Training Of Primary Health Care Workers Research Articles

Experience of primary healthcare workers in using the mobile app-based WHO mhGAP intervention guide in detection and treatment of people with mental disorders: A qualitative study in Nepal

This study assessed perception and experience of trained primary health care workers in using a mobile app-based version of the WHO mental health gap action programme (mhGAP) Intervention Guide in the assessment and management of people with mental health conditions in primary care in Nepal. A qualitative study was conducted with primary healthcare workers who were trained in using the WHO mhGAP mobile application in Jhapa, a district in eastern Nepal. Semi-structured interviews were carried out with 15 healthcare workers (3 females and 12 males) nine months after the training. Interviews were audio recorded, transcribed and translated into English for the thematic qualitative data analysis. Health care workers (HCWs) found the mobile app helpful to verify and confirm their assessment and diagnosis. The other benefits reported by the participants were: bringing uniformity in diagnosis and management of mental health conditions across primary healthcare facilities; reminding the HCWs specific assessment questions; creating awareness on the importance of psychosocial intervention; improving the interaction between patients and service providers; and the importance of follow-up care. Despite these advantages, lack of clarity about report submission modality; lack of electricity or internet connectivity; and low technology literacy among older HCWs were some of the barriers in using the app. The major recommendation made by the HCWs for the guide included revision of the assessment process and system; inclusion of a chat function with supervisors; minimizing the amount of patients’ data to be collected in the app; and addition of conversion and anxiety disorders to the app. This study concludes that the mobile decision support application could be acceptable and feasible in primary care settings if the suggested modifications are incorporated, in addition to addressing other systemic issues facing the primary care-based delivery of mental health services.

Maternal health in Sri Lanka: 75 years of national commitment towards excellence

Sri Lanka has a legacy of religious and cultural practices promoting health, and its rulers have been responsive to health needs of the populace. The healthcare milieu that prevailed in the pre-colonial and colonial periods favorably influenced the evolution of maternal health in the last 75 years. Since independence, maternal health in the country improved in many dimensions and directions, in the backdrop of multiple sociodemographic changes and geopolitical fluxes, while far-reaching advances in the medico-technological and communication fields were taking place at global level.By 1948, maternal health services were extensive with maternity hospitals, midwifery training school and functional health units in place. The establishment of a cadre of government-trained midwives instead of training traditional birth attendants (TBAs) was a key policy decision that brought long-term dividends. The WHO supported training primary health care workers even before opening their country office in 1952. In the early days, obstetricians relied mostly on their skills to conduct dexterous maneuvers with the generous use of rotational forceps rather than resorting to abdominal deliveries.The Family Planning Association was founded in 1953, which introduced family planning services to the country till the government took over the subject in 1958. A rigorous campaign (punchi pawla raththaran), promoting sterilization was conducted for population control in 1974, which resulted in the total fertility rate coming down significantly.Maternal Death Surveillance and Response system (MDSR) was established in 1981 which has been recognized globally as a success and is being upscaled to a confidential Inquiry status. Commitment and untiring efforts of the Ministry of Health: Family Health Bureau, professional organizations, development partners including the WHO, have contributed for the achievements in the area of women’s health.

Maternal Health in Sri Lanka: 75 years of national commitment towards excellence.

Sri Lanka has a legacy of religious and cultural practices promoting health, and its rulers have been responsive to health needs of the populace. The healthcare milieu that prevailed in the pre-colonial and colonial periods favorably influenced the evolution of maternal health in the last 75 years. Since independence, maternal health in the country improved in many dimensions and directions, in the backdrop of multiple sociodemographic changes and geopolitical fluxes, while far-reaching advances in the medico-technological and communication fields were taking place at global level. By 1948, maternal health services were extensive with maternity hospitals, midwifery training school and functional health units in place. The establishment of a cadre of government-trained midwives instead of training traditional birth attendants (TBAs) was a key policy decision that brought long-term dividends. The WHO supported training primary health care workers even before opening their country office in 1952. In the early days, obstetricians relied mostly on their skills to conduct dexterous maneuvers with the generous use of rotational forceps rather than resorting to abdominal deliveries. The Family Planning Association was founded in 1953, which introduced family planning services to the country till the government took over the subject in 1958. A rigorous campaign (punchi pawla raththaran), promoting sterilization was conducted for population control in 1974 ,which resulted in the total fertility rate coming down significantly. Maternal Death Surveillance and Response system (MDSR) was established in 1981 which has been recognized globally as a success and is being upscaled to a confidential Inquiry status. Commitment and untiring efforts of the Ministry of health: Family Health Bureau, professional organizations, development partners including the WHO, have contributed for the achievements in the area of women's health.

Adapting and piloting a social contact-based intervention to reduce mental health stigma among primary care providers: Protocol for a multi-site feasibility study

Stigma among primary care providers (PCPs) is a barrier to successful integration of mental health services in primary healthcare settings globally. Therefore, cross-culturally adaptable and feasible strategies are needed to reduce stigma among PCPs. This protocol is for a multi-site pilot study that aims to adapt and evaluate cross-cultural feasibility and acceptability of a social contact-based primary healthcare intervention in 7 sites in 5 low-and-middle-income countries. A mixed methods pilot study using an uncontrolled before-after study design will be conducted in China (Beijing, Guangzhou), Ethiopia (Sodo), India (Bengaluru, Delhi), Nepal (Syangja), and Tunisia (Testour). The intervention, entitled REducing Stigma among HealthcAre ProvidErs (RESHAPE), is a collaboration with people with lived experience of mental health conditions (PWLE), their family members, and aspirational figures (who are PCPs who have demonstrated high motivation to integrate mental health services). PWLE and their family members are trained in a participatory technique, PhotoVoice, to visually depict and narrate recovery stories. Aspirational figures conduct myth busting exercises and share their experiences treating PWLE. Outcomes among PCPs will include stigma knowledge, explicit and implicit attitudes, and mental healthcare competencies. To understand the feasibility, and acceptability of the intervention, qualitative interviews will be carried out with PWLE, family members, and aspirational figures, PhotoVoice trainers, mental health specialists co-leading the primary care trainings, and PCPs receiving mental health training. The sites will also generate evidence regarding feasibility, acceptability, recruitment, retention, fidelity, safety, and usefulness of the intervention to make further adaptations and modifications. The results will inform cross-cultural guidelines for collaboration with PWLE when conducting mental health training of primary healthcare workers. The results will be used to design future multi-site hybrid trials focusing on effectiveness and implementation.

Training primary healthcare workers on a task-strengthening strategy for integrating hypertension management into HIV care in Nigeria: implementation strategies, knowledge uptake, and lessons learned

BackgroundWith improved access to anti-retroviral drugs, persons living with HIV/AIDS (PLWHA) are living longer but with attendant increased risks of non-communicable diseases (NCDs). The increasing burden of NCDs, especially hypertension, could reverse gains attributed to HIV care. Nurses and Community Health Officers (CHO) in Nigeria are cardinal in delivering primary health care. A task-strengthening strategy could enable them to manage hypertension in HIV care settings. This study aimed to assess their knowledge and practice of hypertension management among Healthcare workers (HCWs) and to explore the challenges involved in conducting onsite training during pandemics.MethodsNurses and CHOs in the employment of the Lagos State Primary Health Care Board (LSPHCB), Lagos State, Nigeria, were recruited. They were trained through hybrid (virtual and onsite) modules before study implementation and a series of refresher trainings. A pre-and post-training test survey was administered, followed by qualitative interviews to assess skills and knowledge uptake, the potential barriers and facilitators of task-sharing in hypertension management in HIV clinics, and the lessons learned.ResultsSixty HCWs participated in the two-day training at baseline. There was a significant improvement in the trainees' knowledge of hypertension management and control. The average score during the pre-test and post-test was 59% and 67.6%, respectively. While about 75% of the participants had a good knowledge of hypertension, its cause, symptoms, and management, 20% had moderate knowledge, and 5% had poor knowledge at baseline. There was also an increase in the mean score between the pre-test and post-test of the refresher training using paired t-tests (P < 0.05). Role-playing and multimedia video use improved the participants' uptake of the training. The primary barrier and facilitator of task sharing strategy in hypertension management reported were poor delineation of duties among HCWs and the existing task shifting at the Primary Healthcare Centres (PHC) level, respectively.ConclusionsThe task strengthening strategy is relevant in managing hypertension in HIV clinics in Nigeria. The capacity development training for the nurses and CHOs involved in the Integration of Hypertension Management into HIV Care in Nigeria: A Task Strengthening Strategy (TASSH-Nigeria) study yielded the requisite improvement in knowledge uptake, which is a reassurance of the delivery of the project outcomes at the PHCs.

Integrated community case management of childhood illnesses; impact on training of community health workers in Vandeikya, North-East Zone of Benue State, Nigeria

Community health workers appropriately trained on Integrated Community Case Management (ICCM) of childhood illnesses can correctly treat children below 5 years who have pneumonia, diarrhoea and malaria. In Benue State, Nigeria, primary healthcare workers care for most children at community level, as such they need to be trained on ICCM. The objective of this study was to find out if training of primary healthcare workers in Vandeikya, North-East Zone of Benue State can improve their knowledge on ICCM. In Benue North-East, Vandeikya Local Government Area (LGA) was randomly selected out of seven LGAs. Health Officers’ in-charge of 30 Primary HealthCare Clinics were selected and trained based on our adapted ICCM training manual. The Pre- and Post-training assessment test for this study was designed based on the training manual. Paired sample t-test was conducted to find out if there was any significant difference in the knowledge of primary health care workers before and after receiving training. There was statistical difference in pre-training scores (X = 142.100, S1 = 25.925) and post-training scores (X =177.600, S2 =13.587) at (t=6.643, P=0.000). This result strongly indicated that the teaching intervention has improved the knowledge of the Primary Health Care workers on ICCM in Vandeikya LGA.

Challenges in Cervical Cancer Prevention: Real-World Scenario in India.

Satinder KaurIn spite of global falling trends, cervical cancer remains a major healthcare challenge for India, South Asia Association for Regional Cooperation region, and other low- and middle-income countries. Our survey was to document the real-world challenges that still exist in India. A total of 316 eligible and complete responses to the 21 questions were analyzed. Screening of mothers and vaccinating their daughters was considered as the most important strategy to prevent cervical cancer by 65.8% (208/316). Screening was offered to all asymptomatic eligible females by 79% (250/316). Improvement in screening rates requires promoting the national program (67.7%; 214/316), strengthening existing infrastructure (62%; 196/316), regular training of primary healthcare workers (57.6%; 182/316), and increasing awareness among schools and colleges (57.9%; 183/316). Almost all responders (93%; 294/316) wanted to have human papillomavirus (HPV) vaccination included in the national immunization schedule. Cost of vaccine was considered a major roadblock. If it became available at INR 250 per dose, 96.8% (306/316) respondents would recommend it for all eligible patients. With the impending availability of this indigenous tetravalent HPV vaccine jointly produced by Department of Biotechnology, Govt of India and Serum Institute of India, the war against cervical cancer just got easier.

Feasibility of training primary healthcare workers to identify antenatal depression.

Identifying women with depressive symptoms is the first step to reducing the risk of the short-term and long-term consequences of antenatal depression. Task shifting by training primary healthcare workers may help to reduce the burden in low-resource settings. Twenty health workers in a primary healthcare center in urban Bengaluru were trained to screen and identify antenatal depression. The training had two components: knowledge-based, using the depression module in the Mental Health Gap Action Program; and skills-based hands-on training, using the Patient Health Questionnaire-9. Knowledge about antenatal depression in the health workers improved by three units after training (p<0.001). Their perceived skills and self-efficacy also improved by one unit each (p=0.032 and p=0.036, respectively). Following the training, 25% of the pregnant women who underwent screening by health workers reported depressive symptoms, as compared to no positive screening before training. Training was found to improve the knowledge, perceived skills and self-efficacy of nurses, junior health assistants and Accredited Social Health Activists (ASHAs), and was found to increase the screening rate of depression in an antenatal clinic in urban India. Incorporating screening for depressive symptoms into regular antenatal care is feasible in low-resource settings.

Viability of Point of Care Ultrasound screening in Primary Health Care Setting: A Kenyan Experience

The limited number of sonographers in developing countries and high cost of conventional obstetric ultrasound screening services has led to only 6.9 percent of pregnant women accessing the service in rural areas. It is a World Health Organization (WHO) requirement to have pregnant women access obstetric ultrasound screening before 24 weeks gestation. This led to Amref International University piloting a business model that can make point of care obstetric ultrasound screening (POCUS) affordable and sustainable. One-year post intervention, an evaluation survey got conducted in the project sites in two pilot counties in Kenya (Kajiado and Kisii counties) to establish the viability of the entrepreneurship driven implementation of POCUS. Two stage cluster sampling was employed with mixed methods of data collection. A sample of 33 Midwives and 196 women of reproductive age from the pilot sites participated in the evaluation. The survey findings were that midst the COVID-19 pandemic, a total of 1250 pregnant women were screened in one year at a fee of USD 5 per scan. Among those interviewed, 168 (85.7%) of the women confirmed the service was affordable and easily accessible. It emerged that 85 (43.4%) of the respondents were screened by midwives in local health centres. Notably,180 (91%) of the women interviewed recommended scaling up of the service and 32 (96%) of the midwives reported that the continuous coaching from radiographers enhanced skills acquisition. Despite the marginal negative net present value of cash flows, the impact generated by the project was of high significance. The conclusion drawn was that the business model is viable from implementation perspective since it demonstrated the potential to reach a Break-Even Point (BEP) at a modest of 1833 ultrasound scans per year. The project has potential for further buy-in by Primary health care professionals having accorded them a gross margin of 60% with a probable increase to 80% in subsequent years. Further, Obstetric Ultrasound screening services can be provided sustainably at low cost by trained Primary Health Care Workers (PHCWs). Financial viability of the POCUS is subject to increasing pregnant women’s access to POCUS.

Impact of demographic factors on delayed presentation of oral cancers: A questionnaire-based cross-sectional study from a rural cancer center

Background: Oral cancer is a major health issue in India. The majority of patients with oral cancer present at an advanced stage.Objectives: We aimed to understand the factors responsible for delay in presentation of patients with oral cancer in rural areas.Materials and Methods: This questionnaire-based, cross-sectional study on patients with oral cancer was conducted in the head and neck surgical outpatient department of our tertiary care center at Homi Bhabha Cancer Hospital, Sangrur, between June and September 2021. A questionnaire consisting of 31 multiple choice questions was administered to consenting patients. The demographic and socio-economic profile of the patients, their knowledge of risk factors, and their symptomatology, attitude towards cancer management, access to cancer care, and knowledge about cancer treatment and its outcomes were assessed.Results: A total of 200 patients were included; 70% were men. About 60% of the participants had to travel more than 100 km to reach our center. About 50% of the patients were addicted to tobacco in some form. Only 30% of the participants were aware of the risk factors for oral cancer. The median time between symptom onset and seeking any medical consultation was 120 days, whereas the median time between symptom onset and cancer diagnosis was 165 days. About 75% of patients initially consulted an alternative medicine practitioner, and 90% took some form of alternative treatment before consulting a cancer specialist. Around 80% considered alternative medicines to be an effective form of cancer treatment.Conclusion: Our study shows a gross lack of awareness and multiple misconceptions that prevail in the rural population. Increasing public awareness, training primary healthcare workers to pick up on early signs of oral cancer, promoting tobacco cessation activities, and teaching oral self-examination and its importance to people can help tackle the problem of delayed presentation of oral cancers.

Performance of primary health care workers in detection of mental disorders comorbid with epilepsy in rural Ethiopia

BackgroundTimely detection and management of comorbid mental disorders in people with epilepsy is essential to improve outcomes. The objective of this study was to measure the performance of primary health care (PHC) workers in identifying comorbid mental disorders in people with epilepsy against a standardised reference diagnosis and a screening instrument in rural Ethiopia.MethodsPeople with active convulsive epilepsy were identified from the community, with confirmatory diagnosis by trained PHC workers. Documented diagnosis of comorbid mental disorders by PHC workers was extracted from clinical records. The standardized reference measure for diagnosing mental disorders was the Operational Criteria for Research (OPCRIT plus) administered by psychiatric nurses. The mental disorder screening scale (Self-Reporting Questionnaire; SRQ-20), was administered by lay data collectors. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PHC worker diagnosis against the reference standard diagnosis was calculated. Logistic regression was used to examine the factors associated with misdiagnosis of comorbid mental disorder by PHC workers.ResultsA total of 237 people with epilepsy were evaluated. The prevalence of mental disorders with standardised reference diagnosis was 13.9% (95% confidence interval (CI) 9.6, 18.2%) and by PHC workers was 6.3% (95%CI 3.2, 9.4%). The prevalence of common mental disorder using SRQ-20 at optimum cut-off point (9 or above) was 41.5% (95% CI 35.2, 47.8%). The sensitivity and specificity of PHC workers diagnosis was 21.1 and 96.1%, respectively, compared to the standardised reference diagnosis. In those diagnosed with comorbid mental disorders by PHC workers, only 6 (40%) had SRQ-20 score of 9 or above. When a combination of both diagnostic methods (SRQ-20 score ≥ 9 and PHC diagnosis of depression) was compared with the standardised reference diagnosis of depression, sensitivity increased to 78.9% (95% (CI) 73.4, 84.4%) with specificity of 59.7% (95% CI 53.2, 66.2%). Only older age was significantly associated with misdiagnosis of comorbid mental disorders by PHC (adjusted odds ratio, 95% CI = 1.06, 1.02 to 1.11).ConclusionRoutine detection of co-morbid mental disorder in people with epilepsy was very low. Combining clinical judgement with use of a screening scale holds promise but needs further evaluation.

Epidemiology of cervical spine injury in Northern India: A retrospective study

Background: The epidemiology of cervical spine injuries in trauma patients of Northern India is largely unknown. Study Design: Retrospective study. Objectives: To find out the epidemiology and demographic factors associated with patients of traumatic cervical spinal injury presented to a level 1 trauma center. Patients and Methods: The study sample includes patients with cervical spine injury admitted to our level one trauma centre from the period of July 2018 to June 2019. Those patients who succumbed to their injuries due to various reasons before imaging or brought dead having suspected cervical spine injury were excluded from the study. Results: During the study period, 83 patients having cervical spine injury were admitted and treated. Out of 83, 75.9% (63) were male and the remaining 24.1% (20) were female. The most common mode of injury was fall from height (66.3%) followed by road traffic accidents (24%). About 64% of the patient population belonged to rural areas. The most affected age group in this study was 20–39 years. The most common associated injury is Extremities fracture (9.6%) followed by head injury (8.4%). C5C6 was the most common level and 69.9% underwent surgery. Pressure sore was presented in 12% of cases. Conclusion: The epidemiology of cervical spine injury in Northern India is different from developed countries. In the present study, the most common cause of cervical spine injury was fall from height followed by motor vehicle accidents. Proper awareness program, educating people, national policymaking, and involvement of NGOs and training primary health care workers will help in reducing the incidence of cervical spine injuries in this region

Training primary healthcare workers in China\u2019s township hospitals: a mixed methods study

BackgroundPrimary health care (PHC) was a keystone toward achieving universal health coverage and Sustainable Development Goals (SDGs). China has made efforts to strengthen its PHC institutions. As part of such efforts, regular in-service training is crucial for primary healthcare workers (PHWs) to strengthen their knowledge and keep their skills up to date.ObjectiveTo investigate if and how the existing training arrangements influenced the competence and job satisfaction of PHWs in township hospitals (THs).MethodsA mixed method approach was employed. We analyzed the associations between in-service training and competence, as well as between in-service training and job satisfaction of PHWs using logistic regression. Interviews were recorded, transcribed, and analyzed using NVivo12 to better understand the trainings and the impacts on PHWs.ResultsThe study found that training was associated with competence for all the types of PHWs except nurses. The odds of higher competence for physicians who received long-term training were 3.60 (p < 0.01) and that of those who received both types of training was 2.40 (p < 0.01). PHWs who received short-term training had odds of higher competence significantly (OR = 1.710, p < 0.05). PHWs who received training were more satisfied than their untrained colleagues in general (OR = 1.638, p < 0.01). Specifically, physicians who received short-term training (OR = 1.916, p < 0.01) and who received both types of training (OR = 1.941, p < 0.05) had greater odds of general job satisfaction. The odds ratios (ORs) of general job satisfaction for nurses who received short-term training was 2.697 (p < 0.01), but this association was not significant for public health workers. The interview data supported these results, and revealed how training influenced competence and satisfaction.ConclusionsConsidering existing evidence that competence and satisfaction serve as two major determinants of health workers’ performance, to further improve PHWs’ performance, it is necessary to provide sufficient training opportunities and improve the quality of training.

Perception of service users and their caregivers on primary care-based mental health services: a qualitative study in Nepal

BackgroundIntegration of mental health services into primary health care systems has been advocated as a strategy to minimize the tremendous mental health treatment gap, particularly in low- and middle-income countries. Barriers to integration of mental health into primary health care have been widely documented; however, very little is known about the perception of service users and their caregivers on primary care-based mental health services. This study assessed service users’ and caregivers’ perceptions of mental health services provided by trained primary health care workers in Nepal.MethodsA qualitative study was conducted among people with depression, psychosis, alcohol use disorder and epilepsy, and their caregivers in Chitwan, a district in southern Nepal. Semi-structured interviews were conducted with 43 service users and 38 caregivers to assess their perceptions about the accessibility of the services, types of services they received, skills and competencies of health care providers, satisfaction and barriers to receiving services.ResultsOverall, both service users and caregivers were satisfied with the mental health services provided by primary health care providers. They also perceived health workers to be competent and skillful because the services they received were effective in reducing their mental health problems. Both psychological and pharmacological services were made available free of cost, however, they considered psychological services more effective than pharmacological treatment. Major challenges and difficulties accessing services were associated with frequent transfer of trained health workers, non-availability of the same health care provider at follow-ups, frequent stock-out of medicines or non-availability of required medicines, lack of a confidential space for consultation in health facilities, and stigmatizing and negative behavior of some health workers.ConclusionThe results demonstrated that both service users and caregivers perceived primary care-based mental health services to be accessible, acceptable and effective. The key recommendations emerging from this study for improving mental health services in primary care include the provision of a separate cadre of psychosocial workers to provide psychological interventions, developing quick and efficient mechanisms for the procurement and supply of psychotropic medicines, establishing a confidential place within health facilities for consultation, and further training of health workers to reduce stigma.

Impact of training of primary healthcare workers on integrated community case management of childhood illnesses in North-West district of Benue State, Nigeria

The World Health Organization and United Nations Children’s Fund has introduced Integrated Community Case Management of childhood illness (ICCM) in order to train health workers at community level on how to treat children below 5 years who have pneumonia, diarrhoea and malaria. Since Primary Health Care workers in Benue State are actively involved in caring for sick children at community level, there is every need for them to be trained on ICCM. The objective of this study is to find out if training of primary health care workers in North-West district of Benue State can improve their knowledge on ICCM. The study was carried out in Benue North-west where Gboko Local government was randomly selected out of seven local governments. Health Officers’ in-charge of 38 Primary Health Care Clinics were selected for the study and were trained based on our adapted ICCM training manual. The Pre and Post training assessment test for this study was designed based on the training manual. A paired sample t-test was conducted to find out if there were any significant difference in the knowledge of primary health care workers before and after receiving training. There was significant difference in the pre training scores ( x1 = 136.684, S1 = 37.370) and post-training scores (x2 =177.895, 2 S =14.469) at (t=6.783, P=0.000). This result strongly indicates that the teaching intervention has improved the knowledge of the Primary Health Care workers on ICCM in Gboko Local Government.&#x0D; Keywords: ICCM; Pneumonia; Malaria; Diarrhoea

Evaluation of mhGAP training for primary healthcare workers in Mulanje, Malawi: a quasi-experimental and time series study

BackgroundThere has been a growing global movement championed by the World Health Organization (WHO) to integrate mental health into primary health care as the most effective way of reducing the mental health treatment gap. This study aimed to investigate the impact of WHO Mental Health Gap Action Programme (mhGAP) training and supervision on primary health workers’ knowledge, confidence, attitudes and detection rate of major mental disorders in Mulanje, Malawi.MethodThe study used a quasi-experimental method (single cohort pre- and post-measures) with an interrupted time-series design. A 2 day mhGAP training was delivered to 43 primary healthcare workers (PHWs) working in 18 primary care clinics serving the entire population of Mulanje, Malawi (population 684,107). Modules covered were psychosis, moderate-severe depression, and alcohol & substance use disorders. The PHWs completed pre and post-tests to assess knowledge, confidence and attitudes. Number of diagnosed cases was obtained from clinic registers for 5 months prior to and 7 months following training. Data was analyzed using mean scores, t-test, one-way analysis of variance and linear regression.ResultsThe mean knowledge score increased significantly from 11.8 (SD: 0.33) before training to 15.1 (SD: 0.38) immediately after training; t (42) = 7.79, p < 0.01. Similarly, mean knowledge score was significantly higher 6 months post training at 13.9 (SD: 2.52) compared to before; t (42) = 4.57, p < 0.01. The mean confidence score also increased significantly from 39.9 (SD: 7.68) before training to 49.6 (SD: 06.14) immediately after training; t (84) = 8.43, p < 0.01. It was also significantly higher 6 months post training 46.8, (SD: 6.03) compared to before; t (84) = 6.60, p < 0.01. One-way analysis of variance showed no significant difference in mean scores on all four components of the scale used to measure attitudes. A significant positive change in the trend in mental health service utilization after the intervention was demonstrated using a segmented linear regression (β = 2.43 (95% CI 1.02; 3.83) as compared to before (β = − 0.22 (95% CI − 2.67; 2.23) and immediately after (β = 1.63 (95% CI − 7.31; 10.57).ConclusionThe findings of this study add to the growing evidence for policy makers of the effectiveness of mhGAP training and supervision in a resource-constrained country.

Protocol for the evaluation of a pilot implementation of essential interventions for the prevention of cardiovascular diseases in primary healthcare in the Republic of Moldova

IntroductionNearly 90% of all deaths in the Republic of Moldova are caused by non-communicable diseases, the majority of which (55%) are caused by cardiovascular diseases (CVD). In addition to reducing...

Assessment of resources available for integrated primary eye care in obokun local government Area, Nigeria

Background: The integration of eye care services into the primary health-care (PHC) system and the accessibility and quality of eye health in the community is hugely dependent on available resources.Objective: The aim was to assess the resources available for eye care delivery in public PHC facilities in Obokun Local Government Area (LGA), Osun State, Nigeria.Methodology: This was a descriptive cross-sectional study of public PHC facilities and workers in Obokun LGA, Nigeria. A PHC facility checklist was used to obtain data on available infrastructure, material resources, primary eye care (PEC) services, and human resources during a tour and inspection of each facility. Further data on human resources were obtained with a semi-structured questionnaire administered to PHC workers. Data included information on the age, sex, cadre, duration of service, PEC practices, and training of PHC workers.Results: There were 4 (10.0%) primary health (PH) centres, 19 (47.5%) PH clinics and 17 (42.5%) health posts. The number and distribution of PHC facilities, material resources, and PEC services were below-recommended guidelines. There were 12 (11.2%) nurses, 4 (3.7%) community health officers, 19 (17.8%) community health extension workers (CHEWs), 7 (6.5%) health technicians, 8 (7.5%) junior CHEWs, and 57 (53.3%) health assistants. There was a sufficient number of PHC workers and community services to build capacity for PEC delivery.Conclusions: Resources were available for PEC in Obokun LGA; however, some were insufficient or unevenly distributed. Further training of PHC workers in PEC and the provision of the minimum required infrastructure and material resources are recommended.

Pattern of referral before and after referral intervention among primary health centers in North-Western Nigeria

Introduction: The revised Nigerian National Health Policy and the WHO Expert Committee on the Role of Hospitals as the First Referral Level both recognize primary health care (PHC) as the entry point in the referral system. This study was carried out to assess the effect of training of PHC workers on referral and instituting referral focal person among PHCs on key referral indicators in Zaria and Giwa local government areas, North-Western Nigeria. Methodology: The study was a quasi-experimental study with pre- and postinterventional components carried out among seventy participants in the intervention and 62 participants in the control groups who were selected through a multistaged sampling technique. Data were collected using a structured self-administered questionnaire containing close-ended questions. Data were analyzed with SPSS software version 20.0. Results: Preintervention, majority of the respondents (74.3%) in the intervention and (67.7%) control groups had not received training on referral process. Postintervention, increase was noted in mean referral rate from 0.18 ± 0.28 to 0.52 ± 0.34, which was statistically significant, and mean counter referral rate from 0 ± 0 to 40.34 ± 45.53 in the study group, but there was no statistically significant change in the control group. Conclusion: Postintervention, significant increases were noticed in two of the practice indicators; referral rate and counter-referral rate in the study group only. The other practice indicators did not record a significant increase.

Bridging the gap in health systems through task-sharing: A model of PHC workers’ competency for cervical screening

BackgroundSeveral developing countries have begun implementing the recently proven ‘Screen and treat’ approach using visual inspection methods and cryotherapy. Nonetheless, a dire lack of established screening programs in Nigeria necessitates proffering effective task sharing to improve the availability of screening at the primary care level thereby making it more accessible to women. MethodsThis study employed a cross-sectional, analytic design with competency-based training of health workers to underscore the competence of primary healthcare (PHC) workers to perform cervical screening. The degree of agreement for the visual inspection with acetic acid (VIA) and visual inspection with Lugol’s iodine (VILI) results between the PHC workers and O & G doctors was determined using Kappa statistics, and indices of validity were used to express the accuracy of results. Results Following training, the PHC workers demonstrated a fair to excellent proficiency at the procedures for VIA and VILI, although the phase of VIA/VILI proper was the best performed. The degree of agreement (kappa) between workers for VILI (k - 0.442) and VIA (k - 0.374) was statistically significant (p < 0.001). The sensitivity of VILI among PHC workers (42.9%) was lower than O & G doctors (78.6%), however, PHC had a higher specificity (45.5% vs. 22.7%). The positive predictive values of VILI and VIA were similarly low for both groups (PHC workers vs. O & G doctors - 33.3% vs. 39.3%; 28.6% vs. 27.3%); whereas the negative predictive values for VILI and VIA were moderately better for PHC workers (PHC workers vs. O & G doctors - 62.5% vs. 55.6%; 58.6% vs. 56.0% respectively). The diagnostic accuracy for VILI was the same for both groups of healthcare workers, however VIA accuracy was slightly higher among PHC workers. The sensitivity of VIA was lower among the PHC workers (PHC workers vs. O & G doctors −14.3% vs. 21.4%), who also had a higher specificity (PHC workers vs. O & G doctors - 77.3% vs. 63.6%). ConclusionThe findings of this study suggest that VIA and VILI as done by trained PHC workers is comparable to those performed by registrars of obstetrics and gynecology, which is in keeping with reports from several other studies. This study thus highlights the value of competency-based training for primary healthcare workers in order to accomplish task sharing for cervical screening using visual inspection methods.