Public Health Care Centers Research Articles

The Association Between Pre-Pregnancy Body Mass Index and Gestational Weight Gain on Pregnancy Outcomes: A Retrospective Cohort Study

Introduction: Elevated pre-gestational body mass index (obese/overweight) and improper gestational weight gain are important risk factors for predicting adverse pregnancy outcomes. Objective: We aimed to identify the association between pre-pregnancy body mass index (BMI) and gestational weight gain on birth outcomes. Materials and Methods: Data from this retrospective cohort study were extracted from 1457 (out of 1800) pair health records belonging to the pregnant mother and infants at Ahvaz Iran health care centers from 2010 to 2018. Ten public health care centers were randomly selected from the headquarters west and east of Ahvaz City. The samples were selected based on the inclusion criteria. They divided into different groups based on BMI (underweight, normal, overweight, and obese) and gestational weight gain (GWG) groups (inadequate and excessive versus adequate). Pregnancy outcome was analyzed according to the GWG during pregnancy for each BMI group through multivariable multinomial logistic regression. Relationships between maternal BMI, GWG, and offspring weight were examined. The analysis of covariance (ANCOVA) was used with adjusting the baseline values. The risks for adverse birth weight outcomes in women with different pre-pregnancy BMIs and GWGs were tested using the multivariable multinomial logistic regression analysis. Results: The Mean±SD of maternal age was 28.36±5.60 years. The Mean±SD birth weight was 3271.37±486.57 g. About 4.5%, 89.3%, and 6.2% of newborns were low birth weight, normal weight, and macrosomia, respectively. Also, 46.4% of women had weight gain above the guidelines. The increased risk for large for gestational age in overweight mothers (odds ratio [OR] =3.18, 95%CI; 0.45-7.29, P=0.007) and an increased risk for small for gestational age in those mothers with gestational weight gain below the guidelines (OR=2.9, 95%CI; 1.16- 7.45, P=0.02). An increased risk of large for gestational age, low birth weight, and macrosomia were observed in overweight mothers with gestational weight gain out of the guidelines. An increased association was found between the maternal pre-pregnancy BMI and fasting blood sugar in 24 to 28 weeks of gestation. Hence, hyperglycemia is related to the incidence of macrosomia (OR=3.58, 95%CI; 1.70-7.66, P=0.0001). Conclusion: Managing maternal weight with respect to reproductive health care is required for all women in childbearing age (before and during pregnancy) to reduce the adverse pregnancy outcome.

Occurrence of mycotoxins and microbial communities in artisanal infant flours marketed in Côte d'Ivoire.

The aim of this study was to determine the microbial diversity and mycotoxin profile of artisanal infant flours commonly vended in public healthcare centres and retail markets in Côte d'Ivoire. Thus, maize, millet, sorghum, soya and multigrain (mix of different cereals) flour samples collected from different localities were first, analysed for nutritional composition, then for microbial communities using high-throughput sequencing and for mycotoxins through UHPLC-MS/MS method. Firmicutes was the most abundant bacterial phylum and the dominant genera were Weissella, Staphylococcus, Pediococcus. Potential pathogenic genera such as Bacillus, Enterobacter, Acinetobacter and Burkholderia were also found. The fungal community was composed of two dominant phyla (Ascomycota and Basidiomycota) and 31 genera with > 0.1% relative abundance. In samples from public healthcare centres, Candida, Hyphopichia, Trichosporon, and Cyberlindnera were the most dominant genera according to the flour type while in samples from retail markets, they were Cyberlindnera, Clavispora, Nakaseomyces, Aureobasidium and Candida. Possible toxigenic genera Fusarium and Aspergillus were also detected. Aflatoxin B1 (AFB1), Ochractoxin (OTA), Fumonisin B1 (FB1) and B2 (FB2) were the mycotoxins found in the analysed flours. AFB1 was detected in 100% of maize (range 1.2-120.5µg/kg; mean: 44.2µg/kg) and 50-83.3% of millet flours (range 0.2-31.5µg/kg; mean: 31.5µg/kg). Its level in all maize and rice flour samples exceeded EU standard (0.1µg/kg). For OTA and fumonisins, millet and maize flours showed the highest levels of sample exceeding the EU standard. Thus, artisanal infant flours marketed in Côte d'Ivoire, mainly maize and rice flours, although containing potentially beneficial bacteria, represent potential health risks for children.

Perception of Group Prenatal Care among Pregnant Adolescents: A Qualitative Study in Iran

BackgroundUnderstanding the pregnant adolescent's perception of group prenatal care is necessary for introducing and implementing this model of care. The aim of this qualitative study was to explore adolescent pregnant women's perception of group prenatal care in Iran. MethodsThis qualitative study was conducted in Iran from November 2021 to May 2022 to explore adolescents’ perception of group prenatal care during pregnancy. Fifteen adolescent pregnant women (from a low-income population) who received group prenatal care were recruited and interviewed individually at a public health care center through an intentional sampling method. Interviews were digitally recorded, transcribed verbatim in Persian, and analyzed using conventional content analysis. ResultsFrom the data analysis, 2 themes, 6 main categories, and 21 subcategories emerged. The themes were “Maternal empowerment” and “Pleasant prenatal care.” The first theme included four categories: knowledge enhancement, improving self-efficacy, perceived support, and feeling of security. The second theme was composed of 2 categories: motivation and effective interaction with peers. ConclusionThe findings of this study show the effectiveness of group prenatal care in promoting feelings of empowerment and satisfaction of adolescent pregnant women. Further research is needed to assess the benefits of group prenatal care for adolescents in Iran and other populations.

Analysis of human rabies deaths reported at two hospitals in Karachi, Pakistan: a call to save lives by reforming rabies prevention facilities.

Rabies is endemic in low- and middle-income countries. It is caused mainly by the bite of a rabid dog and is fatal if not treated effectively and in a timely manner with quality post-exposure prophylaxis. Despite a profusion of private and public healthcare centres in Sindh province, most are ill-equipped to treat dog bites. We analysed 129 human deaths from rabies who presented at the emergency departments of two tertiary care hospitals in Karachi over 10y. Demographic data, time, location of the bite and distance travelled to report symptoms of rabies were recorded. Most victims were male, and children were more often affected; almost none had received post-exposure prophylaxis. A total of 12% of bites were on the face, head or neck. The mean incubation period was 56d. Most (60%) of the rabies victims travelled long distances, hoping to receive treatment. Rabies deaths were either due to a lack of awareness or the non-availability of rabies immunobiologicals within easy reach. Public health services must raise awareness, conduct surveillance and provide appropriately spaced centres for free treatment of dog bites. This lethal disease must be prevented at all costs.

Inadequate Iodine Intake in Mothers of Young Children in Innlandet County, Norway

BackgroundIodine has an essential role in child growth and brain development. Thus, sufficient iodine intake is particularly important in women of childbearing age and lactating women. ObjectivesThis cross-sectional study aimed to describe iodine intake in a large random sample of mothers of young children (aged ≤2 y) living in Innlandet County, Norway. MethodsFrom November 2020 to October 2021, 355 mother–child pairs were recruited from public health care centers. Dietary data were obtained using two 24-h dietary recalls (24-HRs) per woman and an electronic FFQ. The Multiple Source Method was used to estimate the usual iodine intake from the 24-HR assessment. ResultsBased on the 24-HRs, the median (P25, P75) usual iodine intake from food was 117 μg/d (88, 153) in nonlactating women and 129 μg/d (95, 176) in lactating women. The median (P25, P75) total usual iodine intake (from food combined with supplements) was 141 μg/d (97, 185) in nonlactating women and 153 μg/d (107, 227) in lactating women. Based on the 24-HRs, 62% of the women had a total iodine intake below the recommendations (150 μg/d in nonlactating women and 200 μg/d in lactating women), and 23% of them had an iodine intake below the average requirement (100 μg/d). The reported use of iodine-containing supplements was 21.4% in nonlactating women and 28.9% in lactating women. In regular users of iodine-containing supplements (n = 63), supplements contributed to an average of 172 μg/d of iodine. Among regular iodine supplement users, 81% reached the recommendations compared with 26% of nonsupplement users (n = 237). The iodine intake estimated by FFQ was substantially higher than that estimated by 24-HRs. ConclusionsMaternal iodine intake in Innlandet County was inadequate. This study confirms the need for action to improve iodine intake in Norway, particularly among women of childbearing age.

Challenge of Absenteeism of Public Healthcare Center Workers in the Rural Area: A Study on Sylhet District, Bangladesh

Absenteeism has been linked to ineffective healthcare delivery in several studies. This research looks at absenteeism in Bangladesh's public healthcare centers (PHCs), a health system level recognized as vulnerable to absenteeism. Front-line health workers, administrators, service consumers, and health propensity committee chairpersons were interviewed in detail and participated in focus groups. Absenteeism was shown to be quite common among healthcare employees, and it is a big problem in PHCs in rural areas when lateness is included. Absenteeism influences the pair service consumers and associates, although it is not necessarily intentional. Even though there are measures to prevent absenteeism in PHCs, our results reveal that they are readily evaded and ineffectual due to utilization and formative difficulties. The Anti-Corruption Evidence (ACE) strategy, which aims to include and improve the stimulations of significant players in the system to support efficiency-renovating measures and, in turn, ensure efficient service delivery, might be relevant in this case. In this research, we evaluate the patient satisfaction and the quality of services at PHCs, and the effect of a lack of health workers in Bangladesh's rural public healthcare centers (PHCs).

Challenge of Absenteeism of Public Healthcare Center Workers in the Rural Area: A Study on Sylhet District, Bangladesh

Challenge of Absenteeism of Public Healthcare Center Workers in the Rural Area: A Study on Sylhet District, Bangladesh

Long-term trend of antibiotic use at public health care institutions in northwest China, 2012–20 —— a case study of Gansu Province

BackgroundOver the past 20 years, excessive antibiotic use has led to serious antimicrobial resistance (AMR) worldwide, and the phenomenon is particularly serious in China. To this end, the Chinese health sector took a series of measures to promote rational antibiotic use. In this study, to reveal the impact of policies on antibiotic use, we explored the long-term trend and patterns of antibiotic use at public health care institutions from 2012 to 2020 in northwest China, taking Gansu Province as an example.MethodsAntibiotic procurement data were obtained from the provincial centralized bidding procurement (CBP) platform between 2012 and 2020. Antibiotic use was quantified using the Anatomical Therapeutic Chemical (ATC)/defined daily doses (DDD) methodology and standardized using the DDD per 1000 inhabitants per day (DID). Twelve relevant quality indicators were calculated for comparison with the European Surveillance of Antimicrobial Consumption (ESAC) project monitoring results.ResultsTotal antibiotic use increased from 18.75 DID to 57.07 DID and then decreased to 19.11 DID, a turning point in 2014. The top three antibiotics used were J01C (beta-lactam antibacterials, penicillins), J01F (macrolides, lincosamides and streptogramins), and J01D (other beta-lactam antibacterials, cephalosporins), accounting for 45.15%, 31.40%, and 11.99% respectively. The oral antibiotics used were approximately 2.5 times the parenteral antibiotics, accounting for 71.81% and 28.19%, respectively. Different use preferences were shown in public hospitals and primary health care centres (PHCs), and the latter accounted for more than half of total use. The absolute use of all classes of antibiotics in Gansu is almost higher than any of the 31 European countries included in the ESAC, but the relative use of some focused antibiotics is lower than theirs.ConclusionsThe intervention policies of the health department reduced antibiotic use in Gansu Province, but the proportion of broad-spectrum and parenteral antibiotics was still high. It is necessary to further improve the quality of antibiotic prescriptions and pay more attention to the rationality of antibiotic use in PHCs.

Use of Slack for COVID-19 disaster response in Hyogo Prefecture.

The coronavirus disease 2019 (COVID-19) pandemic has caused great disruptions in education and healthcare systems. However, before the COVID-19 pandemic, Hyogo Prefecture did not have a centralized system for sharing information among hospitals, public healthcare centers, the government, fire departments, and medical associations. In March 2021, we used Slack,® an enterprise social network, to invite people from hospitals, healthcare centers, the government, fire departments, and medical associations to join our workspace. This study was undertaken to verify whether the use of Slack can improve information sharing during a disaster. A questionnaire on whether information-sharing tools such as Slack are useful for disaster response in Hyogo Prefecture, including for COVID-19, was administered using a Google Form. Of the 19 people who responded to the questionnaire, 15 (78.9 percent) were first-time users of Slack and 18 (94.7 percent) found it easy to use. All 19 participants stated that Slack proved useful in providing pertinent information regarding preventive measures for the control of COVID-19, and they believed that it would be a helpful tool if such disasters were to occur in the future. Regarding the launch time of Slack, 11 respondents (57.9 percent) answered that it was launched at the appropriate time, while five respondents (26.3 percent) answered that it was launched too late. The participants thought that Slack was effective for accelerating their communication. The use of Slack could also improve future disaster response communications.

Management of complex urethral stricture in public health facilities in developing nations in the 21st century

Management of complex urethral stricture in public health facilities in developing nations in the 21^st century

Knowledge, perception and acceptance of generic drugs in the general Lebanese population: A cross-sectional survey among adults.

Many governments encouraged generic use to enhance health equality and minimise health expenditure. The lack of knowledge and acceptance of generic medicines are the main barriers to their use. This study aimed to assess population knowledge and perception towards generic drugs, identify their primary sources of information and examine which variables are independently related to their acceptance. An observational cross-sectional study was performed targeting the Lebanese adult population. Overall, 385 patients participated in the study. Data were collected using a uniform survey from six public healthcare centres. The participants reported a distrust towards generic drugs; they either said that they were not as effective as the brand (36.9%), were of less quality than the brand (38.5%) or had more side effects than the brand (38.4%). Around 52% said they would never buy a generic drug, and two-thirds (68.6%) preferred using a brand drug over a generic one. After adjusting for socio-demographics, a high income (odds ratio (OR) = 3.7), knowing that brands and generics have the same active ingredients (OR = 2.28) and that brands and generics were equally effective (OR = 6.46) were the strongest independent predictors for the willingness to buy generic drugs. A lack of knowledge and misperceptions about generic drugs limited the use of generic drugs, and therefore must be addressed.

The Knowledge and Skills of Nutritional Menu Preparation Among Toddler Mother

Background: In Indonesia, the proportion of toddlers having nutritional issues in 2018 was 17.7%. In contrast, in Central Java, malnutrition among toddlers was 1.1% frequent, and inadequate nutrition among toddlers was 5.0% in 2020. According to the Banyumas District Health Office report, there were 6,638 people who needed to improve their diet immediately. In the working area of Kalibagor Public Health Care Center, 69 toddlers had low nutrition and 12 had malnutrition. Objective: The purpose of this research is to find out the nutrient knowledge and skill of toddlers’ mothers before and after the training of toddlers’ nutritional menu processing in the working area of Kalibagor Public Health Care Center, Banyumas District. Method: The method of this research was pre-experimental design with one group pre-test and post-test design. The samples included 45 mothers who were selected using the Slovin formula, and the population included 81 mothers whose children had low malnutrition. Results: The mothers' knowledge and competence level in planning and digesting their toddlers' diets were the variables that were measured. It indicated that the degree of ability and knowledge had a significant effect (p=0.000). Conclusion: Thus, it can be concluded that providing training on toddler nutrition has a favorable impact on a mother's skills. The next researcher is expected to explore social and cultural elements in order to improve respondents' knowledge and skills.

Personal protective equipment: Analysis of supply among midwives during the COVID-19 pandemic in Peru

ObjectiveTo report the details of provision of personal protective equipment to midwives during the COVID-19 pandemic in Peru MethodsThis is a non-experimental, descriptive, cross-sectional study. An online survey of 679 midwives working at public healthcare centres was conducted via questionnaires. The following aspects were outlined: method of supply and frequency of delivery of personal protective equipment, type of personal protective equipment provided by the institution, and self-purchase. Furthermore, features of the midwives’ workplace were described. For statistical analysis, absolute frequencies and relative proportions were used for categorical variables, and mean and standard deviation were used for numerical variables. Measurements and findingsThe most important finding of this study is that a large proportion of midwives (66.6%) did not receive new personal protective equipment for each shift; 41.9% of midwives who received personal protective equipment during each shift exclusively provided services in the COVID-19 ward, whereas 27.6% did not. The least received supplies were of N95 respirator masks (41.7%) and disposable isolation suit gown (50.5%). Only a certain proportion of midwives (38.6%) were trained by their own institutions on the use of personal protective equipment. Key conclusionsThe provision of personal protective equipment to midwives and training on personal protective equipment were insufficient at all workplaces. Therefore, measures must be taken to increase the supply of this material to midwives who are essential workers in reproductive health.

Early orthodontic treatment in a Finnish public health centre: a retrospective cross-sectional study

Objectives The aim of this observational cross-sectional one-centre study was to assess whether the previously described national orthodontic treatment practises and international recommendations are implemented in a public health care centre in Finland. We also assessed early treatment practices and appliances used. Methods The study group comprised 801 children born in 2011 and 2012 residing in the Riihimäki health centre catchment area in Finland, representing 80% of the age cohort. The patient records were examined for data on orthodontic treatment, timing of treatment, appliances used, and occlusal traits. Results The children had been examined by four orthodontist specialists and two orthodontic postgraduate students. Mean age at occlusal examination had been 9 years. Of the children, 212 (26%) were undergoing or had undergone orthodontic treatment. An additional 4.4% were scheduled for treatment. The proportion of children deemed to need treatment was significantly different between the different orthodontists. The most frequently used appliances were quad-helix (30%), eruption guidance appliance (20%), head gear (14%), fixed appliances (10%), protraction facemask (10%), and passive mandibular lingual arch (6%). Conclusions Nearly one-third of children aged less than 12 years in the health centre were currently or had been in orthodontic treatment. Approximately half had received treatment with either quad-helix or eruption guidance appliance.

Exploring facilitators of the implementation of electronic health records in Saudi Arabia

IntroductionThe introduction of information technology was one of the key priorities for policy-makers in health care organisations over the last two decades due to the potential benefits of this technology to improve health care services and quality. However, approximately 50% of those projects failed to achieve their intended aims. This was a result of several factors, including the cost of these projects. The Saudi Ministry of Health (MoH) planned to implement an electronic health record system (EHRS) in approximately 2100 primary health care centres nationwide. It was acknowledged that this project may face hurdles, which might result in the failure of the project if implementation facilitators were not first determined. According to the Saudi MoH, previous electronic health record system implementation in primary health care centres failed as a consequence of several barriers, such as poor infrastructure, lack of connectivity and lack of interoperability. However, the facilitators of successful electronic health record system implementation in Saudi primary health care centres are not understood.AimTo determine the facilitators that enhance the success of the implementation of an EHRS in public primary health care centres in SA.MethodA mixed methods approach was used with both qualitative and quantitative methods (qualitative using semistructured interviews and quantitative with a closed survey). The purpose of the utilisation of exploratory mixed methods was to identify a wide range of facilitators that may influence EHRS implementation. The data were obtained from two different perspectives, primary health care centre practitioners and project team members. A total of 351 practitioners from 21 primary health care centres participated in the online survey, and 14 key informants at the Saudi Ministry of Health who were directly involved in the electronic health record system implementation in the primary health care centres agreed to be interviewed face to face.ResultsThe findings from both studies revealed several facilitators. Among these facilitators, financial resources were found to be the most influential factor that assisted in overcoming some barriers, such as software selection. The size of the primary health care centres was the second facilitator of successful implementation, despite the scale of the project. Perceived usefulness was another facilitator identified in both the interviews and the survey. More than 90% of the participants thought that the electronic health record system was useful and could contribute to improving the quality of health care services. While a high level of satisfaction was expressed towards the electronic health record system’s usability and efficiency, low levels of satisfaction were recorded for organisational factors such as user involvement, training and support. Hence, system usability and efficiency were documented to be other facilitators of successful electronic health record system implementation in Saudi primary health care centres.ConclusionThe findings of the present study suggest that sufficient financial support is essential to enhance the success of electronic health record system implementation despite the scale of the project. Additionally, effective leadership and project management are core factors to overcome many obstacles and ensure the success of large-scale projects.

Having allies-Experiences of support in people with stress-related exhaustion: A qualitative study.

The number of people seeking care for symptoms of exhaustion and stress is a major concern in several countries. The condition is a challenging and life-changing experience, and a deeper understanding of support to help people on sick leave due to stress-related exhaustion in their early stages is needed to facilitate recovery. The aim was to explore experiences of support in people with stress-related exhaustion being on sick-leave less than six months. A qualitative interview study was conducted with 12 participants (7 women and 5 men; aged 25-46 years) who were on sick leave that had not exceeded six months due to stress-related exhaustion. The participants were recruited from public healthcare centres in the western part of Sweden, and the intention was to reach them early in their ongoing sick leave period. The interviews were performed face-to-face and analysed using a phenomenological hermeneutical approach. The findings show that people affected by stress-related exhaustion struggle to maintain their dignity and define support in terms of allies who acknowledge their personhood and provide them helpful guidance. Participants expressed their needs to be taken seriously by professionals, family, and friends willing to engage in their situation. Lack of empathy and professional knowledge in the clinical encounter induced additional stress. This study indicates that people affected by stress-related exhaustion need allies from their surrounding networks in their struggle to maintain their dignity. Our findings highlight that it is essential to acknowledge them as persons and establish an alliance to provide appropriate support based on each person's specific situation, needs and resources. This approach can be facilitated in a partnership, as emphasized in person-centred care (PCC). PCC emphasizes the co-creation of care in partnership between the patient (often with relatives) and health care professionals which may imply a more collaborative view of health care in which patients are engaged as active partners in planning their care.

Primary health care reforms in Slovenia: leveraging existing structures to expand care

Abstract Primary health care (PHC) in Slovenia is delivered mainly by a network of 63 public community-based primary health care centres (CPHCs), serving as entry points to the health system. Here, multidisciplinary teams provide an array of preventative, diagnostic, therapeutic, palliative, and health promotion services under one roof. Since 2011, several reforms in PHC highlight integrated care. A national scale-up of Family Medicine Practices is underway, where all family medicine teams include a 0.5 FTE registered nurse to improve prevention, early diagnosis and care coordination of chronic patients. Health promotion centers (HPCs) are being introduced in CPHCs to support people in healthy lifestyle, with currently 28 HPCs managed by CPHCs and supported operationally by the National Institute of Public Health. New mental health centers facilitate access to comprehensive mental health care. In 2020, dedicated temporary COVID-19 units in CPHCs played a key role in treating mild/moderate cases and shielding hospitals from overburden. Regarding implementation, pilots have been critical to creating a strong evidence base to enable sustainable (sometimes external) financing, while innovations capitalize on existing links between Slovenia's primary care and public health functions and the Ministry of Health for governance and the flexibility of the multidisciplinary, multiple-practice care model represented by CPHCs. Though this has eased their initial introduction into existing structures, challenges remain. These include dissatisfaction among family physicians due to high administrative burden and an outdated CPHC governance model that limits managers’ authority as well as workforce shortages in public health and primary care. Financial incentives, task shifting, and adjustments to education and training have been used to mitigate these issues. Slovenia's experience may serve as a case study for countries interested in improving their primary healthcare services.

Student nurse experiences in public healthcare clinical practice during the COVID-19 pandemic: A qualitative study

BackgroundThe social crises induced by the coronavirus disease (COVID-19) pandemic have had adverse effects on the global healthcare system. Public healthcare centers have restructured their services to address clinical needs at the forefront of the pandemic. This led to nursing students immersing themselves in clinical experience while practicing at public healthcare centers during the COVID-19 pandemic. ObjectivesThe aim of this study was to explore and understand the experiences of nursing students practicing in public healthcare centers in response to the COVID-19 pandemic. DesignA qualitative study. SettingA public healthcare center in Korea. ParticipantsTwenty third-year nursing students from a university in Korea. MethodsA qualitative study design was used where students provided reflections on their experience in clinical practice at public healthcare centers. Data were collected between November 5 and December 17, 2021. Data were analyzed using the phenomenological approach proposed by Colaizzi. ResultsThree categories emerged. Students immersed themselves in a practicum experience in public healthcare in response to COVID-19. Students recognized the challenges associated with providing healthcare services during the pandemic. The students expanded their field of interest to community nursing. ConclusionIn the context of COVID-19, supplementing academic education and training for nursing students with experience in clinical practice at public healthcare centers enhanced the capabilities of future nurses. It increased confidence in their work and responsibilities.

Prescribing Patterns of Antihypertensives and Antidiabetics in Public and Private Healthcare Centres in North Central Nigeria

Background: Antihypertensive and antidiabetic pharmacotherapy effectively reduces hypertension and diabetic-related morbidity and mortality. Prescribing pattern surveys is one of the drug use evaluation techniques providing an unbiased picture and identification of suboptimal prescribing patterns. The aim of the study is to describe prescription pattern of antihypertensives and antidiabetics in public and private healthcare centres. Method: A cross sectional retrospective study was conducted to obtain related information from prescriptions of 360 patients treated for hypertension and diabetic-related ailments at the public and missionary hospitals, private clinics and community pharmacies with the aid of a data collection sheet. Results: One hundred sixty eight (47.6%) of the patients whose prescription were evaluated were male, with 192 (53.3%) been female counterparts. Those from 45 years and above constituted the highest percentage (76.6%) that were managed for hypertension and diabetic-related ailments across the facilities. Most of the patients (84.2%) were married people, and many of them (45.8%) were government workers. Lisinopril was the highest prescribed in the facilities (44.28%) compared to other antihypertensives, followed by amlodipine ((38.42%), with hydralazine been the least prescribed (0.4%). For the antidiabetics, biguanides were the most commonly prescribed medicine (63.1%), compared to the sulphonyl urea (27.55%. With respect to  number of antidiabetics per prescription, two drugs were the most prescribed pattern (86.3%), and dual therapy were the most prescribed in the faith based (83.20%), private (96.40%) and public (94.4%) healthcare facilities. In all, majority (68.5%) of the prescriptions were by brand with 31.5% by generics names. Conclusion: Diuretics were the most prescribed antihypertensive across faith based, government owned and private health care centres and most patient required two drugs to maintain their blood pressure mostly combined. Biguanides were the most prescribed class of antidiabetics. For hypertension comorbid with diabetes, Biguanides, Sulphonylureas, Glyptins and insulin were mostly combined. Branded medications were more prescribed than generics.

Perceived barriers to physical activity behaviour among patients with diabetes and hypertension in Kosovo: a qualitative study

BackgroundIn a cohort of primary health care users across Kosovo (KOSCO cohort), high rates and poor control of diabetes and hypertension were observed. These conditions can be prevented and better controlled by adapting to a healthy lifestyle. Physical activity is an important target, as inactivity and related obesity were very prevalent in the KOSCO cohort. This qualitative study aims to identify individual and structural barriers to physical activity perceived by patients with diabetes and/or hypertension so as to inform health care providers and policy-makers in Kosovo on strategies for promoting physical activity.MethodsInterviews were conducted from July to October 2020 with 26 public primary health care users from five municipalities of Kosovo (Mitrovica, Vushtrri, Fushe Kosova, Gjakova, and Malisheva). The qualitative study was nested into the KOSCO cohort. KOSCO was implemented in 2019 and recruited consecutive patients visiting the public primary health care centres in these municipalities. Participants of this qualitative sub-study were selected if they had a doctor’s diagnosis of diabetes and/or hypertension. The interview guide consisted of questions related to physical activity barriers these patients are facing, despite having received motivational counselling sessions in primary healthcare centres. Data were analysed using a framework methodology.ResultsThree main themes moderating physical activity behaviour were identified: 1) neighbourhood built environment, 2) health-related problems, and 3) social support. The barriers to physical activity related to the first theme were structural features of the neighbourhoods such as: crowded sidewalks, lack of green spaces, lack of proper lighting in public spaces, as well as dense traffic. In regards to the second theme, the main health reasons for study participants to delay physical activity were related to: physical discomfort as well as stress, worry, and lack of energy. An additional barrier to exercise was lack of social support specifically from friends.ConclusionThe study identifies structural and individual targets for integrated and inter-sectoral physical activity promotion efforts.