS) among pregnant and nursing mothers accessing Lokuwa Primary Health Care (PHC) facility, Mubi, Nigeria