Rural Primary Health Care Facilities Research Articles

A study on multimorbidity patterns, Inpatient care utilization, and associated factors in inpatients with Multimorbidity in township health centers of Guangxi

BackgroundThe epidemiology of multimorbidity, inpatient care utilization, and associated factors among inpatients in rural primary health care facilities in China remains unclear, hindering effective prevention and management of multimorbidity in rural populations. ObjectivesThis study aims to investigate the patterns of multimorbidity, inpatient care utilization, and related factors among hospitalized patients in township health centers (rural primary healthcare facilities) in Guangxi, China. MethodsA multistage stratified and cluster random sampling method was employed to select 10 township health centers (rural primary healthcare facilities) in Nanning, Wuzhou, Liuzhou, Yulin, and Guigang of Guangxi Autonomous Region of China. De-identified inpatient medical records from January 1, 2021, to June 30, 2023, were retrieved from inpatient and chronic disease management systems. Statistical analyses, including the Kruskal-Wallis H test, Mann-Whitney U test, and multinomial logistic regression, were used to explore the demographic characteristics, multimorbidity prevalence, comorbidity number, multimorbidity patterns, hospitalization frequency, and associated factors among inpatients with multimorbidity. ResultsA total of 9,330 patients with multimorbidity were included, with an average age of 68.1 ±11.8 years, and 52.6 % were female. The overall prevalence of multimorbidity was 31.24 %. The most prevalent comorbidity number was 2 (53.22 %), followed by 3 (28.76 %), 4 (12.92 %), and ≥5(5.1 %). Hypertension was the most prevalent co-existing chronic condition, and the most common multimorbidity patterns included combinations of hypertension, chronic cervical and lumbar spondylosis, chronic gastrointestinal diseases, stroke, diabetes mellitus, hyperlipidemia, and chronic pulmonary diseases. The median number of hospitalization frequency for the top 10 multimorbidity patterns ranged from 1 to 4.5, with significant differences in hospitalization frequency across multimorbidity groups. Age, BMI, gender, smoking, alcohol consumption, ethnicity, marital status, and medical insurance were significantly associated with number of co-existing chronic conditions, while age, gender, smoking, alcohol consumption, ethnicity, marital status, education level, medical insurance, and number of co-existing chronic conditions were significantly associated with hospitalization frequency. ConclusionsThe prevalence of multimorbidity among inpatients in township health centers(rural primary healthcare facilities) in Guangxi is high. Hypertension was the most prevalent co-existing condition, with frequent combinations involving chronic cervical and lumbar spondylosis, gastrointestinal diseases, stroke, diabetes, hyperlipidemia, and chronic pulmonary diseases. Multiple factors influence both number of co-exsiting chronic conditions and hospitalization frequency, emphasizing the need for comprehensive, multifaceted strategies to manage the challenges of multimorbidity in rural primary healthcare facilities.

The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study

ObjectivesIn middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China.MethodsData were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians’ communication skills on healthcare quality and patient satisfaction.ResultsThe findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians’ knowledge and other factors, demonstrated positive associations between physicians’ communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training.ConclusionThis study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.

Service-specific Readiness for Hypertension and Diabetes Care and Its Related Factors in Primary Health Facilities in Akwa Ibom State, Nigeria: A Comparative Service Availability and Readiness Assessment Study

Abstract Background: According to the global action plan of the World Health Organization (WHO), private and public health facilities (HFs) must possess at least 80% of affordable basic technologies and essential medicines to tackle the rising burden of hypertension and diabetes (H and D) globally. Literature regarding the realisation of this target is scarce in resource-poor settings like Nigeria. Objective: The objective of this study was to assess and compare the service-specific readiness for H and D care in selected urban and rural primary health-care (PHC) facilities in Akwa Ibom State, Nigeria. Materials and Methods: The WHO’s service availability and readiness assessment tool was adapted and deployed to assess readiness for H and D care in 214 PHCs randomly sampled from the entire 426 government-owned PHCs in the state. Results: A total of 214 PHCs were surveyed (urban, 51.4%). Overall, more urban than rural PHCs had essential drugs (4.8% vs. 0.9%), laboratory equipment (81.7% vs. 76.4%), and were ready for H and D care (23% vs. 11%). Availability of drug-revolving funds (odds ratio [OR] = 4.09; 95% confidence interval [CI] = 1.03–1.12) and the number of health workers (OR = 1.08; 95% CI = 1.03–1.33) were significantly associated with readiness. Conclusion: The level of readiness for H and D care was low in both urban and rural primary HFs. The correlates found to be associated with the readiness for H and D care are the availability of drug-revolving funds and the number of health workers.

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.

Antibiotic Prescription Patterns for Acute Respiratory Infections in Rural Primary Healthcare Settings in Guangdong, China: Analysis of 162,742 Outpatient Prescriptions

Overuse and inappropriate use of antibiotics are important contributors to bacterial antimicrobial resistance (AMR), especially in ambulatory primary healthcare (PHC) settings in low- and middle-income countries. This study aimed to investigate antibiotic prescription patterns among patients with acute respiratory infections (ARIs) in rural PHC facilities in the Guangdong Province, China. A total of 444,979 outpatient prescriptions were extracted from the electronic medical record system of 35 township health centers (THCs) and 2 community health centers (CHCs) between November 2017 and October 2018. We used the chi-square test to analyze the antibiotic prescription patterns and binary logistic regression to explore patient-related factors associated with antibiotic prescriptions. Of the 162,742 ARI prescriptions, 85.57% (n = 139,259) included at least one antibiotic. Among the 139,259 prescriptions with antibiotics, 37.82% (n = 52,666) included two or more antibiotics, 55.29% (n = 76,993) included parenteral antibiotics, and 56.62% (n = 78,852) included Watch group antibiotics. The binary logistic regression indicated that (1) female patients were slightly less likely to be prescribed antibiotics than males (adjusted odds ratio (OR) = 0.954, 95% confidence interval [CI] [0.928-0.981]; p = 0.001); and (2) compared to patients aged ≤5 years, those who were 6-15 years old (adjusted OR = 1.907, 95% CI [1.840-1.978]; p < 0.001), 16-60 years old (adjusted OR = 1.849, 95% CI [1.785-1.916]; p < 0.001), and >60 years old (adjusted OR = 1.915, 95% CI [1.810-2.026]; p < 0.001) were more likely to be prescribed antibiotics. The overuse and irrational use of antibiotics in PHC settings remain major healthcare challenges in rural Guangdong. Thus, it is imperative to implement targeted antimicrobial stewardship (AMS) policies to address this problem.

Drug Use Indicators in Urban and Rural Primary Health Care Facilities in Mansoura District, Dakahlia Governorate, Egypt

Drug Use Indicators in Urban and Rural Primary Health Care Facilities in Mansoura District, Dakahlia Governorate, Egypt

Maternal and child health service readiness among primary health care facilities in Ekiti, Nigeria.

BackgroundThe availability of adequate infrastructure, diagnostic medical equipment, medicines and commodities and well-trained medical personnel are essential for the effective delivery of health care services.AimThis study assessed maternal and child health (MCH) services’ specific readiness by type and location of the health facility and compared the readiness between urban and rural primary health care (PHC) facilities in Ekiti State, Nigeria.SettingThe study was conducted amongst the heads (officers in charge) of PHC facilities in Ekiti State, Nigeria between August 2020 and October 2020.MethodsA descriptive cross-sectional study in which all PHC facilities were conducted and data were collected with the aid of the Service Availability and Readiness Assessment (SARA) tool using the KoboCollect app. Data were cleaned and coded on Microsoft Excel 2016 and exported to Stata SE 12 for analysis. The level of significance was set at p < 0.05.ResultsOverall, the MCH readiness score amongst PHC facilities was 47% (0.47 ± 0.18). About half (52%) of the facilities had necessary and relevant equipment. Health facilities located in urban areas had more medicines and commodities compared with those of rural areas (0.51 ± 0.16 vs 0.45 ± 0.17, p < 0.05). Primary health care facilities in Ekiti North I had an overall higher service readiness score (0.63 ± 0.19) compared with other federal constituencies (p < 0.001).ConclusionThe overall MCH-specific service readiness in Ekiti State was relatively low. Strategies to address the identified gaps for a smooth journey towards the achievement of Universal Health Coverage (UHC) are recommended.

Patient satisfaction and its health provider-related determinants in primary health facilities in rural China

BackgroundPatient satisfaction is an important outcome measure of health service and is one of the main reasons for the gradual deterioration of doctor–patient relationships in China. This study used the standardized patient (SP) method to explore patient satisfaction and its health provider-related determinants among primary health facilities in rural China.MethodsThe dataset comprised 1138 clinic cases in 728 rural primary health facilities in 31 counties, spread across four provinces. Information regarding the consultation interaction between the unannounced SPs and primary physicians was recorded. Patient satisfaction was gathered from the feedback of SPs after the visit.ResultsThe overall average score of SP satisfaction with rural primary health facilities was only 13.65 (SD = 3.22) out of 20. The SP scores were found to be consistent with those of real patients. After controlling variances in patient population via the SP method, the regression analysis demonstrated that health provider-related factors, such as physician-level characteristics, consultation process, affordability, and convenience, have a significant correlation with patient satisfaction among primary physicians. Among factors relating to physician-level characteristics, affordability, convenience and the consultation process of the visit, the quality of the consultation process (e.g., consultation time, proactively providing necessary instructions and other crucial information) were found to be the prominent determinants.ConclusionsThis study revealed the need to improve patient satisfaction in primary health facilities in rural China. To solve this issue, we recommend that policies to increase medical service quality be implemented in rural primary healthcare systems.

Prevalence and Associated Factors of Diabetes Distress, Depression and Anxiety Among Primary Care Patients With Type 2 Diabetes During the COVID-19 Pandemic in Egypt: A Cross-Sectional Study.

The prevalence of type 2 diabetes mellitus (T2DM) is growing worldwide. T2DM is often complicated by a range of psychological disorders that interfere with glycemic control and self-care. Previous studies have reported diabetes distress, depression, and anxiety among patients with T2DM; however; little is known about the burden of these comorbid mental disorders in primary care patients with T2DM treated in Egypt during the COVID-19 era. Participants were selected by convenient sampling from eight rural primary healthcare facilities from Ismailia in Egypt. Symptoms of diabetes distress, depression and anxiety were assessed by using the Arabic version of the 20-item Problem Areas in Diabetes (PAID), Patient Health Questionnaire 9, and Generalized Anxiety Disorder Scales, respectively. Multiple hierarchical logistic regression models were used to estimate the significant factors associated with diabetes distress, depression, and anxiety. A total of 403 individuals with T2DM were interviewed. The prevalence of severe diabetes distress was 13.4% (95% CI: 10.1–16.7), while prevalence of depressive and anxiety symptoms was 9.2% (95% CI: 6.4–12.0%), and 4.0% (95% CI: 2.1–5.9), respectively. In a series of hierarchical logistic regression models, significant predictors for diabetes distress were being married, illiterate, not-working, living with insufficient income, and having multi-comorbidities. Likewise, the significant predictors for depression and anxiety were elevated glycated hemoglobin level and the higher PAID total score, while having multi-comorbidities was a significant predictor for anxiety only. Diabetes distress was more prevalent than depressive and anxiety symptoms in this study population. Several sociodemographic and clinical characteristics were identified to be related with psychological problems among patients with T2DM, which necessitate a multidisciplinary team-based approach for optimal screening and management.

Effects of sociodemographic background on fertility motivation patterns in the Beni-Suef governorate, Upper Egypt

ObjectivesA comprehensive assessment of childbearing motivations in the governorate of Beni-Suef was conducted to better understand fertility patterns, and to develop appropriate familial policies and programs to reduce fertility rates and address the problem of overpopulation in Upper Egypt. Subjects and methodsA cross-sectional study was conducted from May 2019 to May 2021. A total of 1085 married women who attended any health care service in rural or urban primary health care facilities in the Beni-Suef governorate were included in the study. ResultsThe results revealed that 42.1% of participants had a positive desire for childbearing, and 45% of participants had a negative desire for childbearing; the rest of the participants (12.9%) had undecided motivations. The most prevalent positive motive for childbearing was a love of children (40.8%), whereas the most prevalent negative motive for childbearing was economic circumstances (44.7%). A statistically significant difference was observed in fertility motivations among the studied women, depending on age, education, husband's education, age at marriage, marriage duration, number of living siblings, monthly income, occupation, gravidity, parity, and chronic diseases (p = 0.001). ConclusionA great need exists to involve young couples who have not yet attained their desired family size and who do not use family planning methods, in fertility regulation interventions.

A Descriptive Study on Characteristics of Patients with Myocardial Infarction and Their Outcomes: A Rural Primary Healthcare Setting in Lubok Antu District, Sarawak

INTRODUCTION: Myocardial infarction (MI) is the leading cause of death worldwide. More studies are needed to provide insight of MI care in rural settings in Malaysia.OBJECTIVE: This study aims to define characteristics of patients who experienced MI in rural setting and their outcomes. METHODS: We conducted an observational study involving secondary data collection through review of medical records of patients who presented to rural primary healthcare facilities before being referred to regional secondary and/or tertiary centres. We explored their outcomes including inpatient and 30-day cardiac-related mortality.RESULTS: Nine patients were included. Eight (88.9%) experienced STEMI. Eight (88.9%) were male. Median age was 53 (Q1:40.5–Q3:64.5) years. Median duration from symptoms onset to presentation was 2 (1.125 – 35.250) hours. Median time from presentation to aspirin delivery was 45 (12.5 – 86.0) minutes. The median door-to-needle time was 190 (163.0 – 212.5) minutes. Five (55.6%) received medical thrombolysis in secondary hospital prior to elective percutaneous coronary intervention (PCI). Inpatient mortality was 11.1% corresponding to 30-day mortality.CONCLUSIONS: MI is potentially under-diagnosed and under-treated in resource-limited rural settings where community awareness is low complicated by logistic challenges. Better resources with better equipped healthcare facilities are essential for prompt diagnosis and interventions for MI patients.

Knowledge, practice and perceptions on exclusive breastfeeding among lactating mothers in rural primary health facilities in southwestern Nigeria

Background/Aims Exclusive breastfeeding is important for the growth and development of infants. Thus, it is important to examine the practice of exclusive breastfeeding and factors that may affect it. This study aimed to assess nursing mothers' knowledge on and practice of exclusive breastfeeding, the relationship between knowledge and practice and factors perceived to influence exclusive breastfeeding. Methods This cross-sectional study collected data using a self-designed questionnaire from mothers of children aged 0–6 months, at two primary health centres, Leslie and Igbogidi, in Ogun State, Nigeria. Participants were assessed on their knowledge and practice of exclusive breastfeeding, as well as their perceptions of factors that influence the practice of exclusive breastfeeding. Pearson's chi-squared test was used to assess the relationship between participants' knowledge and practice of exclusive breastfeeding. Results The majority (76.0%) of mothers had adequate knowledge on exclusive breastfeeding. However, only 58.5% practised exclusive breastfeeding for 6 months. There was a significant relationship between knowledge and practice of exclusive breastfeeding (P&lt;0.000). Conclusions Participants' knowledge on exclusive breastfeeding did not coincide with its practice. Mothers should be supported through education and resources in order to improve rates of exclusive breastfeeding.

Factors Influencing Patient-Centered Care in the Primary Health Care Settings: The Impact of the Pandemic Crisis and Nurses’ Experience

Patient-centered care has over the past decades, been recognized worldwide as an important component of the health system giving a wider dimension to high-quality healthcare and service delivery. The impact on healthcare and services to the patient is the nurses’ ability to create a friendly rapport with the patients. Yet, the majority in the rural Primary Health Care facilities are still facing many challenges in demonstrating patient-centeredness services to the community. Thus, the objective of this study is to explore and describe the factors influencing patient-centered care provision and nurses’ experience in Primary Health Care facilities. An exploratory qualitative approach with purposive sampling was used to gather data. Individual interviews with 35 nurses were conducted using a semi-structure interview guide question in the Primary Health Care settings in Nigeria. Each of the interviews with the nurses lasted for 25 minutes to one hour. All interviews were audio-taped, and transcribed verbatim using Microsoft Word. The transcripts were read and re-read, coded using NVivo version 12 software to organize the relevant information and categorized them into themes and sub-themes. Thematic analysis guided this study. The findings revealed three themes and sub-themes. The impact of environmental factors with two subthemes—suitable working environment and coordinated care; resources—shortage of staff and inadequate resources as sub-themes, and lastly, cultural sensitivity and religious influence—communication. Poor implementation of PCC strategies in most of the PHC facilities could lead to poor patient care and a lack of job satisfaction among nurses. This study identified that nurses have both negative and positive experience in providing patient-centered care health services. Providing patient-centered care in the Primary Health Care setting promotes the goal of achieving universal health coverage in Nigeria if the government would prioritize nurses’ pay, employ more staff, provide a conducive working environment, and opportunities for further training programs for nurses to enable and empower them with the necessary knowledge and skills. This, in turn, will translate into a range of outcomes that are socially valued, such as health responsiveness, health coverage and fairness.

Opportunities to Integrate Primary Health Care Digital Innovations in Maternal and Child Health Care Services in Kenya

Background: Adequate and quality Maternal and Child Health (MNCH) care is considered essential in reduction of maternal and child mortality. More than half of the global maternal deaths (66%) are in sub-Saharan Africa with infant mortality of 51/1000 live births in the WHO Africa region [1]. There is potential to improve access and utilization of health services through investing in Primary Health Care (PHC) digital innovations [2] especially in underserved settings [3]. In the last quarter of the year 2021 after lifting of the COVID-19 restrictions, Tekeleza project, aims to integrate digital health innovations into MNCH care within PHC settings in Kenya. The project team undertook a baseline survey in three rural counties (Kisii, Kajiado and Migori) characterized with low social-economic status to identify opportunities to leverage on the use of evidence-based digital innovations to reverse the adverse trends in Maternal and Child Health. Methods: A cross-sectional and descriptive study was conducted in 15 Community Health Units (CHUs) in Kenya that were linked to selected Primary Health Care (PHC) facilities from three rural counties. Mixed methods were used to collect data from 404 Households (HHs) selected across the sampled CHUs on Probability Proportionate to Size (PPS). The selected households were assigned unique household or respondent identifiers. The sampling frame for household surveys consisted of all women 18 - 49 years of age, who were either pregnant or in their 18 months post-delivery. From the constructed sampling frame, a simple random sampling procedure was used to select the study sample. An audit was also carried out at the selected PHC facilities and sixty-two (62) Primary Health Workers (PHCWs) including facility managers were interviewed to establish challenges affecting ICT infrastructure and sustainable financing of MNCH services. Findings: The majority of the sampled women (64.9%) were lactating at the time of the study, with 34.4% being pregnant and 0.7% both pregnant and lactating. Despite the high proportions of mothers who received Skilled Birth Attendance, discontinuity in seeking antenatal and postnatal care services was observed in all three counties. The proportion of mothers (n = 404) who reported to have attended at least one ANC was 46.8%. This was attributed to limited access to health facilities, poor staff attitude, and negative cultural practices that got exacerbated by the COVID-19 pandemic. An average of 53.2% of the respondents started attending ANC clinics much later after 12 weeks of gestation to minimize the costs and time they will spend on attending ANC clinics. It also emerged that 68.7% of the respondents had low knowledge levels of selected perinatal and infant care practices. On the making of Sexual and Reproductive Health (SRH) health-seeking decisions, 54.7% of the respondents said, it is their husbands who decide. The PHCWs expressed limited access to Continuing Professional Development (CPDs), a situation that worsened with the COVID-19 Pandemic. Notably, only 54.9% of the PHCWs reported having access to either a Smartphone or desktop at the point of service delivery. Nearly the same proportion (54.8%) has access to the internet at their workstations. Facilities reported delayed reimbursement of National Hospital Insurance Fund (NHIF) and only 54% of the women interviewed had registered in Linda mama NHIF package meant to enable them to access free maternity care. Only one county (Migori) had significant utilization of CHVs. Conclusion: There is increasing access to Skilled Birth Attendance (SBA) in rural Kenya but discontinuous pregnancy care is still a problem and it got worse during the COVID-19 pandemic. Rural PHC facilities have poor ICT infrastructure and despite the 98% rural access to a phone by women, there is limited bankable usage of handheld technology to improve health information literacy on self and infant care among women of reproductive age. Recommendations: Feasibility studies to be conducted on how to sustainably deploy Primary Health Care digital solutions to improve the quality of, access to, and Utilization of Maternal and Child Health (MNCH) services.

Reduced health services at under-electrified primary healthcare facilities: Evidence from India.

Primary healthcare systems worldwide suffer from major gaps in infrastructure and human resources. One key infrastructure gap is access to reliable electricity, absence of which can significantly affect the quantity and quality of healthcare services being delivered at rural primary health facilities. However, absence of granular empirical evidence is a barrier for quantitatively understanding the significance of electricity access as one of the determinants of access to reliable primary healthcare. Using data from India's District Level Household and Facility Survey, we develop zero-inflated negative binomial models with co-variates and state-level fixed effects to estimate the relationship between levels of electricity access and the quantity of basic health services delivered at Primary Health Centers (PHCs). We find that lack of electricity access is associated with a significant and large decrease in the number of deliveries (64 percent), number of in-patients (39 percent), and number of out-patients (38 percent). We further find that lower level of electricity access at primary health centers is disproportionately associated with adverse effects on women's access to safe and quality healthcare.

Medicines Availability among Hypertensive Patients in Primary Health Care Facilities in a Rural Province in South Africa: Findings and Implications.

Objective:Controlling blood pressure (BP) in hypertensive patients is a challenge, with the lack of antihypertensive medicines negatively impacting on BP control. Consequently, we assessed the availability of prescribed antihypertensives among patients with chronic hypertension attending primary health care (PHC) facilities in a rural province of South Africa and explored any association between medicines availability, the number of prescribed antihypertensive medicines and BP control.Methods:Secondary data that included patients' demographics, BP, and data on medicines availability of the intervention group from a 3 months' operational study conducted in rural PHC facilities in South Africa were analyzed. The association between medicines availability, the number of antihypertensive medicines, and BP control was explored.Findings:Fifty-five African patients (89.1% females) with a mean age of 61.3 years were included. Two-thirds (67.2%) received all their medicines during their monthly visits, 25.5% received some, and for 7.3%, there was no record of whether medicines were dispensed or not. Patients with controlled BP (60.0%) were more likely to have been prescribed only one antihypertensive medicine compared to patients with uncontrolled BP (20.7%) (P = 0.017; odds ratio: 5.75; 95% confidence interval: 1.46, 22.61).Conclusion:It is concerning that one-third of patients went home without all of their antihypertensive medicines from PHC facilities in this Province of South Africa where there is evidence of use of herbal medicines and uncontrolled BP contributing to high morbidity and mortality from cardiovascular diseases. Additional studies are needed to fully explore the association between medicines availability, their use, and BP control among patients.

Medical waste management of village clinics in rural China

Medical waste is rising on policy agendas as a serious public health and environmental issue. The aim of this study was to assess current practices of medical waste management, which include waste generation, collection, storage, segregation, disposal, and use of protective equipment, in village clinics in rural China. Based on survey results from 236 randomly selected village clinics in 21 counties from three provinces of China, we used descriptive statistics to determine the medical waste management of village clinics in sample area. We found that the generation rate of medical waste in sampled village clinics was approximately 0.65 kg per day or 0.17 kg/patient per day on average. Given the large number of primary healthcare facilities and population in rural areas of China, the total quantity of medical waste generated in these facilities is noteworthy. However, we also found poor compliance levels with the national regulations regarding medical waste management practices. A large proportion of medical waste was still not packed in required containers, and almost all village clinics did not segregate correctly. Moreover, a significant portion of village clinics used improper disposal methods and lacked the necessary protective equipment. Medical staff in these facilities pointed out four main difficulties in complying with national regulations: a lack of funding, equipment, designated areas, and management personnel specifically delegated for medical waste management. These findings suggest that Chinese policymakers and health administrators should pay more attention to rural areas in addressing potentially hazardous medical waste management practices by investing financial support as well as developing specific guidelines tailored to resource-strained rural primary healthcare facilities.

Road-to-Health Booklet assessment and completion challenges by nurses in rural primary healthcare facilities in South Africa

Background. Appropriate completion of the Road-to-Health Booklet (RTHB) remains crucial as it facilitates the provision of essential packaged health services for the growth and well-being of children under 5 years old. Objective. To assess the new RTHB completion and its utilisation challenges by nurses in rural primary healthcare (PHC) in the West Rand District, Gauteng Province, South Africa. Methods. A concurrent mixed-method design was used to conduct a retrospective record review of the 75 RTHBs completed by the nurses in the two PHC facilities. Nine in-depth interviews were also conducted with purposefully selected nurses to explore their RTHB utilisation challenges. Categorical data were analysed descriptively, comparing ‘fully completed’, ‘partially completed’ and ‘not completed’ sections of the RTHB. In-depth interviews were analysed using a thematic analysis approach which involved conducting inductive coding, grouping codes according to their similarity and identifying emerging themes. Results. The highest completed sections of the RTHB were the weight-for-age growth chart (81%) and mother PMTCT/HIV (78%). The lowest completed section was the oral health examination, with only one booklet completed (7%). Length/height × age (37%) and weight × length/height (33%) charts were partially completed. RTHB utilisation challenges included healthcare provider dilemmas (lack of time, burnout, habitual practices); patient-related dilemmas (language barriers, tampering with RTHB pages, lack of resources); and health system dilemmas (equipment shortages and lack of training for health personnel). Conclusion. Although the quality of the RTHB is improving, there are still considerable challenges concerning its completion. It is therefore necessary to implement ways to improve its utilisation in this rural district, for effective under-5 child health management. Without substantial improvement, opportunities for enhancing under-5 child health will be missed.

How Energy Access Impacts Primary Healthcare: Evidence from India

Background: Basic primary healthcare provides a critical safety net for the poor, but it is not always accessible. Unfortunately, primary health systems worldwide suffer from major gaps in infrastructure and human resources. One key infrastructure gap is access to reliable electricity, absence of which can significantly affect the quantity and quality of healthcare services being delivered at rural primary health facilities. However, absence of granular empirical evidence is a barrier for quantitatively understanding the significance of energy access as one of the determinants of access to reliable primary healthcare. Methods: We study the linkages between energy access and primary health services in extra-urban parts of India by focusing on the Primary Health Centers (PHCs), which are the main points of comprehensive primary care in the Indian public health system. Using data from District Level Household and Facility Survey, we develop zero-inflated negative binomial models with state-level fixed effects to estimate the relationship between levels of electricity access and the quantity of basic health services delivered at the PHCs. Findings: We find that lack of electricity access is associated with a significant and large decrease in the number of deliveries (64 percent), number of in-patients (43 percent), and number of out-patients (40 percent). We further find that lower level of energy access at primary health centers disproportionately affects women’s access to safe and quality healthcare. Interpretation: The evidence presented makes a strong case for rural health system policies to pay much more attention to understanding and integrating reliable energy access as an enabler of more equitable access to primary healthcare.

A population-based study of teenage marriage in Upper Egypt

Background: Early marriage of teenage girls before the age of 18 is a serious problem concerning public health that perils the girls' childhood in developing countries. The current study aims to highlight the socioeconomic background and the adverse drawbacks of teenage marriage in Upper Egypt.Methods: A population-based, cross-sectional study was conducted on 962 married females who were selected randomly by using a multistage random sampling technique. The participants were attending four urban and four rural primary health care facilities in Beni-Suef governorate, Upper Egypt in the period between May 2018 and October 2018. An interviewing questionnaire was designed to detect the suspected socio-demographic factors associated with teenage marriage.Results: The mean age of marriage of the studied participants was 18.7±3.5 years. The study revealed that 50.8% of the studied population was 18 years or less at marriage versus 49.2% married at age more than 18. Also there is a significant difference between the age of marriage and the educational level of both husbands and wives (p&lt;0.001). The rate of accidental hemorrhage (3% versus 1.4%), placenta previa (2.2 versus 0.6%), eclampsia (1.8% versus 0.4%), and intrauterine growth restriction (3% versus 0.6%) were significantly higher in those married before 18 years (p=0.028, 0.036, 0.038, 0.005, respectively).Conclusions: This study demonstrated a significant relationship between the marital age and the implicated socio-demographic determinants. Adverse sexual relationship and pregnancy outcomes were significantly related to the age of marriage.