Rural Primary Health Care Research Articles

Screening of Early Developmental Delay and Its Risk Factors Among Children Seeking Health Care in India-exploring Missed Opportunities

Background and Objectives: Early years are considered to be critical for a child’s development. Lower middle-income countries report developmental delays late, resulting in limited access to early intervention and rehabilitation services. The opportunity to screen children during immunization and regular outpatient department (OPD) clinics is missed. To estimate the proportion of developmental delay and its risk factors among children under two years of age. Methods: A cross-sectional study was conducted among 169 children attending outpatient department (OPD) and immunization clinics of five health centers in Bengaluru City, India. A standardized developmental delay screening tool was used to screen for developmental delay among children under 2 years of age. After receiving informed written consent, a pretested questionnaire was administered, including the child’s socio-demographic details and risk factors responsible for the developmental delay. Proportions were calculated. The relationship between risk factors and developmental delay was assessed using a chi-square test. The odds ratio and adjusted odds ratio were calculated. Results: A total of 59 children (34.9%) were from rural primary health care (PHC), 79(46.7%) from urban primary health care (PHC), and 31(18.3%) from the hospital. A total of 111(65.7%) of them were females, mean age was 10.6±5.5 months. Developmental delay was reported among 30 children (17.8%). Developmental delay was significantly higher among children younger than 12 months of age and those screened in immunization clinics than compared to the other counterparts. Conclusion: The proportion of developmental delay and risk factors for developmental delay is high among children seeking health care. It is required to implement mandatory monitoring and opportunistic screening during immunization sessions to effectively identify developmental delays early in children.

Hypertension Control Status Among Patients Receiving Treatment From Selected Primary Health Centres in Puducherry: A Cohort-Analysis Approach.

High blood pressure (hypertension) is a major risk factor contributing to 60% of premature deaths caused by non-communicable diseases. In India, a mere 15% of the hypertensive population achieves optimal blood pressure control. Effective monitoring of hypertension is crucial for mitigating the morbidity and mortality associated with cardiovascular diseases. This study employed a cohort analysis approach to determine the control status of hypertension and identify factors associated with hypertension among individuals seeking care at selected primary health centres (PHCs) in Puducherry from January 2019 to December 2022. We assessed treatment records of 1127 patients with hypertension registered at PHCs in both urban and rural areas between 2019 and 2022. Information on socio-demographic details and blood pressure readings was collected to assess the control status of hypertension on a quarterly and six-monthly basis. Additionally, 436 patients were interviewed to identify factors associated with uncontrolled hypertension. Control rates of hypertension varied among PHCs on a quarterly and six-monthly basis. The rural PHC achieved the highest quarterly control rate of 80% in Q4 2020, while the urban PHC had the lowest rate of 44% in Q1 2020. Similarly, the highest six-monthly control rate of 78% was observed in Q3 2019 at both rural and urban PHCs, with the lowest rate of 44% in Q1 2020 at the urban PHC. Conclusion:Analysing data obtained from regular monitoring of hypertension control status allows healthcare providers to identify patterns, trends, and correlations. It assists providers in making informed decisions regarding treatment adjustments, medication choices, lifestyle recommendations, and policy changes. This approach is expected to improve control status for hypertension, leading to the ultimate goal of better health outcomes for patients.

Comparative study of feeding practices among children less than two years attending rural and urban primary health centers, Mysuru, Karnataka

Background: Breastfeeding is considered one of the most significant aspects of a child's health and survival. Breastfeeding is unquestionably the "GOLD STANDARD" dietary intake during the first six months after birth. So it is necessary to know about the feeding practices among children less than two years in both rural and urban areas. Aim of study was to compare the feeding practices among children less than two years attending the urban and rural Primary health centers under JSS Medical College, Mysuru. Methods: This analytical cross-sectional study was conducted among 280 mother and their children residing in both rural and urban areas of Mysuru for six months. A pretested structured questionnaire was used to collect the socio-demographic characteristics and feeding practices. Feeding practices among study subjects were analyzed using SPSS 23 software. Results: In the present study, 35% had poor, 57.1% had average and 7.9% had good infant and early child feeding practices in rural areas, on the other hand, 19.3% had poor, 55.0% had average and 25.7% had good in urban. In this study, the frequency of breastfeeding practices, pre-lacteal feeding, and overall feeding practices were significantly associated with place of residence. Conclusions: This study concludes that though pre-lacteal feeding and bottle feeding were more in urban areas, the overall feeding practices were poorer in rural than urban.

Changes in Children and Youth's Mental Health Presentations during COVID-19: A Study of Primary Care Practices in Northern Ontario, Canada.

Recent research suggests that children and youth are at increased risk of anxiety and depression due to the indirect effects of the COVID-19 pandemic. In Canada, children and youths may face additional hurdles in accessing mental health services in rural areas due to socioeconomic disadvantages and healthcare provider shortages worsened by the pandemic. Our study aimed to assess changes in primary healthcare utilization related to depression and anxiety among children and youth aged 10-25 years in Northern Ontario, Canada. We analyzed de-identified electronic medical record data to assess primary healthcare visits and prescriptions for depression and anxiety among children and youth aged 10-25 years. We used provider billing data and reasons for visits and antidepressant/antianxiety prescriptions compared with 21 months pre-pandemic (1 June 2018 to 28 February 2020) and 21 months during the pandemic (1 April 2020 to 31 December 2021). Our interrupted time series analysis showed an average increase in visits by 2.52 per 10,000 person-months and in prescriptions by 6.69 per 10,000 person-months across all ages and sexes. Females aged 10 to 14 years were found to have the greatest relative change in visits across all age-sex groups. The greatest relative increases in antianxiety and antidepression prescriptions occurred among females and males aged 10 to 14 years, respectively. These findings indicate that there were increased anxiety and depression presentations in primary healthcare among children and youths living in northern and rural settings during the COVID-19 pandemic. The increased primary healthcare presentations of anxiety and depression by children and youths suggest that additional mental health resources should be allocated to northern rural primary healthcare to support the increased demand. Adequate mental health professionals, accessible services, and clinical recommendations tailored to northern rural populations and care settings are crucial.

Professional burnout in primary health care workers of the Republic of Kazakhstan

Background/objectivesEmotional exhaustion is the most common feature of overall burnout among primary care physicians. The purpose of our study is to identify professional burnout among doctors and nurses of the highest level. MethodsThe data were obtained using a social survey of doctors and nurses in primary health care organizations. Using the MBI questionnaire. The study locations were medical centers in urban and rural areas in eight regions of Kazakhstan. A total of 612 urban and 244 rural primary health care workers took part. ResultsMean score ±standard deviation on the exhaustion subscale was 32.6 ± 13.5, on the depersonalization subscale — 14.4 ± 6.1, on the personal achievement subscale — 42.2 ± 7.5. Overall, the high prevalence of emotional exhaustion, depersonalization, and personal achievement was 57.4%, 64.6%, and 65.0%, respectively. Statistically significant predictors for emotional burnout were such as the location of work, urban or rural (OR = 1.973; p < 0.050, as well as who the employee was a doctor or nurse (OR = 2.137 p < 0.001). Work for a quieter job was a significant factor for personal achievement (OR = 4.709 p < 0.016), (OR = 9.341 p < 0.001), respectively. Statistically significant predictors for depersonalization was the status of the employee, namely, whether his work was permanent or not full -time (OR = 1.542 p < 0.001). Gender (OR = 0.350 p < 0.018), job location urban or rural (OR = 1.918 p < 0.050), and alcohol consumption (OR = 4.493 p < 0.021) were statistically significant for personal achievement. ConclusionMental and psychological health issues have become an increasingly important research topic in recent years. In our study, more than half of the study population reported professional burnout, namely exhaustion, depersonalization, and lack of personal achievement. We found a statistically significant relationship between emotional exhaustion and job location, as well as employee status, Depersonalization, and employee status and position. Personal achievements and gender with work location. To change my job to a more calm one was in all three parameters. Doctors have higher emotional exhaustion than nurses.

Intention to Undergo Clinical Breast Examination and Its Associated Factors among Women Attending Rural Primary Healthcare Facilities in South Central Ethiopia

Background: Breast cancer is a global public health problem with higher mortality in developing countries. The Ethiopian National Cancer Control Plan recommends clinical breast examination (CBE) for all women aged >18 years. However, there is low breast examination practice in Ethiopia. Therefore, this study aimed to describe level of intention to undergo CBE and associated factors among women visited selected rural healthcare facilities in south central Ethiopia using Theory of Planned Behavior (TPB). Methods: This study used facility-based cross-sectional study design. A total of 420 women participated in this study. Interviewer-administered structured questionnaire was adopted from previously published research works and Ajzen’s TPB manual. Statistical Package for Social Sciences (SPSS), version 27, was used for analysis. Binary logistic regression model was used to determine factors associated with intention to undergo CBE. Results: In this study, nine out of ten women had never had CBE. Mean score for intention to undergo CBE was 12.55 (SD ± 3.22; min 5, max 20). Intention to undergo CBE was negatively associated with being in the second and middle wealth quantiles compared to the highest wealth quantile, and with the spouse not being able to read or write compared to having attended formal education. Positive attitude and higher subjective norm had relevant association with intention to undergo CBE. Conclusion: The high score for intention to undergo CBE should encourage primary healthcare facilities to offer CBE. Behavioral change communication interventions could address women’s attitude, subjective norm, and spouse’s education associated with intention to undergo CBE.

Relationship between honesty-credit, specialty identity, career identity, and willingness to fulfill the contract among rural-oriented tuition-waived medical students of China: a cross-sectional study.

The fulfillment of contractual obligations by rural-oriented tuition-waived medical students (RTMSs) to work in rural medical institutions after graduation directly impacts the improvement of rural health quality. This study aimed to not only quantitatively measure the direct impact of honesty-credit, specialty identity, and career identity on willingness to fulfill the contract of RTMSs but also to quantify the intermediary role of specialty identity and career identity between honesty-credit and willingness to fulfill the contract. The research results provided recommendations for the rural-oriented tuition-waived medical education (RTME) program to achieve its goal of training rural primary healthcare personnel. From March to May 2022, 1162 RTMSs were selected as the research objects. The honesty-credit, specialty identity, career identity, and willingness to fulfill the contract were quantitated using a self-completed questionnaire. Pearson's correlation analysis and structural equation modeling were used for statistical analysis and mediating effect evaluation. A total of 455 (42.3%) RTMSs had high willingness to fulfill the contract, and honesty-credit had a significant direct positive effect on willingness (β = 0.198, P < 0.001), specialty identity (β = 0.653, P < 0.001), and career identity (β = 0.180, P < 0.001). In the intermediary path between honesty-credit and willingness, career identity [95% confidence interval (CI): 0.007-0.051] had significant mediating effects. Career identity (95% CI: 0.030-0.149) also had significant mediating effects between specialty identity and willingness, and specialty identity (95% CI: 0.465-0.760) had significant mediating effects between honesty-credit and career identity. These results strongly confirmed that honesty-credit, specialty identity, and career identity are early and powerful predictors of the willingness to fulfill the contract of RTMSs. The honesty-credit of RTMSs can predict their willingness to fulfill the contract early, significantly and positively. For the students who fail to pass the credit assessment for many times and have a strong tendency to default, their training qualifications should be canceled in time, so that students who are truly willing to serve rural areas can enter the project, and finally achieve the policy goal of "strengthening the rural primary medical and health system".

De la consulta presencial a la teleconsulta: experiencias de profesionales de atención primaria del País Vasco durante la pandemia

ObjectiveTo explore the perceptions of Primary Health Care (PHC) professionals on changes in consultation modalities and their impact on PHC fundamentals during the pandemic. DesignQualitative exploratory research conducted between October and November, 2021. LocationFour urban and one rural primary health care centers with different socioeconomic profiles in the threeterritories of the Basque Country. ParticipantsForty-six professionals from different categories of the PHC team and health centre directors. MethodPurposive sampling. Five focus groups and fourin-depth interviews. Thematic analysis with the support of the Atlas.ti programme. Triangulation of results among the research team. ResultsExperiences with the development of teleconsultation appear to be directly conditioned by the pandemic context in its different phases and by the PC situation. The professionals identified communication barriers, as well as potentialities of its use that require adequate training and evaluation. Risks of inequity were perceived in the use of teleconsultations that could be affecting the quality of care. Longitudinality was assessed as a facilitating factor and problems of coordination and communication through teleconsultation between care levels were identified. ConclusionsThe replacement of face-to-face consultation by teleconsultation had an impact on fundamental aspects of PHC such as quality, accessibility, equity, coordination and longitudinality. Teleconsultation in PHC should always be evaluated considering the specific circumstances and contexts of its implementation.

Inappropriate prescribing in geriatric rural primary care: impact on adverse outcomes and relevant risk factors in a prospective observational cohort study

BackgroundSeveral tools have revealed an association between potentially inappropriate medications (PIM) and adverse outcomes, but the one most fitted for the rural population has not been determined.AimsWe investigated the performance of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert doctors to the Right Treatment (START) in identifying inappropriate prescribing and its association with adverse outcomes among older rural primary health care users.MethodsA cohort of consenting outpatients aged ≥ 65 years in a rural Greek primary care center was assessed for PIM and potential prescribing omissions (PPO) using the START/STOPP version 2 criteria. Medications, comorbidities, functional status, and laboratory data were recorded along with 6-month incidence of emergency department visits, hospitalization, and death prospectively.ResultsAmong 104 participants (median age 78 years, 49.1% women, receiving a median of 6 drugs), PPO was found in 78% and PIMs in 61%. PIM was multivariately correlated with multimorbidity (p = 0.029) and polypharmacy (p < 0,001), while drug-PPO was only associated with multimorbidity (p = 0.039). The number of PIM predicted emergency department visits and hospitalizations at 6-month follow-up (p value 0.011), independent of age, sex, frailty, comorbidities, and total medication number.DiscussionThe START/STOPP tool is useful in identifying inappropriate prescribing patterns leading to increased utilization of acute care services in older adults followed at a rural primary care setting.ConclusionInappropriate prescribing as identified by the START/STOPP criteria is prevalent among older adults with multimorbidity in rural primary care, and independently associated with future acute care visits.

Prevalence and the determinants of diabetic peripheral neuropathy among type 2 diabetes patients in a selected rural primary health centre, Chengalpet

Prevalence and the determinants of diabetic peripheral neuropathy among type 2 diabetes patients in a selected rural primary health centre, Chengalpet

Opportunistic screening of suspected oral precancerous lesions among patients attending outpatient department of primary health centres, Puducherry

Background: Oral cancer ranks among the top three types of cancer in India. Opportunistic screening of the oral cavity at an early stage could potentially offer long-term survival, improve treatment outcomes, and makes health care affordable for oral cancer patients. The objective is to determine the proportion of suspected oral precancerous lesions among the patients attending the outpatient department of the Primary Health Centres of Puducherry (PHC) by opportunistic screening through visual inspection. Methods: This study was a facility-based cross-sectional study, conducted at the outpatient department of one urban and one rural primary health centre of Puducherry. Twelve hundred individuals aged above 18 years were opportunistically screened at the outpatient department using systematic random sampling. The oral examination was done through visual inspection, and socio-demographic characteristics were collected using a semi-structured questionnaire. Results: The prevalence of suspected oral precancerous lesions was 14.3%, of which (18.5%) in rural areas and (10%) in urban areas. The study revealed that 32.1% of the study participants were in 46-60 years with female predominance of 63.3%. A high prevalence of suspected oral precancerous lesions was seen among the age group &gt;60 years (21.8%) and males (19.1%). Smoking, chewing tobacco/betel quid, and alcohol consumption were the risk factors associated with the prevalence of suspected oral precancerous lesions. Conclusions: Further confirmation of those diagnosed positive for suspected precancerous oral lesions, appropriate follow-up, and treatment of the lesions. Opportunistic screening for all individuals above 30 years of age for suspected oral precancerous lesions is recommended and feasible in primary healthcare settings.

Exploring nurse practitioner practice in Australian rural primary health care settings: A scoping review.

Australians in rural areas experience limited access to services and poorer health outcomes than residents of metropolitan areas. Nurse practitioners (NPs) were introduced in 2000 to reduce pressure on the health system, address workforce shortages and improve rural populations' access to health care services. This scoping review sought to identify, examine and synthesise research evidence of NP practice in Australian rural primary health care services to better understand how NPs are addressing service gaps in rural areas and to identify existing gaps in our knowledge. Peer-reviewed and grey literature from July 2012 to June 2022 was accessed from seven electronic databases, grey literature and hand searching of reference lists and citations. From 154 articles, 19 articles of relevance were identified. Several projects describe the processes required for success, whilst others reported the challenges and barriers encountered. Limited research evidence of rural NP practice exists with a significant gap about how roles operate and their value in primary health care. Uptake and envisaged benefits of rural primary health care NP roles have yet to be realised, with barriers to implementing and sustaining NP roles persisting. Low-level awareness with ambiguity at health service and community level adversely impact on systematic implementation of NP roles. Robust evaluations demonstrating the value of NP skills and practice are needed in combination with bipartisan support from all levels of health care and government providing adequate funding to enable effective implementation of NP roles in poorly resourced rural areas.

HealthyRHearts - reducing cholesterol in rural adults via telehealth-based medical nutrition therapy: protocol for a cluster randomised controlled trial

BackgroundFew randomised controlled trials specifically focus on prevention in rural populations. Cardiovascular disease (CVD) contributes to approximately one quarter of deaths in Australia. Nutrition is a key component affecting many risk factors associated with CVD, including hypercholesterolaemia. However, access to medical nutrition therapy (MNT) is limited for people living in rural areas, potentially exacerbating inequities related to health outcomes. Telehealth services present an opportunity to improve MNT access and address healthcare disparities for rural populations. The present study aims to evaluate feasibility, acceptability, and cost-effectiveness of a telehealth MNT CVD intervention program in lowering CVD risk over 12-months in regional and rural primary health care settings.Methods/designA cluster randomised controlled trial set in rural and regional general practices in NSW, Australia, and their consenting patients (n = 300 participants). Practices will be randomised to either control (usual care from their General Practitioner (GP) + low level individualised dietetic feedback) or intervention groups (usual care from their GP + low level individualised dietetic feedback + telehealth MNT intervention). Telehealth consultations will be delivered by an Accredited Practising Dietitian (APD), with each intervention participant scheduled to receive five consultations over a 6-month period. System-generated generic personalised nutrition feedback reports are provided based on completion of the Australian Eating Survey – Heart version (AES-Heart), a food frequency questionnaire. Eligible participants must be assessed by their GP as at moderate (≥ 10%) to high (> 15%) risk of a CVD event within the next five years using the CVD Check calculator and reside in a regional or rural area within the Hunter New England Central Coast Primary Health Network (HNECC PHN) to be eligible for inclusion. Outcome measures are assessed at baseline, 3, 6 and 12 months. The primary outcome is reduction in total serum cholesterol. Evaluation of the intervention feasibility, acceptability and cost-effective will incorporate quantitative, economic and qualitative methodologies.DiscussionResearch outcomes will provide knowledge on effectiveness of MNT provision in reducing serum cholesterol, and feasibility, acceptability, and cost-effectiveness of delivering MNT via telehealth to address CVD risk in rural regions. Results will inform translation to health policy and practice for improving access to clinical care in rural Australia.Trial registrationThis trial is registered at anzctr.org.au under the acronym HealthyRHearts (Healthy Rural Hearts), registration number ACTRN12621001495819.

Patients’ experiences of living with a stoma in rural areas in Northern Sweden

ABSTRACT Introduction: Stoma complications are common and interfere with many aspects of everyday life. Stoma problems are usually managed by a specialised stoma nurse, a service not present in the rural areas of South Lapland in Sweden. The aim of this study was to describe how stoma patients in rural areas experience living with a stoma. Methods: A qualitative descriptive study with semi-structured interviews were conducted with 17 stoma patients living in rural municipalities and who received a part of their care at the local cottage hospital. Qualitative content analysis was employed. Results: Initially, the stoma was experienced as very depressing. Participants had difficulties in properly managing the dressing. Over time they learned how to properly care for their stoma, making their life easier. Both satisfaction and dissatisfaction with the healthcare were experienced. Those who were dissatisfied expressed a lack of competence in dealing with stoma-related problems. Conclusions: Living with a stoma in a rural area in northern Sweden is experienced as a learning process and acceptance of the stoma’s existence is important. This study emphasises the need for increased knowledge of stoma-related problems in rural primary healthcare in order to help patients cope with everyday life.

Correlates for the severity of suicidal risk in participants with common mental disorders with comorbid chronic medical conditions in rural primary healthcare settings in India.

Suicide is on the rise in low- and middle-income countries (LMICs), including India. There are limited studies assessing factors linked to the severity of suicidal risk in patients with depression and comorbid chronic medical disorders in primary healthcare (PHC) settings. This study examines factors linked to suicidal risk among participants in a cluster randomized controlled trial of collaborative care intervention (Healthier Options through Empowerment (HOPE Study)). The setting was at 49 PHC in the rural Ramanagara District of Karnataka State in southern India. Study eligibility criteria included being ≥30 years with at least mild depression or generalized anxiety disorder and at least one medical condition (cardiovascular disorder or type 2 diabetes mellitus). The severity of suicidal risk at baseline was assessed using the Mini International Neuropsychiatric Interview (MINI), and other measures included the severity of depression (Patient Health Questionnaire-9-items (PHQ-9)), the severity of anxiety (Generalized Anxiety Disorder Scale-7-items (GAD-7)), disability, social support, quality of life, number of comorbid chronic medical illnesses, and body mass index (BMI). Chi-square tests and independent-samples t-tests were used to compare the demographic and clinical characteristics of the no-low and mod-high suicidal risk groups. Logistic regression analysis was used to identify correlates associated with the mod-high suicidal risk group. Mod-high suicidal risk was significantly positively associated with the severity of depression and disability and significantly negatively associated with social support. The severity of depression, higher disability scores, and lower social support were found to be independent correlates of mod-high suicidal risk. Screening, managing depression, and facilitating social support for patients with chronic medical illness in PHC settings may reduce suicidal risk.

Evaluating systematic targeted universal testing for tuberculosis in primary care clinics of South Africa: A cluster-randomized trial (The TUTT Trial).

The World Health Organization (WHO) recommends systematic symptom screening for tuberculosis (TB). However, TB prevalence surveys suggest that this strategy does not identify millions of TB patients, globally. Undiagnosed or delayed diagnosis of TB contribute to TB transmission and exacerbate morbidity and mortality. We conducted a cluster-randomized trial of large urban and rural primary healthcare clinics in 3 provinces of South Africa to evaluate whether a novel intervention of targeted universal testing for TB (TUTT) in high-risk groups diagnosed more patients with TB per month compared to current standard of care (SoC) symptom-directed TB testing. Sixty-two clinics were randomized; with initiation of the intervention clinics over 6 months from March 2019. The study was prematurely stopped in March 2020 due to clinics restricting access to patients, and then a week later due to the Coronavirus Disease 2019 (COVID-19) national lockdown; by then, we had accrued a similar number of TB diagnoses to that of the power estimates and permanently stopped the trial. In intervention clinics, attendees living with HIV, those self-reporting a recent close contact with TB, or a prior episode of TB were all offered a sputum test for TB, irrespective of whether they reported symptoms of TB. We analyzed data abstracted from the national public sector laboratory database using Poisson regression models and compared the mean number of TB patients diagnosed per clinic per month between the study arms. Intervention clinics diagnosed 6,777 patients with TB, 20.7 patients with TB per clinic month (95% CI 16.7, 24.8) versus 6,750, 18.8 patients with TB per clinic month (95% CI 15.3, 22.2) in control clinics during study months. A direct comparison, adjusting for province and clinic TB case volume strata, did not show a significant difference in the number of TB cases between the 2 arms, incidence rate ratio (IRR) 1.14 (95% CI 0.94, 1.38, p = 0.46). However, prespecified difference-in-differences analyses showed that while the rate of TB diagnoses in control clinics decreased over time, intervention clinics had a 17% relative increase in TB patients diagnosed per month compared to the prior year, interaction IRR 1.17 (95% CI 1.14, 1.19, p < 0.001). Trial limitations were the premature stop due to COVID-19 lockdowns and the absence of between-arm comparisons of initiation and outcomes of TB treatment in those diagnosed with TB. Our trial suggests that the implementation of TUTT in these 3 groups at extreme risk of TB identified more TB patients than SoC and could assist in reducing undiagnosed TB patients in settings of high TB prevalence. South African National Clinical Trials Registry DOH-27-092021-4901.

Adverse events following COVID-19 vaccination among pregnant women attending primary health centers: An active-surveillance study

IntroductionVaccine safety is a major barrier to the uptake of the COVID-19 vaccine by pregnant women. To bring confidence among pregnant women towards vaccine intake, there is a need to synthesize evidence on safety profile of vaccination. ObjectiveTo assess adverse events (AEs) following COVID-19 vaccination among pregnant women. Materials and methodsA vaccine safety surveillance was conducted at 2 rural primary health centers (PHC) located in Anantapur District, India. A total of 420 pregnant women were monitored for AEs following COVID-19 vaccination for a period of 30 min and followed for 1 month for late reactions through telephonic interviews. All AEs were subjected to causality and severity assessment. Descriptive statistics were used to represent adverse events. ResultsThe COVID-19 vaccine acceptance rate among pregnant women was 64.4%. A total of 420 pregnant women received 670 vaccine doses (Covishield = 372, Covaxin = 298) against COVID-19. Majority of vaccine intake was observed during the second trimester. The incidence rate of AEs following the COVID-19 vaccine among pregnant women was 93.8%, and the majority include injection site pain (28.4%, 29.6%), fever (25.5%, 19.0%), myalgia (8.21%, 12.3%), and malaise (13.6%, 8.4%). Most AEs notified are probable and mild in nature. ConclusionThe COVID-19 vaccine acceptance rate among pregnant women was 64.4%. A 30 days incidence rate of AEs following COVID-19 vaccination among pregnant women was 93.8%, with the most common mild events like injection site pain, and fever. A further follow-up cohort study by taking an adequate sample size was recommended to capture fetal–maternal outcomes.

Realising radical potential: building community power in primary health care through Participatory Action Research

BackgroundWhile community participation is an established pro-equity approach in Primary Health Care (PHC), it can take many forms, and the central category of power is under-theorised. The objectives were to (a) conduct theory-informed analysis of community power-building in PHC in a setting of structural deprivation and (b) develop practical guidance to support participation as a sustainable PHC component.MethodsStakeholders representing rural communities, government departments and non-governmental organisations engaged through a participatory action research (PAR) process in a rural sub-district in South Africa. Three reiterative cycles of evidence generation, analysis, action, and reflection were progressed. Local health concerns were raised and framed by community stakeholders, who generated new data and evidence with researchers. Dialogue was then initiated between communities and the authorities, with local action plans coproduced, implemented, and monitored. Throughout, efforts were made to shift and share power, and to adapt the process to improve practical, local relevance. We analysed participant and researcher reflections, project documents, and other project data using power-building and power-limiting frameworks.ResultsCo-constructing evidence among community stakeholders in safe spaces for dialogue and cooperative action-learning built collective capabilities. The authorities embraced the platform as a space to safely engage with communities and the process was taken up in the district health system. Responding to COVID-19, the process was collectively re-designed to include a training package for community health workers (CHWs) in rapid PAR. New skills and competencies, new community and facility-based alliances and explicit recognition of CHW roles, value, and contribution at higher levels of the system were reported following the adaptations. The process was subsequently scaled across the sub-district.ConclusionsCommunity power-building in rural PHC was multidimensional, non-linear, and deeply relational. Collective mindsets and capabilities for joint action and learning were built through a pragmatic, cooperative, adaptive process, creating spaces where people could produce and use evidence to make decisions. Impacts were seen in demand for implementation outside the study setting. We offer a practice framework to expand community power in PHC: (1) prioritising community capability-building, (2) navigating social and institutional contexts, and (3) developing and sustaining authentic learning spaces.

Responding to Humanitarian Crises: Midwifery Care in Bangladesh.

Sexual and reproductive health and rights (SRHR) is often a neglected topic of intervention in humanitarian crises despite its wide-ranging impact on women and girls' well-being. Increasing frequency of climate-induced natural disasters calls for an urgent need to identify innovative practices for sustainable and effective humanitarian preparedness and response to ensure SRHR of affected populations. One such innovation is the empowerment of midwives in disaster response program planning and implementation. This article describes how midwives deployed to rural primary health centers provided quality SRHR services, particularly for labor and birth assistance and initial management of perinatal emergencies and referral in the aftermath of the 2022 flooding in northern and northeastern Bangladesh. Supportive supervision from physicians, adequate health care logistics and supplies, and administrative support from local health authorities created an enabling environment for the midwives. Community engagement through volunteers helped build rapport with residents and allowed patients to navigate health services. Deploying midwives as a response to climate-induced natural disaster was successful in establishing quality SRHR services. Future recommendations include systematically deploying midwives in health centers closest to the communities in locations vulnerable to climate change as part of routine health service delivery. This innovative approach clearly demonstrated that utilization of midwives during and after natural disasters could build community and health system resilience to climate change.

Utilisation of rural primary health centers for outpatient services - a study based on Rajasthan, India

IntroductionOutpatient services are crucial for strengthening primary healthcare and reducing out-of-pocket spending, which has been one of the major causes of impoverishment. So it is also critical to comprehend the people’s preferences in accessing primary healthcare facilities, as government primary healthcare facilities in India are underutilized. The current paper explores the factors that construct the individual’s decision to seek outpatient care in primary healthcare facilities in India’s largest state Rajasthan.MethodsIt was a cross-sectional survey conducted in 72 primary sample units of 24 primary health centers in 11 districts of Rajasthan, India, from November 2019 to January 2020. The study selected 368 households through purposive sampling. Out of 368 households, 460 people reported any illness and 326 reported outpatient visit to any health facility in the last 30 days from the date of the survey.AnalysisThe focus was on analyzing the data in the context of public and private health facilities to understand the factors influencing people’s choice to access outpatient services. The principal component analysis is used to understand the relationship between facility preparedness and OPD uptake. Also, multivariate logistic regression is applied to assess the significant predictors in using primary health facility services.ResultExcept for the 29% of patients who received no care, the proportion of patients attended public health facilities was 35%, and the rest were utilizing private health facilities. Those who sought care at PHCs were mostly over 45 years age, non-literate, and from the lowest wealth quintile. Logistic regression suggests that people belong to upper wealth quintile (OR = 0.298; 95% 0.118–0.753) are less likely to visit PHCs for treatment. Also, increase in distance of PHC (OR = 0.203; 95% CI 0.076–0.539) reduces the likelihood of their visit outpatient care. People are 9.7 times (OR = 9.740; 95% CI 2.856–33.217) more likely to visit a PHCs that are better equipped in terms of human resources, equipment, and medicine.ConclusionThe uptake of PHCs depends on several factors, which should be considered to ensure that all segments of society have equitable access to them. Through improved accessibility and quality of service, PHCs can be made more appealing to the larger population.