RLEP LAMP for the laboratory confirmation of leprosy: towards a point-of-care test

Background Nucleic acid-based amplification tests (NAAT), above all (q)PCR, have been applied for the detection of Mycobacterium leprae in leprosy cases and household contacts with subclinical infection. However, their application in the field poses a range of technical challenges. Loop-mediated isothermal amplification (LAMP), as a promising point-of-care NAAT does not require sophisticated laboratory equipment, is easy to perform, and is applicable for decentralized diagnosis at the primary health care level. Among a range of gene targets, the M. leprae specific repetitive element RLEP is regarded as highly sensitive and specific for diagnostic applications. Methods Our group developed and validated a dry-reagent-based (DRB) RLEP LAMP, provided product specifications for customization of a ready-to-use kit (intended for commercial production) and compared it against the in-house prototype. The assays were optimized for application on a Genie® III portable fluorometer. For technical validation, 40 “must not detect RLEP” samples derived from RLEP qPCR negative exposed and non-exposed individuals, as well as from patients with other conditions and a set of closely related mycobacterial cultures, were tested together with 25 “must detect RLEP” samples derived from qPCR confirmed leprosy patients. For clinical validation, 150 RLEP qPCR tested samples were analyzed, consisting of the following categories: high-positive samples of multibacillary (MB) leprosy patients (> 10.000 bacilli/extract), medium-positive samples of MB leprosy patients (1.001–10.000 bacilli/extract), low-positive samples of MB leprosy patients (1–1.000 bacilli/extract), endemic controls and healthy non-exposed controls; each n = 30. Results Technical validation: both LAMP formats had a limit of detection of 1.000 RLEP copies, i.e. 43–27 bacilli, a sensitivity of 92% (in-house protocol)/100% (ready-to-use protocol) and a specificity of 100%. Reagents were stable for at least 1 year at 22 °C. Clinical validation: Both formats showed a negativity rate of 100% and a positivity rate of 100% for high-positive samples and 93–100% for medium positive samples, together with a positive predictive value of 100% and semi-quantitative results. The positivity rate for low-positive samples was 77% (in-house protocol)/43% (ready-to-use protocol) and differed significantly between both formats. Conclusions The ready-to-use RLEP DRB LAMP assay constitutes an ASSURED test ready for field-based evaluation trials aiming for routine diagnosis of leprosy at the primary health care level.

Malnutrition in children under the age of 5 years in a primary health care setting

In this study, we outlined the types of malnutrition amongst children, the causes of malnutrition intervention at the primary health care level and some recommendations to alleviate childhood malnutrition in South Africa.

Prospects and Challenges of Telemedicine at the Primary Health Care Level: A Basis for Certification of Providers in Ghana

Background: Telemedicine has proven to be one of the modern medical discoveries in recent times, serving as a technological tool to deliver healthcare at a distance and providing medical solutions to remote communities with limited access to quality healthcare. However, the challenges associated with the use of telemedicine in Ghana make it difficult to scale up its application at the Primary Healthcare (PHC) level. Aim: The aim of the study was to assess the current trends and applications of telemedicine in health care delivery at the primary health care level in Ghana. The study also sought to identify the prospects and challenges of telemedicine implementation in Ghana. Study Design: The study employed both qualitative and quantitative design involving 200 respondents made up of 80 healthcare professionals and 120 patients from four primary healthcare facilities in the Ahafo-Ano North District of the Ashanti region of Ghana Methods: Survey questionnaire, semi-structured interview guide, and field observations were used to find out the knowledge of providers, capacity, availability of network infrastructure, and challenges of implementing telemedicine at the PHC level from the viewpoint of healthcare 'professionals' and to verify factors that can persuade patients to participate in the implementation of telemedicine. Logistic regression analysis was conducted to estimate the factors influencing 'patients' decision to participate in telemedicine, while the qualitative data were analyzed using thematic content analysis. Results: The results show that knowledge and education about telemedicine, easy access to specialist care at home, widespread use of mobile telephony, and reduction in travel cost due to telemedicine significantly influence both providers' and patients' participation in telemedicine at the primary healthcare level. The minimum educational level for patients to participate in telemedicine implementation is a primary education (OR = 0.233, p<0.025). On the other hand, inadequate infrastructure, legal issues such as non-certification of providers, reimbursement and confidentiality challenges are some of the factors that impede telemedicine implementation. Conclusion: The authors suggest that developing countries need to take advantage of the massive use of mobile telephony and embrace telemedicine application to increase access to healthcare in rural areas. Again, certification of care providers is critical for effective application and integration of telemedicine and this should be adaptive to local needs, high internet connectivity and the demands of both healthcare professionals and patients especially in rural communities.

Health consumer expectations and perception of quality care services at primary health care level in Nigeria

The success of universal coverage of health at primary health care level depends on patient’s perceptions or judgment on quality products and service rendered by the health personnel in the hospitals. Quality of health care services can be determined by gap between perception of what is offered in term of services and expectation from the health consumers. The study examined the expectations of health consumers and perception used in judging the quality of health care services at the primary health care level. A cross-sectional study was carried out among randomly selected health consumers that had received health care services in the hospitals designated as primary health care facilities in Kwara State Nigeria. Overall health consumers’ means score expectations was 6.57 while perception was 5.80. Though was high in favour of females with no statistical significant difference. However, correlation test revealed significant association in socio-demographic variables such as age, occupation and educational status. Conversely, relationship was inverse in terms of increase in education attainment with lower perception value (p<0.001). Expectation-perception gap was a major determinant of quality of health care services at primary health care levels. Significant relationship occurred between heath consumer’s age, occupation, educational status and overall expectation-perception of quality health care received. It is recommended that hospital management need to monitor the link between the expectations including perception of services received by patients for quality improvement at primary health care level.

The epidemiological characteristics of the primary health care based COVID-19 swabbed persons in Qatar, March- October 2020

BackgroundIn March 2020, Qatar started reporting increased numbers of COVID-19 positive cases. National preventive measures were put in place and testing plan has been developed to respond to the pandemic with the primary health care as the main provider. The study aims to describe the epidemiological characteristics of COVID-19 at the primary health care level in Qatar and to examine the factors associated with the positivity rate.MethodRetrospective data analysis for all the cases screened for COVID-19 at the primary health care level in Qatar between the 11th of March and 31st of October 2020. The study analyzed the demographic characteristics of the tested persons and non-communicable disease burden, positivity rate by month, nationality, and age-group, factors associated with the positivity rate.ResultsBetween the 11th of March and the 31st of October 2020, 285,352 persons were tested for SARS-CoV-2, with a median age (IQR) of 32 (22-43) years. 59.9% were from the Middle East and North Africa region and 29.6% originally from Asia. Overall, among them, 11.2% had diabetes mellitus and 11.4% had hypertension. The epidemiological curve showed a steep increase in positivity rate from March till June 2020 at the highest rate of 21.4% in June 2020. The highest positivity rate was observed among Asian males at 20.3%. The positivity rates were almost the same among the tested persons for SARS-CoV-2 in the main three age-groups (0-18, 19-39, 40-59) at 13%, 14.5%, and 14.0%, respectively. In a multi regression model, being a male was associated with a higher risk (OR 1.16; 95% CI 1.13 to 1.18). Persons originally from Asia were at higher risk than those originally from the Middle East and North Africa (OR 1.5; 95% CI 147 to 1.54). COVID-19 infection was higher among those presenting with clinical symptoms than those asymptomatic (OR. 4.16; 95% CI 4.05 to 4.28).ConclusionThe epidemic predominantly affected younger ages and males namely coming from Asia. At the primary health care level, COVID-19 infection rate was higher among those who presented with clinical symptoms. The scale-up of the testing at the primary health care level helped in detecting more cases and was reflected in a steady increase in the positivity rate to be flattened afterward.

Chronic Care for Neglected Infectious Diseases: Leprosy/Hansen's Disease, Lymphatic Filariasis, Trachoma, and Chagas Disease

In 2016, PAHO's Directing Council, through Resolution CD55.R9, approved the “Plan of Action for Elimination of Neglected Infectious Diseases (NID) and Post-Elimination Actions, 2016-2022.” This Resolution urges Member States to implement a set of interventions to reduce the burden of disease by NID in the Americas by 2022, including “…support promotion of treatment, rehabilitation, and related support services through an approach focused on integrated morbidity management and disability prevention for individuals and families afflicted by those neglected infectious diseases that cause disability and generate stigma.” NIDs can have devastating chronic sequelae for patients, such as disability, visible change or loss in body structure, loss of tissue, and impairment of proper tissue and organ function, among others. All of these can in turn lead to unjustified discrimination, stigmatization, mental health problems, and partial or total incapacity to work, perpetuating the vicious cycle of neglected diseases as both a consequence and a cause of poverty. Patients with chronic conditions caused by NIDs require proper health care in order to prevent further damage and improve their living and social conditions. This should be provided at the primary health care level, as patients suffering from NIDs are often unable to travel to or afford to pay for specialized care services. Care for patients suffering from chronic morbidity caused by NID should be integrated into care for other chronic conditions caused by non-communicable diseases. This manual provides a framework for morbidity management and disability prevention of patients affected by NIDs and gives specific guidance for the proper care of patients suffering from chronic conditions caused by lymphatic filariasis, leprosy, trachoma, and Chagas disease. It is intended to be used mainly by health care workers at the primary health care level, but health workers at more complex and specialized levels may also find it useful.

Evaluation of nursing documentation: The experience of nurses from the primary and secondary/tertiary health care

Introduction: Aim of the study is to piloting nursing documentation to obtain comments based on the experience of nurses/medical technicians from the primary, secondary, and tertiary health care about the documentation before it is published and starts being used.Methods: A questionnaire was designed in the electronic form to be used for the evaluation and suggestions by nurses/medical technicians on the piloted form and content of nursing documentation for all levels of health care. A piloting sample was prepared to make 10% of nurses/medical technicians from health care institutions from the territory of the Federation of Bosnia and Herzegovina.Results: A total of 94.3% of examinees at the primary health care level and only 17.2% of the examinees in the secondary and tertiary health care fill out nursing documentation both manually and electronically. All examinees at all levels of health care understand the purpose and importance of nursing documentation. A total of 27.7% of the examinees at the primary and 40.9% of the examinees at the secondary and tertiary level of health care pointed out that filling out nursing documentation was too time-consuming.Conclusion: A total of 51.2% of the examinees at the primary and 64.2% at the secondary and tertiary level of health care agreed that submitted nursing documentation was adequate for use. It is suggested that after the adoption of nursing documentation at all levels of health care, piloting of its use should be conducted to evaluate the quality and quantity of all nursing documentation.