Primary Health Care Facilities Research Articles

Primary Healthcare Workers' Awareness of Acute Rheumatic Fever & Rheumatic Heart Disease: A Study in Public Health Facilities in South Western Uganda.

Timely identification and treatment of a streptococcal throat infection prevents acute rheumatic fever (ARF) and its progression to Rheumatic Heart Disease (RHD). However, children in developing countries still present with established RHD, due to either missed, untreated or sub-optimally treated sore throats and ARF. We aimed to determine the level of knowledge, skills, and practices of primary health workers in South Western Uganda in providing care such children. We conducted a comparative quantitative cross-sectional study to assess knowledge, practices, and skills regarding the care of a child with a sore throat, ARF, and RHD. The responses were scored against a structured guide. The Fisher's exact test and the chi-squared test with level of significance set at 0.05 were utilized to compare differences in knowledge, skills, and practices among health workers in private and public health facilities about ARF and RHD. Eighty health workers from health facilities were interviewed in Mbarara district with a median age of 29.5 years (IQR 27.34) and median duration in practice of 5 years (IQR: 2, 10). On average, there were at least 3 children with sore throats weekly. At least 95% (CI: 87.25%-98.80%) of the health worker had awareness about ARF and RHD. Only 43.75% (95% CI: 33.18%-54.91%) had good knowledge about ARF and RHD. Majority, 61.25% (95% CI: 50.03%-71.39%) did not know the proper prophylaxis and investigations for a child with ARF. There were no statistically significant differences but a clinically meaningful differentials in the level of knowledge among health workers in public and private facilities. The knowledge and skill level of health workers in primary healthcare facilities about ARF and RHD in South Western Uganda remains low, with no difference between practitioners in public and private facilities.

Integrating eye care into primary healthcare in Nigeria: Challenges of the primary healthcare workforce

AbstractVisual impairment and blindness pose a significant and growing public health threat in Nigeria. Over 1.6 million Nigerians are visually impaired or blind, with more than 80% of these cases being preventable and treatable. The risk for ocular morbidities is expected to increase due to rapid population growth, an aging population, and the rising burden of noncommunicable diseases. Despite efforts to improve eye health services, universal eye health remains elusive, with 35% of Nigerians unable to access eye care in primary healthcare (PHC) facilities. Many Nigerians instead turn to traditional and alternative medicine for primary eye care (PEC), which can worsen their outcomes. This article highlights the potential of the country's PHC system to address these challenges, emphasizing the importance of PEC as an integral part of PHC. The article discusses the various challenges faced by PHC workers in delivering eye care services in Nigeria, focusing on financing, training, leadership, and policies for eye care. It also provides a set of comprehensive recommendations aimed at overcoming these challenges, including improved leadership and policy implementation, optimized financing, strengthened collaborations and partnerships, enhanced education and training, and effective human resource management systems. We emphasize the importance of holistic and strategic efforts to bolster the PHC workforce's capacity to provide universal eye healthcare in Nigeria, ultimately improving access to high‐quality eye care services for all.

Job Satisfaction and Associated Factors Among Primary Healthcare Workers: A Cross-Sectional Study From Qassim Region, Saudi Arabia.

Background The healthcare sector is one of the most important sectors in any country. Any disruption in the productivity of the workforce majorly affects healthcare entities. Job satisfaction directly interferes with the individual's productivity. Hence, the job satisfaction of healthcare workers (HCWs) is a fundamental issue to discuss, investigate, and study to improve the outputs to their maximal levels, especiallyif limited studies are done in this regard. Methodology A descriptive, cross-sectional, facility-based study was conducted among 302 HCWs in 30 primary healthcare centers (PHCCs) in the Qassim region, Saudi Arabia, using a pretested, validated, electronically self-administered "Satisfaction of Employees in Health Care" (SEHC) questionnaire. Our sample included physicians, nurses, pharmacists, dental workers, and lab and radiology technicians. Data were analyzed using SPSS version 29 (IBM Corp., Armonk, NY). Results The mean score of the overall perception of job satisfaction in primary healthcare staff was 3.9 (±1.01) out of one to five scale questions. This implies a high satisfaction in 71.2% (n = 215) of the sample. Nurses expressed the highest satisfaction with their roles, comprising 26.5% (n = 80)who reported high satisfaction. Second in line were physicians, demonstrating high satisfaction levels with 14.2% (n = 43). The third place was for lab technicians, 4.6% (n = 14) of whom expressed high satisfaction. Many factors were found to be significantly statistically associated with job satisfaction, including gender (p = 0.015), age (p = 0.001), job rank (p = 0.027), number of patients seen per day (p = 0.002), type of primary healthcare duty (p = 0.042), and health workers' years of experience (p = 0.000). Conclusion The study revealed that HCWsat primary healthcare facilities in the Qassim region, Saudi Arabia, were highly satisfied with their jobs. Significant statistical relationships were found between job satisfaction and factors such as years of experience, type of duty in PHCCs, and number of attendees per day. To improve HCWs' job satisfaction, we recommend that they receive additional organizational support and response to feedback, a reduced workload achieved through increased staffing, and flexible work shifts. We also recommend investigating satisfaction in the private healthcare sector.

Gestational weight gain and adverse birth outcomes in South African women with HIV on antiretroviral therapy and without HIV: a prospective cohort study.

Outside of pregnancy, evidence shows that persons with HIV initiating or switching to dolutegravir (DTG)-based antiretroviral therapy (ART) experience greater weight gain compared to those on other ART classes. However, there are few data on the impact of DTG-based ART on gestational weight gain (GWG) in sub-Saharan Africa where HIV is most common. According to the National Academy of Medicine (NAM), GWG below and above NAM guidelines is associated with adverse birth outcomes. Therefore, the objective of this study was to describe GWG by HIV status and ART regimen, and examine the associations with adverse birth outcomes. We enrolled pregnant women with HIV (WHIV) and without HIV (≥18 years) in a peri-urban primary healthcare facility in Cape Town, South Africa between 2019 and 2022. GWG was study-measured at 24-28 (baseline) and 33-38 weeks gestation and converted to GWG rate (kg/week) in accordance with NAM guidelines. GWG z-scores were generated using the INTEGROWTH-21 and US standards to account for differing lengths of gestation. Birth outcome data were obtained from medical records. Associations of GWG z-score with adverse birth outcomes were assessed using multivariable linear or log-binomial regression. Among 292 participants (48% WHIV), median age was 29 years (IQR, 25-33), median pre-pregnancy body mass index (BMI) was 31 kg/m2 (IQR, 26-36) and 20% were primiparous at baseline. The median weekly rate of GWG was 0.30 kg/week (IQR, 0.12-0.50), 35% had GWG below NAM standards (59% WHIV) and 48% had GWG above NAM standards (36% WHIV). WHIV gained weight more slowly (0.25 vs. 0.37 kg/week, p<0.01) than women without HIV. Weekly rate of GWG did not differ by ART regimen (DTG-based ART 0.25 vs. efavirenz-based ART 0.27 kg/week, p = 0.80). In multivariable analyses, GWG z-score was positively associated with continuous birth weight (mean difference = 68.53 95% CI 8.96, 128.10) and categorical high birth weight of >4000 g (RR = 2.18 95% CI 1.18, 4.01). Despite slower GWG among WHIV, nearly half of all women gained weight faster than recommended by the NAM. GWG was positively associated with infant birth weight. Interventions to support healthy GWG in sub-Saharan Africa are urgently needed.

Community-led monitoring and the role of Ritshidze in improving the quality of primary healthcare in South Africa.

Community-led monitoring (CLM) of health services is a mechanism of community participation and accountability that is increasingly advocated across the globe. In South Africa (SA), a large-scale community-led monitoring initiative called Ritshidze ('saving our lives') was established in 2019. Steered by a coalition of civil society organisations representing people living with HIV, Ritshidze monitors just over 400 primary healthcare (PHC) facilities in 8 provinces on a quarterly basis. In this piece we describe the purposes and design features and the five-step approach to CLM of the Ritshidze model. We also highlight some of the positive changes achieved, and reflect on possible reasons for successes. In doing so, we aim to draw attention to this significant national initiative and its potential as a mechanism of social accountability in SA.

Effect of Passive Energy Efficiency Measures in Designing Sustainable Primary Healthcare Facilities in Nigeria

This study aims to develop a design for a sustainable healthcare centre through passive energy efficiency measures to improve the thermal comfort, cooling, lighting and ventilation requirements for primary healthcare centres in Nigeria. The methodology adopted for the study included both primary and secondary data collection. Primary data were collected from the administered questionnaire (5-point Likert scale closed-ended), a total of 350 sets of questionnaires administered and 87% were valid. A case study research strategy was adopted to ascertain the effectiveness and efficiency of building design with an emphasis on sustainable architectural design principles. A significant regression equation was revealed (F (2,257) = 33.619, p &lt;.000, with an R2 of 0.294, which revealed that implementing passive measures for energy optimization has a significant and positive effect on designing sustainable healthcare centres. It further recommends the integration of passive design, design for deconstruction, adaptive reuse, and design for human comfort as part of architectural design principles that would result in sustainable energy optimization should be adopted in every design of primary healthcare centres by architects.

Non-uptake of COVID-19 vaccines and reasons for non-uptake among healthcare workers in Uganda: a cross-sectional study

BackgroundVaccines play a crucial role in eradicating and containing disease outbreaks. Therefore, understanding the reasons behind vaccine refusal and associated factors is essential for improving vaccine acceptance rates. Our objective was to examine the determinants of COVID-19 vaccine non-uptake and explore the reasons for non-uptake among healthcare workers (HCWs) in Uganda.MethodsBetween July and August 2021, we conducted a cross-sectional study among healthcare workers in primary healthcare facilities (private and government) in Entebbe Municipality, Uganda. Participants were recruited using convenience sampling, and consenting individuals received credentials to access an electronic database and complete a structured questionnaire. There were no established HCWs contact registers in the municipality, and the study was conducted during a national lock down, therefore, the HCWs who were on duty at the time of the study were approached. The survey questions were based on the ‘3Cs’ model of vaccine hesitancy and focused on confidence, convenience, and complacency factors. Non-uptake of vaccines was defined as not having received any of the available vaccines in the country. We employed counts, percentages, and simple logit models to summarize the reasons for non-uptake of COVID-19 vaccines and to identify associated factors.ResultsThe study recruited 360 HCWs, 61.7% of whom were female, with an average age of 31 years (SD = 7.9). Among them, 124 (34.4%) healthcare workers did not receive any COVID-19 vaccine. Non-uptake of COVID-19 vaccines was independently associated with several factors, including age [35 + years adjusted odds ratio (aOR) = 0.30, 95% CI: 0.13–0.66 compared with 18–24 years], facility ownership [government, aOR = 0.22 (0.10–0.49) compared with private not-for-profit], previous testing for coronavirus [yes, aOR = 0.35 (0.19–0.65)], and previous involvement in COVID-19 vaccine activities [yes, aOR = 0.17 (0.10–0.29)]. The primary reasons cited for non-uptake of COVID-19 vaccines were related to a lack of confidence in the vaccines, such as concerns about side effects (79.8%) and the need for more time to understand the vaccines (89.5%), as well as the importance of weighing benefits and risks (84.7%) before being vaccinated. A smaller proportion, approximately 23%, cited reasons related to complacency and lack of convenience in accessing vaccination services.ConclusionThe high proportion of non-uptake of COVID-19 vaccines among this population primarily stems from a lack of confidence and trust in the vaccines, coupled with insufficient time allowed for users to make informed decisions. This underscores the urgent need for ongoing monitoring and trend analysis of vaccine non-uptake to guide the development and implementation of strategies aimed at building and sustaining vaccine confidence. Adequate time should be allowed to explain benefits of vaccination to the population to allay fears that might exist before actual vaccination is rolled out.

Management of iron deficiency anemia during pregnancy: a midwife-led continuity of care model

BackgroundGlobally, 36.5% of pregnancies are affected by anemia, particularly in low-and middle-income countries, posing significant risks to maternal and perinatal health. In rural Pakistan, 44.3% of pregnant women suffer from iron deficiency, contributing to the high prevalence of anemia. Limited accessibility to antenatal care exacerbates the challenge, necessitating innovative solutions. This study assessed a midwife-led continuity of care model, utilizing intravenous (IV) iron therapy for the management of anemia in Karachi, Pakistan.MethodsWe performed a retrospective analysis of data from a prospective cohort study conducted in two primary healthcare facilities, which employed a community midwife (CMW)-led continuity of care model for antenatal care, including IV iron therapy. We extracted data from February 2021 to March 2022 for women who were diagnosed with anemia based on hemoglobin (Hb) levels, categorized as mild (10.0 to 10.9 g/dL), moderate (7.0 to 9.9 g/dL), or severe (less than 7.0 g/dL). Assessment occurred at the initial antenatal care (ANC) visit to establish baseline anemia severity, and approximately 2 weeks after intravenous (IV) iron therapy administration to evaluate post-treatment changes were considered.ResultsWe enrolled 114 pregnant women, where the majority presented with moderate (88.6%) anemia. After IV iron treatment, 48.5% improved to normal-mild levels, while 50% remained unchanged. Severe anemia affected 10.5% at baseline; 42% shifted to moderate and 50% to normal-mild post-treatment, with one remaining unchanged (p &amp;lt; 0.001). Among women enrolled in the first and second trimesters, severe anemia improved to normal-mild (50%) and moderate levels (50%) (pre-treatment: n = 10, post-treatment: n = 0), and moderate anemia decreased by 48% (pre-treatment: n = 92, post-treatment: n = 47).ConclusionOur midwife-led model of care demonstrated an improvement in iron levels among pregnant women. The model addressed the challenges of anemia prevalence in Pakistan and underscored the significance of empowering front-line healthcare providers, such as community midwives (CMWs) for managing these common conditions.

Attitude and concerns on antenatal pelvic floor exercises among pregnant women in Ibadan, Nigeria.

Several studies had investigated the importance and benefit of pelvic floor exercises (PFEs) to the pregnant women and their unborn babies, however, the concerns of antenatal women on the exercise have been sparsely investigated. This study examined the attitude and concerns of pregnant women towards engaging in PFEs in Ibadan, Nigeria. This was cross-sectional study of pregnant women aged ≥15 years. Participants were recruited at primary, secondary and tertiary health facilities. A face-to-face interview was conducted using a structured questionnaire with open and close-ended questions for data collection. Bivariate analysis was performed using chi-square and Fisher's exact test to investigate the association between categorical variables. Multivariate analysis was performed with log-binomial and multinomial regressions to select significant variables that affect the attitude of pregnant women. Of the 373 pregnant women recruited, 118 had ever practiced PFEs. A little below average (43%) performed PFE for less than 3 days a week. Ability to have easy childbirth was the most common motivator for practicing PFE. Participants were most concerned about abdominal pain. No association between any of the factors and participants' attitudes. Though there was a positive attitude of pregnant women towards the PFE but the practice was low. This might be due to inadequate availability of information. We recommend health promotional messages to encourage pregnant women to engage in PFE as part of antenatal messages for healthy living.

Healthcare Students' Perceptions of the Quality of the Clinical Learning Environment in Morocco: A Cross-Sectional Study.

The clinical learning environment (CLE) is critical for developing the practical skills needed in healthcare professions. This study aimed to evaluate healthcare students' perceptions of the quality of the CLE using the Arabic version of the Clinical Learning Environment, Supervision and Nurse Teacher (ar. CLES + T) scale. The study also aimed to evaluate the tool's measurement invariance and compare perceptions among student groups. This cross-sectional study was carried out at two health education institutes in Morocco throughout the academic year 2018-2019 among 1550 undergraduate students who had just finished a clinical practicum in a hospital or primary healthcare facility. Data were gathered using the ar. CLES + T scale. Confirmatory factor analysis (CFA) and multigroup CFA were performed. The measurement invariance of the ar. CLES + T scale was assessed across gender, study year, and clinical practicum duration, using configural invariance, metric invariance, scalar invariance, and strict invariance. The t-test and analysis of variance were used to compare the mean scores of the student groups. Students expressed positive perceptions toward the CLE. The "Pedagogical atmosphere on the ward" dimension scored the highest, while the "Role of the nurse teacher" dimension received the lowest scores. The measurement invariance of the ar. CLES + T scale by gender, study year, and clinical practicum duration was established. First-year students and those with an extended practicum period were the most satisfied. To promote effective learning in the clinical environment, nurse teachers might use innovative teaching approaches tailored to their evolving role in these settings. Moreover, extending the duration of clinical practicum can further enhance student learning outcomes.

Primary health care preparedness to integrate diabetes care in Blantyre, Malawi: A mixed methods study.

There is limited access to diabetes care services at primary care facilities in Malawi. Assessing the capacity of facilities to provide diabetes care is an initial step to integrating services at primary care. To assess the preparedness for delivering diabetes services at primary care level within the Blantyre District Health Office (DHO) to support the response to NCD epidemic in Malawi. Blantyre DHO primary care facilities. A mixed methods approach nested in a national needs assessment for NCD response in Malawi was used. Fourteen primary healthcare facilities from Blantyre DHO were assessed. A tool adapted from the WHO rapid assessment questionnaire was used to identify human resource, equipment, supplies, and medication needed for comprehensive diabetes care. Descriptive statistics were done to analyze the quantitative data. Fisher's exact test was used to assess if there was a statistically significant difference between urban and rural facilities. Seventeen health care workers from the selected facilities participated in key informant interviews. Framework analysis method guided the qualitative data analysis. The quantitative and qualitative data were merged and displayed jointly. The quantitative assessment showed that none of the facilities assessed had capacity to provide all the interventions recommended by WHO for diabetes care at primary level. Eight (57%) of the facilities had the capacity to diagnose diabetes, monitor glucose, prevent limb amputations and manage hypoglycemia and hyperglycemia. Four themes emerged from the qualitative data: differences in level of preparedness and implementation of diabetes care; disparities in resources between urban and rural facilities; low utilization of diabetes services; and strategy and policy recommendations for improvement of diabetes care. Inadequate health financing resulted in significant disparities in the available resources between the rural and urban facilities to offer diabetes care services. There is need to develop national policies and guidelines for diabetes care to strengthen the capacity of primary care facilities to facilitate achievement of universal health coverage.

Pregnancy outcomes following non-screening of tuberculosis at primary healthcare facilities.

In South Africa, tuberculosis (TB) screening should be offered to all pregnant women at each antenatal care (ANC) visit. Therefore, access to TB screening for women and their families is crucial through maternity and child health services. The study aimed to explore the repercussions of the non-screening of TB among pregnant women in the Capricorn District of Limpopo province. The study was conducted in the selected primary healthcare facilities in the Capricorn District, Limpopo province, at selected primary healthcare facilities. Midwives employed within the primary healthcare facilities of Limpopo, offering ANC to pregnant women comprised the population. The study was carried out using a qualitative exploratory research methodology. Ten participants were selected using purposive sampling method. As a result of limitations on coronavirus disease, data were gathered through in-depth, semi-structured virtual interviews with individual participants. Data analysis was employed manually using Tesch's method. Two themes emerged from the data analysis: obstetric outcomes because of non-screening of TB and suggestions to enhance TB screening during ANC. The study's findings revealed that non-screening of TB among pregnant women may lead to severe pregnancy outcomes for both the mother and the unborn child should the woman be suffering from TB. The Department of Health may employ the results of this study to develop strategies that might be implemented to enhance TB screening among pregnant women and improve pregnancy outcomes for women diagnosed with TB.

Behavioural support and nicotine replacement therapy for smokeless tobacco cessation in Bangladesh, India and Pakistan: A pilot randomized controlled trial.

Smokeless tobacco (ST) use in South Asia is high, yet interventions to support its cessation are lacking. We tested the feasibility of delivering interventions for ST cessation in South Asia. We used a 2× 2 factorial design, pilot randomized controlled trial with a duration of 26 weeks, including baseline and follow-up (6, 12 and 26 weeks) assessments. Two primary health-care facilities each in Dhaka (Bangladesh) and Karachi (Pakistan) and a walk-in cancer screening clinic in Noida (India) took part. Adult daily ST users willing to make a quit attempt within 30 days. Of 392 screened, 264 participants [mean age: 35 years, standard deviation = 12.5, 140 (53%) male] were recruited between December 2020 and December 2021; 132 from Bangladesh, 44 from India and 88 from Pakistan. Participants were randomized to one of three treatment options [8-week support through nicotine replacement therapy (NRT, n= 66), a behavioural intervention for smokeless tobacco cessation in adults (BISCA, n= 66) or their combination (n= 66)] or the control condition of very brief advice (VBA) to quit (n= 66). Recruitment and retention, data completeness and feasibility of intervention delivery were evaluated. Biochemically verified abstinence from tobacco, using salivary cotinine, was measured at 26 weeks. Retention rates were 94.7% at 6 weeks, dropping to 89.4% at 26 weeks. Attendance in BISCA pre-quit (100%) and quit sessions (86.3%) was high, but lower in post-quit sessions (65.9%), with variability among countries. Adherence to NRT also varied (45.5% Bangladesh, 90% India). Data completion for key variables exceeded 93% among time-points, except at 26 weeks for questions on nicotine dependence (90%), urges (89%) and saliva samples (62.7%). Among follow-up time-points, self-reported abstinence was generally higher among participants receiving BISCA and/or NRT. At 26 weeks, biochemically verified abstinence was observed among 16 (12.1%) participants receiving BISCA and 13 (9.8%) participants receiving NRT. This multi-country pilot randomized controlled trial of tobacco cessation among adult smokeless tobacco users in South Asia demonstrated the ability to recruit and retain participants and report abstinence, suggesting that a future definitive smokeless tobacco cessation trial is viable.

Barriers and facilitators to community acceptability of integrating point-of-care testing to screen for sickle cell disease in children in primary healthcare settings in rural Upper East Region of Northern Ghana.

Sickle cell disease (SCD) remains a public health problem especially in sub-Saharan Africa including Ghana. While pilot initiatives in Africa have demonstrated that neonatal screening coupled with early intervention reduces SCD-related morbidity and mortality, only 50-70% of screen-positive babies have been successfully retrieved to benefit from these interventions. Point-of-care testing (POCT) with high specificity and sensitivity for SCD screening can be integrated into existing immunization programs in Africa to improve retrieval rates. This study explored community acceptability of integrating POCT to screen for SCD in children under 5 years of age in primary healthcare facilities in Northern Ghana. This was an exploratory study using qualitative research approach where 10 focus group discussions and 20 in-depth interviews were conducted with community members and health workers between April and June 2022. The recorded interviews were transcribed verbatim after repeatedly listening to the recordings. Data was coded into themes using QSR Nvivo 12 software before thematic analysis. Most participants (70.9%) described SCD as serious and potentially life-threatening condition affecting children in the area. Of 148 community members and health workers, 141 (95.2%) said the screening exercise could facilitate diagnosis of SCD in children for early management. However, discrimination, fear of being tested positive, stigmatization, negative health worker attitude linked with issues of maintaining confidentiality were reported by participants as key factors that could affect uptake of the SCD screening exercise. Most participants suggested that intensive health education (78.3%), positive attitude of health workers (69.5%), and screening health workers not being biased (58.8%) could promote community acceptability. A large majority of participants viewed screening of SCD in children as very important. However, opinions expressed by most participants suggest that health education and professionalism of health workers in keeping patients' information confidential could improve the uptake of the exercise.

Identification and uptake of cervical cancer screening during active surveillance in HIV-positive women attending a primary health care facility in Tshwane District, South Africa

Cervical cancer constitutes 20 - 25% of cancers in women in Sub-Saharan Africa. It is a preventable disease, subject to adequate screening, management and follow up. Nevertheless, more than half a million women worldwide develop invasive cervical cancer annually, with middle-and low-income countries achieving only 19% of successful screening coverage compared with high-income countries (63%). The age-standardised incidence rate for cervical cancer in South Africa is 24.71 per 100 000 women.

Migrated Intrauterine Contraceptive Device: A Case Report

The use of long-term and reversible family planning methods such as intrauterine contraceptive devices is common in Nigeria likely due to the large population, fertility as well as less economic burden of placement, and maintenance of this device. Uterine embedment, perforation, and extrauterine migration of the device is becoming more frequent with the increased number of patients benefitting from the contraceptive technique. Distant abdominal migrations and intrathoracic migrations have been reported. Transabdominal ultrasound is an initial imaging modality used in assessment of such patients; in some cases, however, plain abdominal radiograph also needs to be used. This paper will discuss a 30-year-old female who had intrauterine contraceptive device inserted at a primary healthcare facility about 7 months before presentation that got misplaced and was referred to our facility for radiologic investigations and localization of the device.

Self-reported depression and its risk factors among hypertensive patients, Morocco: a cross-sectional study.

Hypertensive patients are at an elevated risk of developing mental diseases such as depression, which can impair their quality of life. The purpose of this study is to measure the prevalence of self-reported depression among hypertensive patients treated at primary health care facilities in Marrakech. Between May 2021 and December 2022, a cross-sectional study of 1053 hypertensive patients attending primary health care facilities in Marrakech was conducted. A face-to-face questionnaire was used to collect socio-demographic, behavioral, and clinical data, as well as hypertension treatment characteristics and the care-patient-physician triad. The Patient Health Questionnaire-9 was used to assess self-reported depression. To identify self-reported depression risk factors, multivariate logistic regression was used. Depressive symptoms were reported by 56.1% of hypertensive patients. The patients' average age was 63.2 ± 9.5years, and 508 (85.9%) were female. Female sex, stress, a low-salt diet, pain and physical discomfort, an urban living environment, a lack of self-monitoring of hypertension, an unsatisfactory relationship with the healthcare system, a family history of hypertension, and the perception of adverse effects of the antihypertensive drug were all associated with self-reported depression. Self-reported depression is prevalent among hypertensive patients in Marrakech. The mental health component should be emphasized while addressing hypertensive patients in primary health care facilities.

Implementing HbA1c monitoring in sub-Saharan Africa: Lessons learnt from a pilot project in Mozambique

AimsWe aimed to evaluate lesson learnt from a pilot project in Mozambique focused on point-of-care (POC) HbA1c testing for diabetes management in primary health care facilities. MethodsOver a three-year period, several health centers were equipped with POC HbA1c testing machines. The evaluation involved 12 months of data collection, interviews with patients and staff, and regular supervision visits. ResultsThe project screened over 22,000 individuals and provided HbA1c testing to 2362 diabetes patients. Among the analyzed results, 65.7 % had HbA1c levels below 7 %, 10.9 % between 7 % and 8.5 %, and 23.4 % above 8.5 %. POC testing showed advantages such as reduced costs and improved workload management. ConclusionsLimited access to HbA1c testing remains a challenge in African countries. The pilot project demonstrated the feasibility of POC HbA1c testing and highlighted the need for increased efforts to make it more widely available, leading to improved diabetes management and patient outcomes.

Knowledge and attitudes of oral health care workers on HIV-associated oral lesions: A study at PHC facilities in Gauteng

Oral health care workers (OHCWs) are critical in providing holistic treatment and preventing the spread of HIV disease. They are uniquely placed to identify, diagnose, manage and treat HIV-related oral lesions.Aim To determine oral health clinicians’ knowledge and attitudes towards HIV-associated oral lesions. Methodology A descriptive cross-sectional survey was conducted at Gauteng’s primary health care (PHC) facilities. Data collection targeted the three categories of OHCWs – dentists, dental therapists and oral hygienists. ResultsThe response rate was 67.5% (n=110), majority of the participants, 76.4% (n=84), were female. Nearly all participants, 91.8% (n=100), agreed that oral lesions are common in people living with HIV and AIDS (PLWHA) and that early diagnosis of HIV/treatment increases PLHIV’s life expectancy. More than three-quarters (80%) reported that they had no problem treating patients diagnosed with HIV. Almost a third, 36.4% (n=40), listed necrotising periodontal conditions and oral candidiasis 34.5% (n=38) as the most common oral manifestations. Most respondents correctly identified oral candidiasis (92.7%), Kaposi sarcoma (84.5%) and necrotising ulcerative periodontal conditions (80.9%).ConclusionAlthough OHCWs had sound knowledge of oral manifestations of HIV, training programmes must be prioritised for knowledge transfer. Dental facilities can be used as a health-promoting platform and a viable location for provider-initiated testing and counselling (PICT) and client-initiated counselling and testing (CICT), also known as voluntary counselling and testing (VCT). The use of HIV rapid testing kits is an option to be explored in the dental facility by OHCWs.

Understanding the interplay of colorectal cancer awareness and attitudes among Palestinians: a national cross-sectional study

BackgroundIn Palestine, colorectal cancer (CRC) is the second most common cause of cancer-related mortality after lung cancer. No studies have examined the relationship between CRC awareness and attitudes. This study aimed to investigate the interplay between CRC awareness and attitudes among the Palestinian population.MethodsA nationwide cross-sectional survey was carried out between July 2019 and March 2020. Convenience sampling was used to collect data from hospitals, primary healthcare facilities, and public areas in 11 governorates. Modified, translated-into-Arabic versions of the validated Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were utilized to assess the awareness of CRC signs/symptoms, risk factors, and causation myths. The cumulative awareness score for each domain was computed and stratified into tertiles. The top tertile denoted ‘high’ awareness, while the remaining two tertiles denoted ‘low’ awareness.ResultsThe final analysis included 4,623 participants; of whom, 3115 (67.4%) reported positive attitudes toward CRC. In total, 1,849 participants (40.0%) had high awareness of CRC signs/symptoms. There was no association between displaying a high awareness of CRC signs/symptoms and having positive attitudes toward CRC. A total of 1,840 participants (38.9%) showed high awareness of CRC risk factors. Participants with high CRC risk factor awareness were more likely to display positive attitudes toward CRC (OR = 1.22, 95% CI: 1.07–1.39). Only 219 participants (4.7%) had high awareness of CRC causation myths. Participants with high awareness of CRC causation myths were more likely to exhibit positive attitudes toward CRC (OR = 2.48, 95% CI: 1.71–3.58).ConclusionA high awareness level of CRC risk factors and causation myths was associated with a greater likelihood of demonstrating positive attitudes toward CRC in terms of perceived susceptibility, importance of early detection, and consequences of developing the disease. Future educational interventions should focus on raising public awareness about CRC, with a particular emphasis on risk factors and causation myths, to maximize the potential for shaping favorable attitudes toward the disease.