Rural Primary Health Care Centers Research Articles

Factors affecting the technical efficiency of rural primary health care centers in Hamadan, Iran: data envelopment analysis and Tobit regression

BackgroundStudying and monitoring the efficiency of primary health care centers has a special place in the health system. Although studies have been conducted in the field of efficiency in Iran, few have focused on rural primary health care centers. In addition, previous studies have not used the child mortality rate and Behvarzes as input and output.ObjectiveThe present study was conducted aimed to estimate the technical efficiency of rural primary health care centers and determinant factors in Hamadan using data envelopment analysis and Tobit regression.MethodsThis is a Longitudinal study of rural primary health care centers in Hamadan province (2002–2016). Data Envelopment Analysis was employed to estimate technical efficiency of sampled health facilities while Panel Tobit Analysis was applied to predict factors associated with efficiency levels. The outputs were child mortality rate under 1 year of age and child mortality rate 1 year to 5 years of age. The input was Behvarzes (rural health workers).ResultsThe results of efficiency analysis showed that the average efficiency scores of the centers had a fluctuating trend during the period of the study, but the average performance scores generally decreased in 2016, as compared with 2002. The highest and lowest average performance scores were observed in 2003 (0.78) and 2013 (0.56), respectively. Number of physicians and rural primary healthcare centers per population had a positive statistically significant and the number of midwives and the total fertility per population had a negative statistically significant effect on efficiency.ConclusionsThe findings suggest some level of wastage of health resources in primary health centers. Findings indicate a level of waste of health resources in primary health centers. Behvarz functions in providing primary care services can be considered in the reallocation and optimal use of available resources at the level of rural health centers.

Iranian general populations' and health care providers' preferences for benefits and harms of statin therapy for primary prevention of cardiovascular disease

BackgroundThe use of statins for primary prevention of cardiovascular diseases is associated with different benefit and harm outcomes. The aime of this study is how important these outcomes are for people and what people's preferences are.MethodsWe conducted a preference-eliciting survey incorporating a best–worst scaling (BWS) instrument in Iran from June to November 2019. The relative importance of 13 statins-related outcomes was assessed on a sample of 1085 participants, including 913 general population (486 women) and 172 healthcare providers from the population covered by urban and rural primary health care centers. The participants made trade-off decisions and selected the most and least worrisome outcomes concurrently from 13 choice sets; each contains four outcomes generated using the balanced incomplete block design.ResultsAccording to the mean (SD) BWS scores, which can be (+ 4) in maximum and (− 4) in minimum, in the general population, the most worrisome outcomes were severe stroke (3.37 (0.8)), severe myocardial infarction (2.71(0.7)), and cancer (2.69 (1.33)). While myopathy (− 3. 03 (1.03)), nausea/headache (− 2.69 (0.94)), and treatment discontinuation due to side effects (− 2.24 (1.14)) were the least worrisome outcomes. Preferences were similar between rural and urban areas and among health care providers and the general population with overlapping uncertainty intervals.ConclusionThe rank of health outcomes may be similar in various socio-cultural contexts. The preferences for benefits and harms of statin therapy are essential to assess benefit-harm balance when recommending statins for primary prevention of cardiovascular diseases.

How ready is the system to deliver primary healthcare? Results of a primary health facility assessment in Enugu State, Nigeria.

Primary health centres are an effective means of achieving access to primary healthcare (PHC) in low- and middle-income countries. We assessed service availability, service readiness and factors influencing service delivery at public PHC centres in Enugu State, Nigeria. We conducted a cross-sectional study of 60 randomly selected public health centres in Enugu using the World Health Organization’s Service Availability and Readiness Assessment (SARA) survey. The most senior health worker available was interviewed using the SARA questionnaire, and an observational checklist was used for the facility assessment. None of the PHC centres surveyed had all the recommended service domains, but 52 (87%) offered at least half of the recommended service domains. Newborn care and immunization (98.3%) were the most available services across facilities, while mental health was the least available service (36.7%). None of the surveyed facilities had a functional ambulance or access to a computer on the day of the assessment. The specific-service readiness score was lowest in the non-communicable disease (NCD) area (33% in the rural health centres and 29% in the urban health centres) and NCD medicines and supplies. Availability of medicine and supplies was also low in rural PHC centres for the communicable disease area (36%) and maternal health services (38%). Basic equipment was significantly more available in urban health centres (P = 0.02). Urban location of facilities and the presence of a medical officer were found to be associated with having at least 50% of the recommended infrastructure / basic amenities and equipment. Continuing medical education, funding and security were identified by the health workers as key enablers of service delivery. In conclusion, despite a focus on expanding primary care in Enugu State, significant gaps exist that need to be closed for PHC to make significant contributions towards achieving universal healthcare, core to achieving the health-related Sustainable Development Goal agenda.

Newborn Resuscitation Resources in Selected Rural and Urban Primary Healthcare Centres in Enugu State, Nigeria: A Comparative Analysis

Newborn Resuscitation Resources in Selected Rural and Urban Primary Healthcare Centres in Enugu State, Nigeria: A Comparative Analysis

Assessment of Contraception Use among Early Married Females in Rural Districts in Giza Governorate, Egypt

Background: Family planning improves the health outcomes of mothers and children and reduces pregnancy-related morbidity and mortality, and the economic costs of early pregnancy. Objective: Describe the effect of the age of marriage on contraceptive behaviors. Methods: A cross-sectional study was conducted in a systematic randomly selected five rural primary health care centers in Giza governorate, Egypt to estimate the use of family planning methods among two subgroups using an adapted questionnaire: female married before 18 Y and that married ≥18 Y. A structured interview conducted among 650 females in reproductive age. Results: Pregnancy number and family size were significantly higher among female married before 18years (3.3±1.9) and (4.8±1.6) versus (2.7±1.5) and (4.4±1.3). Family planning use after first and second child were lower among early married females (84.3%) and (82.5%) versus (85.2%) and (87.4%) of their counterparts married ≥18 Y respectively with no statistically significant differences. The bivariate analysis showed that the likelihood of using a family planning method after the first child was higher among educated women and women with an educated husband than among illiterate women and women with non-educated husband [COR, 2.6; 95% CI,1.5-4.5] and [COR,1.7; 95% CI,1.1-2.9] respectively. Conclusions: Family planning method use was particularly low among females married before 18 and consequently, their family size and their pregnancy number were high. Education is a significant determinant of the age of marriage and of FP use. These factors should be considered during the design of short- term and long-term family planning strategies to effectively increase family planning methods use among early married females especially in conservative contexts.

Assessment of Treatment Outcomes of Tuberculosis patients in a Rural Comprehensive Health Care Centre, Benue State, North Central Nigeria

Despite the availability of effective intervention programs over the years, tuberculosis remains a major global health problem. It causes ill-health among millions of people each year and ranks alongside the Human immunodeficiency virus (HIV) as a leading cause of death worldwide. The aim of this study is to assess the outcome of tuberculosis treatment in a Rural Primary Health Care Centre, Benue State, North Central Nigeria. A three-year retrospective study was employed to review 150 tuberculosis cases treated from January 2014 - December 2016. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20 and presented as tables and charts. The relationship between independent and outcome variables were tested with Chi-square test and P-value was set at 0.05. Of the 150 Tuberculosis patients treated, 84(56.0%) were males while 66(44.0%) were females. More than two-thirds (77.3%) of the patients had pulmonary tuberculosis. The successful treatment rate was 60.0% (32.7% treatment completed and 27.3% cured). Over twelve percent defaulted, 10.7% were lost to follow up, 6.7% were transferred out and 0.7% died. In this study, the successful treatment outcome was lower than the National target .The relationship between the disease sites; HIV status, Cotrimoxazole prophylaxis and the treatment outcome were statistically significant. Directly Observed Treatment Short Course (DOTS) providers should address issue of hindrances to adherence to treatment in order to improve the treatment success rate.

Assessment of Treatment Outcomes of Tuberculosis patients in a Rural Comprehensive Health Care Centre, Benue State, North Central Nigeria

Despite the availability of effective intervention programs over the years, tuberculosis remains a major global health problem. It causes ill-health among millions of people each year and ranks alongside the Human immunodeficiency virus (HIV) as a leading cause of death worldwide. The aim of this study is to assess the outcome of tuberculosis treatment in a Rural Primary Health Care Centre, Benue State, North Central Nigeria. A three-year retrospective study was employed to review 150 tuberculosis cases treated from January 2014 - December 2016. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20 and presented as tables and charts. The relationship between independent and outcome variables were tested with Chi-square test and P-value was set at 0.05. Of the 150 Tuberculosis patients treated, 84(56.0%) were males while 66(44.0%) were females. More than two-thirds (77.3%) of the patients had pulmonary tuberculosis. The successful treatment rate was 60.0% (32.7% treatment completed and 27.3% cured). Over twelve percent defaulted, 10.7% were lost to follow up, 6.7% were transferred out and 0.7% died. In this study, the successful treatment outcome was lower than the National target .The relationship between the disease sites; HIV status, Cotrimoxazole prophylaxis and the treatment outcome were statistically significant. Directly Observed Treatment Short Course (DOTS) providers should address issue of hindrances to adherence to treatment in order to improve the treatment success rate.

Assessment of Treatment Outcomes of Tuberculosis patients in a Rural Comprehensive Health Care Centre, Benue State, North Central Nigeria

Despite the availability of effective intervention programs over the years, tuberculosis remains a major global health problem. It causes ill-health among millions of people each year and ranks alongside the Human immunodeficiency virus (HIV) as a leading cause of death worldwide. The aim of this study is to assess the outcome of tuberculosis treatment in a Rural Primary Health Care Centre, Benue State, North Central Nigeria. A three-year retrospective study was employed to review 150 tuberculosis cases treated from January 2014 - December 2016. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20 and presented as tables and charts. The relationship between independent and outcome variables were tested with Chi-square test and P-value was set at 0.05. Of the 150 Tuberculosis patients treated, 84(56.0%) were males while 66(44.0%) were females. More than two-thirds (77.3%) of the patients had pulmonary tuberculosis. The successful treatment rate was 60.0% (32.7% treatment completed and 27.3% cured). Over twelve percent defaulted, 10.7% were lost to follow up, 6.7% were transferred out and 0.7% died. In this study, the successful treatment outcome was lower than the National target .The relationship between the disease sites; HIV status, Cotrimoxazole prophylaxis and the treatment outcome were statistically significant. Directly Observed Treatment Short Course (DOTS) providers should address issue of hindrances to adherence to treatment in order to improve the treatment success rate.

Assessment of Treatment Outcomes of Tuberculosis patients in a Rural Comprehensive Health Care Centre, Benue State, North Central Nigeria

Despite the availability of effective intervention programs over the years, tuberculosis remains a major global health problem. It causes ill-health among millions of people each year and ranks alongside the Human immunodeficiency virus (HIV) as a leading cause of death worldwide. The aim of this study is to assess the outcome of tuberculosis treatment in a Rural Primary Health Care Centre, Benue State, North Central Nigeria. A three-year retrospective study was employed to review 150 tuberculosis cases treated from January 2014 - December 2016. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20 and presented as tables and charts. The relationship between independent and outcome variables were tested with Chi-square test and P-value was set at 0.05. Of the 150 Tuberculosis patients treated, 84(56.0%) were males while 66(44.0%) were females. More than two-thirds (77.3%) of the patients had pulmonary tuberculosis. The successful treatment rate was 60.0% (32.7% treatment completed and 27.3% cured). Over twelve percent defaulted, 10.7% were lost to follow up, 6.7% were transferred out and 0.7% died. In this study, the successful treatment outcome was lower than the National target .The relationship between the disease sites; HIV status, Cotrimoxazole prophylaxis and the treatment outcome were statistically significant. Directly Observed Treatment Short Course (DOTS) providers should address issue of hindrances to adherence to treatment in order to improve the treatment success rate.

Assessment of Treatment Outcomes of Tuberculosis patients in a Rural Comprehensive Health Care Centre, Benue State, North Central Nigeria

Despite the availability of effective intervention programs over the years, tuberculosis remains a major global health problem. It causes ill-health among millions of people each year and ranks alongside the Human immunodeficiency virus (HIV) as a leading cause of death worldwide. The aim of this study is to assess the outcome of tuberculosis treatment in a Rural Primary Health Care Centre, Benue State, North Central Nigeria. A three-year retrospective study was employed to review 150 tuberculosis cases treated from January 2014 - December 2016. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20 and presented as tables and charts. The relationship between independent and outcome variables were tested with Chi-square test and P-value was set at 0.05. Of the 150 Tuberculosis patients treated, 84(56.0%) were males while 66(44.0%) were females. More than two-thirds (77.3%) of the patients had pulmonary tuberculosis. The successful treatment rate was 60.0% (32.7% treatment completed and 27.3% cured). Over twelve percent defaulted, 10.7% were lost to follow up, 6.7% were transferred out and 0.7% died. In this study, the successful treatment outcome was lower than the National target .The relationship between the disease sites; HIV status, Cotrimoxazole prophylaxis and the treatment outcome were statistically significant. Directly Observed Treatment Short Course (DOTS) providers should address issue of hindrances to adherence to treatment in order to improve the treatment success rate.

Primary care physicians’ concerned voices on sickness certification after a period of reorganization. Focus group interviews in Sweden

Objective: This study explored the views of primary health care (PHC) physicians on sickness certification after reforms in 2005 prompted by the Swedish government to increase the quality and decrease the inequalities, and costs of sickness certification.Design: Qualitative design with focus group interviews. Data were analysed using qualitative content analysis.Setting: Urban and rural PHC centres in Region Västra Götaland, Sweden.Subjects: GPs, interns, GP trainees and locums working in PHC centres 2015. Six focus group interviews with 28 physicians were performed.Main outcome measures: Experiences and reflections about the sickness certification system.Results: The latent content was formulated in a theme: ‘The physicians perceived the sickness certification process as emotive and a challenge to master with differing demands and expectations from authorities, management and patients’. Sickness certification could be easy in clear-cut situations or difficult when other factors besides the pure medical were ruling the decisions. The physicians’ coping strategies for the task included both active measures (cooperation with health care staff and social insurance officers) and passive adaptation (giving in or not caring too much) to the circumstances. Proposals for the future were to transfer lengthy sickness certifications and rehabilitation to specialized teams and increase cooperation with rehabilitation coordinators and social insurance officers.Conclusions: Political decisions on laws and regulations for sickness certification impacted the primary health care making the physicians’ work difficult and burdensome. Their views and suggestions should be carefully considered in future organization of primary care. KEY POINTSIn 2005 Swedish government introduced reforms to decrease the inequalities and costs of sickness certification and facilitate the physicians’ work. Focus group interviews with Swedish primary care physicians revealed that sickness certification was challenging due to differing demands from authorities, management and patients.Coping strategies for the sick-listing task included both active measures and passive adaptation to the circumstances.A proposal for future better working conditions for physicians was to transfer lengthy sickness certifications and rehabilitation to specialized teams.

Evidence, theory and context: using intervention mapping in the development of a community-based self-management program for chronic low back pain in a rural African primary care setting - the good back program

BackgroundRural Nigeria has one of the greatest burdens of low back pain but there are no effective evidence-based interventions to manage it in this population. This paper presents the application of the intervention mapping (IM) approach in the development of a complex behavior change intervention – The Good Back program, aimed at reducing non-specific chronic low back pain (CLBP) disability in rural Nigeria.MethodsThe first four steps of IM were applied. A critical review of the literature, 2 qualitative studies and a population-based cross-sectional study in rural Nigeria helped to identify two key program objectives in order to reduce CLBP disability in this population: reduce the impact of illness perceptions, fear avoidance beliefs, catastrophising, anxiety and depression by targeting maladaptive illness perceptions about CLBP; and facilitate the adoption of exercises and good posture to limit disability. A systematic review plus these studies, identified the personal and environmental determinants of the performance objectives including health literacy, self-awareness, self-efficacy, personal preference, health professional skills, health facility structure and family/community support. The theory, techniques and strategies for modifying personal and environmental determinants were also identified from these studies. Intervention components and materials were then produced for practical application. The initial developed intervention was described.ResultsThe feasibility and acceptability of the developed program was then tested using a small pragmatic non-randomised controlled study incorporating qualitative exit feedback interviews in a rural Nigerian primary health care centre. The program appeared feasible and acceptable when delivered by a highly trained physiotherapist. There were promising clinical outcomes in disability, pain intensity, illness perceptions, fear avoidance beliefs and pain medication use. Suggestions for program improvement included shorter but ongoing sessions, video demonstration of exercises/good posture, spacious exercise/demonstration rooms, and community legitimisation of exercise as treatment for back pain. Subsequent modifications to program content and delivery were then described. Theoretical modification included the addition of aspects of the social cognitive theory to the Leventhal’s self-regulatory model of illness cognitions.ConclusionsIM appears to be a suitable framework for designing complex behavior change interventions in rural Nigeria. The need for further testing of the intervention was highlighted.

Courses on Basic Occupational Safety and Health: A Train-the-Trainer Educational Program for Rural Areas of Latin America.

Integrating basic occupational health services into primary care is encouraged by the Pan American Health Organization. However, concrete initiatives are still scarce. We aimed to develop a training program focusing on prevention of occupational risks for primary healthcare professionals. This train-the-trainer program was piloted at four universities in Chile and Peru. Occupational health or primary healthcare lecturers formed a team with representative(s) of one rural primary healthcare center connected to their university (Nparticipants = 15). Training started with a workshop on participatory diagnosis of working conditions. Once teams had conducted the participatory diagnosis in the rural communities, they designed in a second course an active teaching intervention. The intervention was targeted at the main occupational health problem of the community. After implementation of the intervention, teams evaluated the program. Evaluation results were very positive with an overall score of 9.7 out of 10. Teams reported that the methodology enabled them to visualize hazardous working conditions. They also stated that the training improved their abilities for problem analysis and preventive actions. Aspects like time constraints and difficult geographical access were mentioned as challenges. In summary, addressing occupational health in primary care through targeted training modules is feasible, but long-term health outcomes need to be evaluated.

Association between cognitive impairment and criteria for frailty syndrome among older adults.

The association between cognitive impairment and physical frailty has been studied in older adults. The criteria degree of frailty may be keys to associated cognitive impairment. To analyze the association between cognitive impairment and the criteria for frailty. We cross-sectionally examined data from 667 older adults (≥60 years of age) from a study entitled 'Variables associated to cognition in elderly caregivers' involving patients in an urban and rural primary healthcare center. We defined cognitive impairment based on different groups of scores on the Mini Mental State Examination, and defined frailty and prefrailty using the criteria by the Cardiovascular Health Study. We performed multinomial regression models to analyze the association between levels of frailty and cognitive impairment. Similar proportions of women (54.8%) and men (45.2%) participated in the study (mean age: 71 years old). We found cognitive impairment, prefrailty and frailty in 34, 54, and 24% of the participants, respectively. Concomitant cognitive impairment and frailty was found in 13% of them. The chances of cognitive impairment increased up to 330% (Odds Ratio [OR]: 4.3; 95% confidence interval [95%CI] 2.4‒7.7; p<0.001) among frail individuals, and 70% (OR: 1.7; 95%CI 1.0‒2.8; p=0.033) among prefrail individuals compared to robust/non-frail individuals. After controlling for age, education, place of residence and functional dependence, slowness and fatigue criteria were significantly associated with cognitive impairment. Older adults with frailty have a greater likelihood of concomitant cognitive impairment than prefrail and robust older adults. The prevalence of cognitive impairment and frailty is consistent with data reported in literature. The present findings contribute to the investigation of cognitive frailty.

Sizing an Off-Grid Photovoltaic System and Economic Comparison with Petrol Generator Using Life Cycle Cost (LCC) Approach for a Typical Rural Primary Healthcare Center in Nigeria

It is needless to re-emphasize that modern day healthcare systems require uninterruptible power supply, relying on the national grid for power supply most especially in remote areas in Nigeria is a deliberate attempt to paralysis and underutilize both the human and non-human resources. This paper presents the sizing of a stand-alone photovoltaic system and economic comparison with petrol generator in powering a rural Primary Health Care Center (PHC) in Agbado, Ado-Odo, Ota Local Government, Ogun State, Nigeria. Load survey of the PHC was done in order to know the daily energy demand. The average annual solar radiation and the estimated load for the PHC used as case study are 4.89kWh/m2/day and 14.40kWh/day respectively. The result obtained from sizing the photovoltaic system reveals that the estimated load will require 5.25kW photovoltaic array capacity, 21 modules (24V, 250W each), 10 batteries (12V, 200Ah each), 3 solar charge controllers (24V, 80A each), 1 unit of 4kW inverter (24Vdc/220Vac, 50Hz), 3x70mm2 insulated flexible copper cable and 3x2.5mm2 insulated flexible copper cable. Life Cycle Cost (LCC) technique was used to assess the most economically viable option in powering the PHC. The study also reveals a savings of 64.4% in LCC using PV system as against petrol generators in powering the PHC. The replacement cost constitutes the higher factor affecting the LCC of the PV system constituting about 47.7%, while the operation and maintenance cost forms the least factor with about 28.9%. Also, for that of petrol generator, the fuel cost constitutes the highest factor affecting the LCC, constituting about 87.6%, while the initial capital cost forms the least factor which is about 0.24%. The insights from this study can be reciprocated to other rural PHCs in Nigeria.

Dyspnoea symptom intensity and impact on health-related quality of life in patients with cardiovascular or pulmonary diseases: a longitudinal observational study

Introduction: Dyspnoea is a prevalent symptom associated with significantly reduced health-related quality of life (HRQoL). Accurate estimates of the severity and intensity of dyspnoea using standard tools in the clinic are important for the assessment of the severity of symptoms at later follow ups. Objectives: The current study had two aims. First, we sought to determine one-year changes in dyspnoea and health-related quality of life in patients with cardiac or respiratory diseases. Second, we sought to analyse the long-term associations between one-dimensional measurement methods and a generic instrument reflecting the multi-dimensionality of dyspnoea using the Short-Form Health Survey (SF-36). Methods: We prospectively recruited adult dyspnoeic patients in a rural primary health care centre. Participants were assessed for demographics, symptoms, medications, and N-terminal B-Type natriuretic pro-peptide (Nt-proBNP) level, and underwent spirometry and echocardiography. Results were analysed at baseline and one-year after enrolment. Based on the assessment results, we categorized the patients into one of three groups as the underlying disorder for dyspnoea: cardiovascular, pulmonary or psychiatric disease. Results: The ordinal scales [New York Heart Association (NYHA), modified Medical Research Council (mMRC) and Verbal Rating Scale (VRS)] indicated a slight but not significant decrease in dyspnoea severity, whereas the VAS showed a significant reduction in dyspnoea severity (p = 0.001) overall as well as in the cardiovascular group. By contrast, patients with pulmonary disease showed no improvement. HRQoL, as determined by the eight domains of SF-36, was unchanged, and dyspnoea severity had no impact on the worsening of health status. The correlation coefficient by test-re-test (reliability) of values at baseline and at the end of the study was highly significant. Conclusion: As appropriate measurements for the assessment of dyspnoea using one-dimensional scales, both mMRC and VAS should be considered for measuring changes in dyspnoea severity. VAS should be considered particularly for long-term changes in dyspnoeic patients with cardiovascular disorders. Changes in the different domains of the SF-36 were not seen after one year.

Optimizing osteoporosis care in a rural primary health care center: Findings of a research study aimed to support seniors.

Osteoporosis is one of the most under-diagnosed and under-treated health conditions in Canada. This study questioned whether an invitation to self-refer for osteoporosis risk evaluation would improve the number of patients who were tested for bone mineral density (BMD) at a rural Primary Health Care Center (PHCC). The purpose of this study is to improve osteoporosis care and decrease bone fracture risk in a population of patients 65 years of age and older. A quasi-experimental research design was used to review screening rates of BMD testing and identified patients in this population who were at low, moderate, and high risk for developing osteoporosis. Screening rates at the PHCC were compared to screening rates at another rural PHCC in the province. The self-referral program for BMD testing and a nurse-led intervention resulted in an increased number of people who were BMD tested at the study PHCC compared with the control PHCC, and identified more male patients 65 years of age and older who were at risk for osteoporosis and bone fractures. Recommendations suggest future research in other provincial PHCCs that may encourage self-referral programs for BMD testing and improved osteoporosis care for patients 65 years of age and older.

Organised Versus Opportunistic Cervical Cancer Screening in Urban and Rural Regions of Lithuania.

Background and Objectives: In 2004, Lithuania started the Nationwide Cervical Cancer Screening Programme. However, screening is more opportunistic than population-wide and the programme’s coverage is insufficient. The aim of this study was to assess the effect of systematic personal invitation on coverage of cervical cancer (CC) screening in urban and rural regions of Lithuania. Materials and Methods: The study was conducted in an urban primary healthcare centre (PHCC) and in a rural PHCC, where prevailing CC screening practice was highly opportunistic. Over the first year, all women aged 25–60 who had not received a Pap smear test within the last three years in urban (n = 1591) and rural (n = 1843) PHCCs received a personal invitation letter to participate in the screening. Over the second year, the reminder letter was sent to the non-attendees (n = 1042 in urban and n = 929 in rural PHCCs). A random sample of women (n = 93), who did not attend for screening after two letters, was contacted by phone in order to identify the barriers of non-attendance. Results: Before the study, only 9.6% of the target population in urban and 14.7% in rural PHCCs participated in CC screening. After the first invitation letter, the participation in CC screening increased up to 24.6% in urban and 30.8% in rural areas (p < 0.001). After the reminder letter, the attendance was 16.4% in urban and 22.2% in rural PHCCs (p < 0.001). The most common barriers for the non-attendance were lack of time, long waiting time for family doctor’s appointment, worries that a Pap test might be unpleasant and preventive gynaecological examination outside of the screening program. Conclusions: A systematic personal invitation with one reminder letter significantly increased the coverage of CC screening and was more effective in rural regions than in urban regions. The assessed barriers for non-attendance can be used to improve the coverage of screening.

Agreement between 2017 ACC/AHA Hypertension Clinical Practice Guidelines and Seventh Report of the Joint National Committee Guidelines to Estimate Prevalence of Postmenopausal Hypertension in a Rural Area of Bangladesh: A Cross Sectional Study.

Background and objectives: Justification for application of 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines to detect hypertension (HTN) among Bangladeshi population is understudied. This prompted us to examine the level of agreement between 2017 ACC/AHA and Joint National Committee 7 (JNC 7) guidelines to detect postmenopausal HTN in a rural area of Bangladesh. Materials and Methods: This cross-sectional study recruited 265 postmenopausal women of 40–70 years of age who visited a rural primary health care centre of Bangladesh. HTN was diagnosed based on two definitions: the JNC 7 guidelines (SBP ≥ 140 or DBP ≥ 90 mmHg), and the 2017 ACC/AHA guidelines (SBP ≥ 130 mmHg, or DBP ≥ 80 mmHg). The prevalence of postmenopausal HTN, its sub-types and stages were reported and compared using frequency and percentage. Agreement was evaluated using Cohen’s Kappa (κ), Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) and First-order Agreement Coefficient (AC1). Results: The prevalence of postmenopausal HTN was 67.5% and 41.9% using 2017 ACC/AHA and JNC 7 guidelines respectively. Among the HTN sub-types and stages, the new 2017 ACC/AHA guideline classified higher proportion of respondents as having isolated systolic hypertension (ISH) (42.6%) and stage 2 HTN (35.8%) compared to JNC 7 (28.7% and 6.8% respectively). On the other hand, the JNC 7 guideline identified more respondents as pre-hypertensive (32.5%) when compared with the 2017 ACC/AHA guideline (3.8%). Between two guidelines, highest agreement was observed for ISH (86.03%) and those had pre-hypertension/elevated blood pressure (71.3%). Similarly, Landis & Koch’s approach detected highest agreement for ISH (κ = 0.74, substantial; PABAK = 0.76, substantial; AC1 = 0.84, excellent; p < 0.001) and pre-hypertension/elevated blood pressure (κ = 0.12, slight; PABAK = 0.42, moderate; AC1 = 0.83, excellent; p < 0.001). Conclusions: The 2017 ACC/AHA HTN guideline reported high agreement and detected more participants as hypertensive when compared with JNC 7 guideline for Bangladeshi postmenopausal women that demands further large-scale study in general population to clarify the current findings more precisely.

The paradox of acceptance: A content analysis of Iranian married female adolescent in confronting pregnancy.

Adolescent pregnancy is a major health problem significantly associated with adverse effects on the health of both adolescents and their newborns. However, there is a lack of clarity over adolescent pregnancy from adolescents' perspective, particularly in the low- and middle income countries including Iran. This study aimed to explore the experiences of Iranian married female adolescent in confronting pregnancy. This qualitative research was conducted using conventional content analysis approach. Unstructured interviews with 24 female adolescents (aged 14–18 years) were used for data collection, and data analysis was done simultaneously. In this study, the participants were recruited from urban and rural primary healthcare centers (PHCs). The PHCs were selected randomly from several towns and villages of Guilan Province, Iran. The participants were recruited through a purposive sampling method. After data analysis, four categories were extracted from 24 interviews, including "actively accepting pregnancy", "passively accepting pregnancy", "hope and satisfaction" and "frustration and regret". These categories formed the main theme of "paradox of acceptance" in confronting pregnancy. The concepts that have emerged based on the results of the study can potentially help develop comprehensive and age-tailored health promotion programs to confront pregnancy more successfully for female pregnant adolescents. Further research, particularly on the long-term effects of teenage motherhood is suggested.