Primary Health Care Program Research Articles

Treating drug-resistant tuberculosis in a low-intensity chronic conflict setting in India.

IntroductionThe eastern part of India has been affected by an ongoing low-intensity conflict between government forces and armed Maoist groups, known as Naxalites. Since 2006, Médecins Sans Frontières (MSF) has been providing primary health care services in the conflict-affected region along the Andhra Pradesh-Chhattisgarh border. In 2011, treatment for drug-resistant tuberculosis (DR-TB) was included in the services provided. This report aims to describe MSF experiences of providing treatment to DR-TB patients in a mobile primary health care outpatient clinic, in a low-intensity conflict setting in India.Case descriptionA total of thirteen patients were diagnosed with drug-resistant TB (DR-TB) between January 2011 and October 2013. An innovative treatment model was developed which delegated responsibility to non-TB clinicians, including primary-care nurses and nurse-aids who were remotely supported by a TB-specialist from the MSF DR-TB project in Mumbai. Individualised regimens were designed for each patient based on WHO guidelines. Of these 13 patients, 10 patients had an outcome, of whom seven (70%) patients were cured. One patient became lost to follow-up prior to treatment initiation, one patient died prior to starting treatment and one patient refused treatment. Three patients were on-treatment, were clinically improving and were culture-negative at the end of their intensive phase of treatment.Discussion and evaluationDrug-resistant tuberculosis diagnosis and treatment is a highly specialised and technical subject which requires continued patient follow-up. However, our study demonstrates that it is feasible to manage DR-TB patients in a conflict setting, using a primary-care model with remote expert support. Long-term commitment and sustainability are essential for continued care, even more so in similar conflict settings. Loss to follow-up in patients remains a programmatic challenge and community involvement may play a key role.ConclusionManaging DR-TB in a primary health care programme is feasible in a low-conflict setting with an appropriate treatment model. Ambulatory strategies and standardised treatment regimens should be considered to further simplify treatment delivery and allow for scale-up when needed.

A transition program to primary health care for new graduate nurses: a strategy towards building a sustainable primary health care nurse workforce?

BackgroundThis debate discusses the potential merits of a New Graduate Nurse Transition to Primary Health Care Program as an untested but potential nursing workforce development and sustainability strategy. Increasingly in Australia, health policy is focusing on the role of general practice and multidisciplinary teams in meeting the service needs of ageing populations in the community. Primary health care nurses who work in general practice are integral members of the multidisciplinary team – but this workforce is ageing and predicted to face increasing shortages in the future. At the same time, Australia is currently experiencing a surplus of and a corresponding lack of employment opportunities for new graduate nurses. This situation is likely to compound workforce shortages in the future. A national nursing workforce plan that addresses supply and demand issues of primary health care nurses is required. Innovative solutions are required to support and retain the current primary health care nursing workforce, whilst building a skilled and sustainable workforce for the future.DiscussionThis debate article discusses the primary health care nursing workforce dilemma currently facing policy makers in Australia and presents an argument for the potential value of a New Graduate Transition to Primary Health Care Program as a workforce development and sustainability strategy. An exploration of factors that may contribute or hinder transition program for new graduates in primary health care implementation is considered.SummaryA graduate transition program to primary health care may play an important role in addressing primary health care workforce shortages in the future. There are, however, a number of factors that need to be simultaneously addressed if a skilled and sustainable workforce for the future is to be realised. The development of a transition program to primary health care should be based on a number of core principles and be subjected to both a summative and cost-effectiveness evaluation involving all key stakeholders.

Assessment of primary health care in a rural health centre in Enugu South east Nigeria.

Objective:Primary health care (PHC) is a vital in any community. Any health centre with a well implemented PHC program can stand the test of time in curbing under five mortality and morbidity. This study was therefore aimed at assessing the activities in a health centre located in a rural area in Enugu state and to determine the pattern and presentation of various diseases in the health centre.Methods:This is retrospective study undertaken in a primary health care centre in Abakpa Nike in Enugu east LGA of Enugu State of Nigeria from December 2011 to December 31st 2013. Data retrieved were collected with the aid of a structured study proforma and analyzed using SPSS Version 18.Results:Total number of children that attended immunization program in the health centre over 20 months period was 25,438 (12,348 males and 13090 females), however only 17745 children (7998 males and 9747 females) were actually registered in the hospital records. None of the children was immunized for DPT2 and OPV0 and HBV1 in the course of this study. The dropout rate using DPT1, 2 and 3 (DPT1-DPT2/DPT3) was very high (494%). The mean immunization coverage rate was 8.3%. Family planning activities, integrated management of childhood illnesses program were also carried out in the health centre but at very low level.Conclusions: The major fulcrum of events in the health centre which include immunization coverage, IMCI, and management of common illnesses were simply non operational. However the health centre had a well knitted referral system.

Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy.

BackgroundSocial determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP) and primary health care (Family Health Program-FHP) programs on new case detection rate of leprosy.Methodology/Principal FindingsWe conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004–2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI = 0.74–0.83) and significantly increased in municipalities with FHP coverage in the medium (72–95%) (Risk Ratio 1.05; 95% CI = 1.02–1.09) and higher coverage tertiles (>95%) (Risk Ratio 1.12; 95% CI = 1.08–1.17).ConclusionsAt the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.

Picking up the bill - improving health-care utilisation in the Democratic Republic of Congo through user fee subsidisation: a before and after study.

BackgroundUser fees have been shown to constitute a major barrier to the utilisation of health-care, particularly in low-income countries such as the Democratic Republic of Congo (DRC). Importantly, such barriers can lead to the exclusion of vulnerable individuals from health-care. In 2008, a donor-funded primary health-care programme began implementing user fee subsidisation in 20 health zones of the DRC. In this study, we quantified the short and long-term effects of this policy on health-care utilisation.MethodsSixteen health zones were included for analysis. Using routinely collected health-care utilisation data before and after policy implementation, interrupted time series regression was applied to quantify the temporal impact of the user fee policy in the studied health zones. Payment of salary supplements to health-care workers and provision of free drugs - the other components of the programme - were controlled for where possible.ResultsFourteen (88%) health zones showed an immediate positive effect in health-care utilisation rates (overall median increase of 19%, interquartile range 11 to 43) one month after the policy was introduced, and the effect was significant in seven zones (P <0.05). This initial effect was sustained or increased at 24 months in five health zones but was only significant in one health zone at P <0.05. Utilisation reduced over time in the remaining health zones (overall median increase of 4%, interquartile range −10 to 33). The modelled mean health-care utilisation rate initially increased significantly from 43 consultations/1000 population to 51 consultations/1000 population during the first month following implementation (P <0.01). However, the on-going effect was not significant (P =0.69).ConclusionsOur research brings mixed findings on the effectiveness of user fee subsidisation as a strategy to increase the utilisation of services. Future work should focus on feasibility issues associated with the removal or reduction of user fees and how to sustain its effects on utilisation in the longer term.

Community health nurses' HIV health promotion and education programmes: a qualitative study.

Globally, nurses practice in many settings with people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), taking an increasing share of the professional burden of care and helping to reduce morbidity and mortality. International literature is sparse about Thai community nurses providing primary healthcare programmes for people with HIV. This study aimed to describe background, experiences and strategies of community nurses regarding their design and delivery of programmes for people living with HIV and AIDS in Chiang Mai Province, Thailand. This study used a qualitative mixed-methods study employing a qualitative survey and in-depth interviews. Twenty community health nurses from 18 small community hospitals completed a survey comprising demographic data and 13 open-ended questions. Four of them later engaged in in-depth interviews using the same questions. Survey, interview data and field notes were analysed using interpretive content analysis. Four themes and six sub-themes portrayed participants' rich experiences and knowledge of HIV health promotion and education; challenges of daily work, discrimination and ethical issues; success through programme diversity comprising promotion of community volunteerism, networking and relationships; and holistic connections with Thai cultural traditions and Buddhism. Findings help to recognize the diversity, uniqueness and contributions of Thai community nurses regarding culturally appropriate health promotion and education programmes for people living with HIV and AIDS. Findings inform nurses and health officials in and outside of the country to complement innovation in future HIV health promotion and education programmes. Our sample came from one province of Thailand. Findings might not be reflective of nurses elsewhere. Three decades of collective experience in providing holistic and multifaceted HIV and AIDS nursing care, education and health promotion by community health nurses have the potential to effect new and existing policies and protocols on HIV community care in Thailand, but more research is required for this.

Interprofessional curriculum on environmental and social determinants of health in rural Kenya: Aga Khan University East Africa-University of California San Francisco Integrated Primary Health Care Program

Interprofessional curriculum on environmental and social determinants of health in rural Kenya: Aga Khan University East Africa-University of California San Francisco Integrated Primary Health Care Program

The Effect of Primary Health Care Learning Programme in Health Care Service Delivery: Case Study of Ehlanzeni Health District in Mpumalanga Province

This research was aimed mainly at determining the significance of the primary health care learning programme in health care service delivery, focusing mainly in the Ehlanzeni Health district of Mpumalanga Province. The focus was on how professional nurses trained in the Primary Health Care programme confidently apply the skills and expertise to the benefit of clients in community health facilities. A quantitative study was conducted at the local clinics of Ehlanzeni Health District. Probability Sampling Technique was used to select 30 Primary Health Care Professional nurses. A questionnaire survey comprising closed ended questions was used to collect data. The data was coded in the computer, analysed in Statistical Analysis software (SAS) packages and summarised using frequency tables. The researcher discovered the value of the training programme as a functional difference in the scope of practise between the Primary Health Care trained and non-trained professional nurses. The interviews distinguished trained professional nurses from general nurses and those specialised in Midwifery and mental health. This clearly indicated that the PHC trained Nurses are capable to render comprehensive health care services in their facilities without causing burden to the referral system. As a result the study strongly recommended that all professional Nurses in Primary health care facilities should be trained in the learning programme in order to strengthen the primary health care system. DOI: 10.5901/jesr.2014.v4n6p207

Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data

Objectives To evaluate the impact of Brazil’s recently implemented Family Health Program (FHP), the largest primary health care programme in the world, on heart and cerebrovascular disease mortality across Brazil...

Iron-rich drinking water and ascorbic acid supplementation improved hemolytic anemia in experimental Wistar rats

Anemia is a frequent problem in both the primary and secondary health care programs. In contrast, most areas of northeast India are vulnerable to iron toxicity. In the present study, we documented the effect of administration of iron rich water on hemolytic anemia in a Wistar rats’ animal model. Hemolytic anemia was induced by phenyl hydrazine through intraperitoneal route and diagnosed by the lowering of blood hemoglobin. After inducing the hemolytic anemia, 24 Wistar rats (n = 6 in four groups) were randomly assigned to 1 mg/l, 5 mg/l, and 10 mg/l ferric oxide iron along with 1 mg/ml ascorbic acid administered through drinking water; a control group was treated with iron-free water. The hematological and biochemical parameters, iron levels in liver, spleen, and kidney were estimated after 30 d of treatment. In the group treated with 5 mg/l iron and ascorbic acid, a significant increase of serum iron and ferritin, and a decrease of TIBC (total iron binding capacity) were observed without changes in other biochemical parameters and histopathological findings. However, in the group treated with 10 mg/l iron and ascorbic acid, hematological changes with significantly higher values for white blood cell count, serum glutamic phospho transaminase, serum glutamic oxaloacetic transaminase, alkaline phosphatase, glucose, splenic, and liver iron content, indicate potential toxicity at this supplementation level. Data suggest that the optimum concentration of iron (5 mg/l) and ascorbic acid solution may improve anemic conditions and may be therapeutically beneficial in the treatment of iron deficiency anemia without any negative impact, while 10 mg/l in drinking water seems to be the threshold for the initiation of toxicity.

Incidence and severity of childhood pneumonia in the Drakenstein Child Lung Health Study, a birth cohort in South Africa

Background: Childhood pneumonia remains the major cause of global under-5 mortality. Conjugate vaccinations against Streptococcus pneumoniae (PCV13)was introduced into the South African primary health care program in 2009, while immunisation against Haemophilus influenzae b has been in place for a decade. This study investigated the incidence and severity of pneumonia in a South African birth cohort with high coverage for these vaccines. Methods & Materials: Active pneumonia case detection was performed from June 2012 to November 2013, in infants enrolled in the Drakenstein Child Lung Health study, a birth cohort study in a peri-urban area of South Africa. Pneumonia case definitions and treatment were according to IMCI and national guidelines; ambulatory and hospitalised cases were included. Results: Amongst 555 births, 369 child-years of follow-up were accrued with median follow-up of 33 weeks (IQR 19 – 49 weeks). 108 pneumonia episodes occurred in 87 children, an incidence of 0.29 episodes per child-year (e/cy), 95%CI 0.24 – 0.35. First pneumonia events occurred before 14-week vaccination in 45 children (42%); the earliest event occurred at 21 days. There were 43 cases of hospitalised pneumonia, (incidence 0.12 e/cy, 95% CI 0.08 – 0.16) and 65 ambulatory episodes (incidence 0.18 e/cy, 95%CI 0.14 – 0.22). Hospitalised cases were younger than ambulatory cases: median age 13 weeks (IQR 6 – 27), vs 21 weeks, (IQR 12 – 24), p=0.03. Median length of hospitalisation was 3 days, (IQR 2 -5 days). The in-hospital case fatality was 5%; there were no deaths amongst ambulatory cases and no case progressed to require hospitalisation. Conclusion: There was a high incidence of pneumonia and of severe disease despite high PCV coverage in this area Funding: Bill and Melinda Gates Foundation; SA Thoracic society GSK Fellowship; Federation of Infectious Diseases Societies of South Africa

Uptake of a national primary mental health program by young people in Australia

BackgroundThe purpose of this study was to examine the uptake of an Australian primary mental health care program (Access to Allied Psychological Services) by young people aged 12 to 25 years and the characteristics of consumers and the treatments received. Data were sourced from a national web-based minimum dataset.ResultsBetween 1 July 2003 and 30 June 2012, 51 716 young consumers received 245 704 sessions via the primary mental health program. Around two thirds were female and the average age was 19 years. The majority had depressive and/or anxiety disorders.Most services were delivered to individuals (including just the young person and/or the young person with one or both parents), in a face-to-face context and free of charge. Cognitive and behavioral strategies were the most common interventions delivered.ConclusionsThe primary mental health care program has been well utilized by people aged 12 to 25 years. Similar programs in other developed countries may improve access to primary mental health care for young people.

Barriers to adopting and implementing an oral health programme for managing early childhood caries through primary health care providers in Lima, Peru

BackgroundTo identify barriers to participation in a primary oral health care programme aimed at preventing early childhood caries, as perceived by nurses.MethodsOf a total of 140 randomly selected nurses employed in 40 government health centres in Lima, 123 completed a pre-tested questionnaire. Background variables were districts’ ‘socio-economic status’ (SES) and ‘years of experience’. Factor analysis was performed. ANOVA was applied for testing the influence of the background variables on the barrier factors. Chi-square test was applied to test for differences between single item barriers and the background variables. The Likert-scale (1–4) was used.ResultsThere was no statistical significant effect of ‘SES’ or of ‘years of experience’ of nurses on any of the 7 barrier factors, nor on the 11 single item barrier factors. The highest mean score (3.81) was obtained for the barrier factor ‘importance of oral health’, followed by ‘perceived responsibility’ (3.44). The lowest mean score was (1.70) for ‘knowledge on caries prevention’.ConclusionsNurses consider oral health very important and are willing to participate actively in programmes aimed at reducing Early Childhood Caries, provided that they will be trained well and that the director and dentists of the health centre give their consent.

Reduction in early mortality on antiretroviral therapy for adults in rural South Africa since change in CD4+ cell count eligibility criteria.

To explore the impact of expanded eligibility criteria for antiretroviral therapy (ART) on median CD4⁺ cell count at ART initiation and early mortality on ART. Analyses included all adults (≥16 years) initiated on first-line ART between August 2004 and July 2012. CD4⁺ cell count threshold 350 cells per microliter for all adults was implemented in August 2011. Early mortality was defined as any death within 91 days of ART initiation. Trends in baseline CD4⁺ cell count and early mortality were examined by year (August to July) of ART initiation. Competing risks analysis was used to examine early mortality. A total of 19,080 adults (67.6% female) initiated ART. Median CD4⁺ cell count at ART initiation was 110-120 cells per microliter over the first 6 years, increasing marginally to 145 cells per microliter in 2010-2011 and more significantly to 199 cells per microliter in 2011-2012. Overall, there were 875 deaths within 91 days of ART initiation; early mortality rate was 19.4 per 100 person-years [95% confidence interval (CI) 18.2 to 20.7]. After adjustment for sex, age, baseline CD4⁺ cell count, and concurrent tuberculosis (TB), there was a 46% decrease in early mortality for those who initiated ART in 2011-2012 compared with the reference period 2008-2009 (subhazard ratio, 0.54; 95% CI: 0.41 to 0.71). Since the expansion of eligibility criteria, there is evidence of earlier access to ART and a significant reduction in early mortality rate in this primary health care programme. These findings provide strong support for national ART policies and highlight the importance of earlier ART initiation for achieving reductions in HIV-related mortality.

Community participation eludes Pakistan's maternal, newborn and child health programme

This study looked at the comprehensiveness of the primary health care approach being applied in Pakistan's National Maternal, Newborn and Child Health (MNCH) Programme launched in 2005. The methods included a review of the programme's guideline documents, in-depth interviews with managers/advisors and focus group discussions with community groups and service providers. The MNCH Programme is applying a selective primary care model. Programme advisors and managers were concerned about the quality of training, political interference and incomplete implementation. Service providers were not working together as envisioned. Community midwives complained about the community's perceptions of them. Community members were unaware of MNCH Programme implementation in their areas. Pakistan's primary health care programme needs to be reviewed and revised according current thinking on community participation and inter-sectoral collaboration to accelerate progress towards achievement of Millennium Development Goals 4 and 5.

Human Genome Sequencing Project and the implications for international primary healthcare programme in Sub-Sahara African nations

This study has critically examined the impact of the Human Genome Sequencing Project on the WHO-championed primary healthcare programme. The investigators outlined how genomic-based research studies have provided relevant cues about curing many of these hitherto incurable genetic diseases. The need for African inter-regional bodies to set aside between 3%–5% of their annual budget to provide funding for the establishment of SSA-African genomic centres of excellence was emphasised. Innovative public health genomics can play a monumental role not only in eliminating most of the disease burden in the region but also enhance the inadequate, current life expectancy in Sub-Sahara-Africa. Strategies for establishing and sustaining the development of public health genomics and innovative genomic medicine were outlined. Finally, the ethical legal and social implication of genomics research in the context of socio-economic development was presented.

Anthropometrically Determined Nutritional Status of Preschool Children in Anambra State, Nigeria

This study was designed to determine the nutritional status and growth of preschool children in Anambra State using vertical anthropometric measurements. Four objectives and one hypothesis were formulated in order to determine the mean measurements of weight, height, left mid upper arm circumference and head circumference of preschool children aged 3 - 5 years plus in the urban and rural communities of Anambra State. A cross sectional survey research design was used for the study to collect sampled data of 1280 preschool children in Anambra state. These data were organized and tested with inferential statistics of t-Test. The weights and heights were compared with the WHO/NCHS standards using graphs. The results showed that children aged 3-5 years plus in the urban areas indicated higher weight and height than those in the rural areas. These preschool children aged 3 - 5 years plus in both urban and rural locations had weights and heights that are higher than that of WHO/NCHS standards for their age. Based on the findings of the study, the researchers recommended that prevention of malnutrition should be given high priority in the implementation of the ongoing Primary Health Care programmes with particular attention paid to the rural population.

Intestinal Parasitic Infection among Primary School Pupils in Osogbo Nigeria

Parasitic infestation caused by intestinal parasites continues to take their roll on mankind. The symptoms commonly associated with parasitic infestation can be severe, acute or chronic. The prevalence of intestinal parasitic infestation was carried out over a period of three months ( January to March 2008) among 505 primary school children between 6-12 years of age in AUD Primary School A and B Sabo, St. Michael School A and B Ago-wande and L.A. Adenle Primary School Ayetoro in Olorunda Local Government with headquarter in Osogbo.Direct smear was used for analyzing faecalsamples for the parasites. Diagnosis was based on identification of the characteristic protozoan cysts and helminthes ova with a compound microscope. The prevalence for Ascarislumbricoides, Entamoebahistolytica,Hookworm, Trichuristrichuria were 68.9%, 8.3% and 5.5% respectively.Parasiticinfections between the male and female showed a significant different in both sexes ( P< 0.01). The percentage prevalence ofAscarislumbricoides was high in between 6-7years and ≥ 12 years. No specific age relationship was established for other intestinal parasites among the pupils. From the findings of this study, it is hereby recommended that deworming and health education should necessarily be a component of the primary health care programme with a focus on school children.This study showed low standard of sanitation among the pupils.

Primary health care program to desensitize children with autism spectrum disorders to the dentist

Primary health care program to desensitize children with autism spectrum disorders to the dentist

Measuring community empowerment as a process and an outcome: preliminary evaluation of the decentralized primary health care programs in northeast Thailand

In 1997, Thailand began to devolve essential public service functions to a local level. However, the implementation process has been slow, especially in the public health domain. Public concerns with local government ineffectiveness and corruption have prompted the Ministry of Public Health to launch a pilot decentralization program whereby a small number of local communities across Thailand were chosen to receive the budget and management authority over basic health services. To evaluate the outcome of health decentralization in these pilot communities, this paper argues that the conventional health outcome measures (e.g. infant mortality rate, fertility rate, and average life expectancy) are inadequate for understanding the dynamics of community learning and development. To address this inadequacy, the community empowerment concept is used to analyze the social and political aspects of public health decentralization. Qualitative techniques, including participant observation, focus group interviews, and face-to-face interviews, are used to analyze the impact of localized public health programs on community empowerment in four communities in northeast Thailand.