Tuberculosis infection control measures and knowledge in primary health centres in Bandung, Indonesia

Background Health care workers (HCWs) in low- and middle-income countries (LMICs) continue to have an unacceptably high prevalence and incidence of Mycobacterium tuberculosis infection due to high exposure to tuberculosis (TB) cases at health care facilities and often inadequate infection control measures. This can contribute to an increased risk of transmission not only to HCWs themselves but also to patients and the general population. Aim We assessed implementation of TB infection control measures in primary health centres (PHCs) in Bandung, Indonesia, and TB knowledge among HCWs. Methods A cross-sectional study was conducted between May and November 2017 amongst a stratified sample of the PHCs, and their HCWs, that manage TB patients in Bandung. Questionnaires were used to assess TB infection control measures plus HCW knowledge. Summary statistics, linear regression and the Kruskal–Wallis test were used for analysis. Results The median number of TB infection control measures implemented in 24 PHCs was 21 of 41 assessed. Only one of five management controls was implemented, 15 of 24 administrative controls, three of nine environmental controls and one of three personal respiratory protection controls. PHCs with TB laboratory facilities and high TB case numbers were more likely to implement TB infection control measures than other PHCs ( p=0.003). In 398 HCWs, the median number of correct responses for knowledge was 10 (IQR 9–11) out of 11. Discussion HCWs had good TB knowledge. TB infection control measures were generally not implemented and need to be strengthened in PHCs to reduce M. tuberculosis transmission to HCWs, patients and visitors.

Treatment-seeking for children with suspected severe malaria attending community health workers and primary health centres in Adamawa State, Nigeria

BackgroundThe Community Access to Rectal Artesunate for Malaria project investigated the feasibility of introducing pre-referral rectal artesunate into existing community-based health services. In that study, the case fatality rate of children visiting primary health centres (PHCs) was 19% compared to 6% in children first visiting community health workers, locally called Community Oriented Resource Persons (CORPs). As case management practices did not fully explain this finding, this publication investigates other reasons underlying the observed difference in case fatality.MethodsThe observational study enrolled 589 children under the age of five years with fever and danger signs indicative of severe malaria attending CORPs and PHCs in Adamawa State, Nigeria, between June 2018 and July 2020. After 28 days, follow-up visits were conducted with caregivers to understand background characteristics, severity of symptoms, home treatment administration, and treatment seeking practices during the child’s illness. These factors were compared between children visiting CORPs versus those visiting PHCs as their first health provider.ResultsChildren visiting PHCs were more likely to display danger signs indicative of central nervous system involvement (90% vs. 74%, p < 0.01) and have four or more danger signs (50% vs. 39%, p = 0.02). The delay between illness onset and visiting the community-based provider did not differ between children attending a CORP and children attending a PHC. PHC attendances more often lived in urban areas (16% vs 4%, p=0.01) and travelled farther to their first health provider, which was usually a community-based provider. Although practicing home treatment was common, especially among children attending PHCs (42% vs 33%, p=0.04), almost none of the children were given an antimalarial. PHCs were visited for their professionalism and experience while CORPs were visited for their low cost and because caregivers personally knew and trusted the provider.ConclusionsOur comparison of children with suspected severe malaria seeking care from two kinds of community-based health care providers in Nigeria suggest that illness severity may be the primary driver behind the observed difference in case fatality rate.

Effectiveness of Intensive Health Education on Tuberculosis Awareness, Attitude and Practice on Pulmonary Tuberculosis among Patients with Pulmonary Tuberculosis

Tuberculosis is an infectious disease which spreads from one person to another which has a devastating impact on the economic well-being of the individual, their families, and the entire community. The effective engagement of all health care providers especially nursing personnel, play an important role to scale up and commensurate to their presence to achieve universal access to tuberculosis care. Majority of times, the nursing personnel were the first person to be contacted, to take care of the patients with tuberculosis. The aim of the study is to evaluate the effectiveness of intensive health education on Pulmonary tuberculosis among patients with newly diagnosed Pulmonary tuberculosis from the four primary health centres as Mettupalayam, Lawspet, Reddiarpalayam and Mudaliarpet under RNTCP (April 2017-February 2018), in Puducherry. The objectives of the study is to assess the tuberculosis awareness, attitude and practice of the subjects among the experimental and control group before and after the intervention, to evaluate the effectiveness of intensive health education and to find out the association between the pretest level of tuberculosis awareness, attitude and practice of the subjects with selected demographic variables. Pre experimental study was adopted. For the purpose of this study, a total of 126 subjects of newly diagnosed pulmonary tuberculosis were under RNTCP(October 2016 to February 2018) selected from the four primary health centres by using cluster stage sampling technique. The investigator explained the purpose of the study to the subjects. The pretest was conducted by using the interview method for all the subjects following that implementation of nursing strategies as intensive health education on health promotion and management of pulmonary tuberculosis, distribution of self-instructional module. Continuous follow up of the subjects every week till 2 months and the posttest-I was conducted by using the same questionnaire after 2 months i.e. end of the intensive phase and again posttest-II was conducted by using the same questionnaire after 6 months i.e. at the end of the continuous phase. The findings of the study as out of 126 subjects, the mean score of tuberculosis awareness score was 9.04±3.65 in the experimental group and 8.32±3.13 of them in the control group. The mean score of attitude towards tuberculosis was 28.38±4.60 and 29.72±5.05 of them in the control group. The mean level of tuberculosis awareness score in the experimental group was 9.04 during pretest and increased to 19.13 in posttest I and further increased to 21.57 in posttest II. But in the control group, the mean tuberculosis awareness score was 8.32 during the pretest and increased to 14.50 in posttest I and 14.84 in posttest II which indicated that there was an increase in the level of tuberculosis awareness score from pretest to posttest II in the experimental group which was significant at p<0.001 level. The mean attitude score in the experimental group was 28.38 during the pretest and increased to 46.80 in posttest I and 57.41 in posttest II and in the control group 29.72 during the pretest and increased to 29.19 in posttest I and 32.24 in posttest II which indicated there was increase in the level of attitude score which was statistically significant at p<0.001 level. The mean practice score in the experimental group was 13.97 during pretest and increased to 20.51 in posttest I and 24.51 in posttest II and in control group 13.51 during the pretest and increased to 18.69 in posttest I and 17.53 in posttest II. The mean values clearly indicated that there was an increase in the practice score which was statistically significant at p<0.001 level. The increased level of Knowledge, attitude and practice score which confirmed that the intervention was much effective in the experimental group when compared to the control group. The Kruskal-Wallis test revealed that there was a significant association between the tuberculosis awareness score of the subjects with selected demographic variables such as the source of information heard about DOTS was statistically significant at p<0.05 level, attitude score of the subjects with selected demographic variable as a marital status which was significant at p<0.05 level than other variables and the practice score of the subjects with gender which was highly significant at p<0.05 level. They concluded that the treatment outcome of the subjects under RNTCP was cured and the cure rate is 100% both in the experimental group and in the control group. Nursing strategies as intensive health education, self-care module along with anti tuberculosis drugs were found to be more effective in improving the tuberculosis awareness, attitude, practice of the subjects in the experimental group than the control group.

Depression, anxiety, stress among ASHA workers, in selected primary health centres in Southern Bengaluru

Background: The COVID-19 pandemic was caused by a novel corona virus first discovered in Wuhan, December 2019. The healthcare system in India was quickly overwhelmed as tens of thousands of people with flu-like symptoms swarmed the hospitals.Methods: The present community based cross-sectional study was conducted among the accredited social health activist (ASHA) workers working under the selected primary health centres from August 2020 to November 2020. Primary health centres were selected by using simple random sampling technique. Three primary health centres were selected from the southern region of Bengaluru. The data was collected, compiled and entered into a Microsoft excel worksheet and analyzed using statistical package for social sciences (SPSS) software v.22.0. Descriptive statistics and suitable tests of significance like Chi-square test were applied as required.Results: A total of 78 ASHA workers participated in the present study. Majority of them belonged to the age group of 33-44 years. The mean age of the participants was 34 (+1.390) years. The present study showed that, 56.5% of the study participants experienced depression, anxiety or stress during the time of COVID-19 pandemic. Around 65% of the ASHA and Anganwadi workers were aware of the personal prophylactic measures to be used to prevent COVID-19 disease according to the present study.Conclusions: A significant proportion (56.5%) of the ASHA workers experienced depression, anxiety and stress during this pandemic. Measures should be undertaken to address the same.

From Theory to Implementation: Adaptations to a Quality Improvement Initiative According to Implementation Context

As countries continue to invest in quality improvement (QI) initiatives in health facilities, it is important to acknowledge the role of context in implementation. We conducted a qualitative study between February 2019 and January 2020 to explore how a QI initiative was adapted to enable implementation in three facility types: primary health centres, public hospitals and private facilities in Lagos State, Nigeria. Despite a common theory of change, implementation of the initiative needed to be adapted to accommodate the local needs, priorities and organisational culture of each facility type. Across facility types, inadequate human and capital resources constrained implementation and necessitated an extension of the initiative’s duration. In public facilities, the local governance structure was adapted to facilitate coordination, but similar adaptations to governance were not possible for private facilities. Our findings highlight the importance of anticipating and planning for the local adaptation of QI initiatives according to implementation environment.

Assessment of health system preparedness to deal with the second wave of COVID-19 in a remote tribal district Surguja, Chhattisgarh, India-April 2021

Background: Present study was conducted to assess the preparedness of the Surguja district to curtail COVID-19.Methods: We conducted a cross-sectional observational study from May 2020 to March 2021 through records of 2 primary health centres areas selected by convenient sampling (farthest and nearest to district headquarters). Data on existing facilities and logistics was from district headquarters. Preparedness was assessed through checklist. Observations were presented as rates, ratios and proportions. Standard error of difference between two proportions was used as test of significance and p value≤0.05 was considered significant.Results: For Surguja district population of 925938 (65% rural), overall attack rate was 1.15%, case fatality rate was 0.96% (102/10636); there was 1 DCH, 9 DCHC, 6 CHCs, 25 PHCs, 3 upgraded PHCs, 197 subcentres, 12 CCC, 01 RT-PCR laboratory and 228 COVID vaccination centres. There were 1151 isolation beds; 300 with oxygen support (26%); ICU beds 134 (11.60%) with 34 ventilators. Cumulative 258229 tests; antigen 67.90%, test positivity rate 4.10% (urban 8.2%, rural 1.7%). This urban-rural difference in test positivity rate was statistically significant (p<0.001). Health care workers, 94.81% (12722/13418) had received one dose of vaccine with 53.36% (6789/13418) both doses. Above 45 years eligible population; 66.68% (154254/231331) received one dose of vaccine.Conclusions: Surveillance and management of COVID-19 were as per GOI guidelines issued. However, to enhance response we recommended strict implementation of appropriate behaviour in community, establishment of containment zones/facilities for high risk population in urban area blocks and increasing laboratories with RT-PCR testing in appropriate proportions.

Effect of COVID-19 pandemic on provision of sexual and reproductive health services in primary health facilities in Nigeria: a cross-sectional study

Background Nigeria, like many other countries, has been severely affected by the COVID-19 pandemic. While efforts have been devoted to curtailing the disease, a major concern has been its potential effects on the delivery and utilization of reproductive health care services in the country. The objective of the study was to investigate the extent to which the COVID-19 pandemic and related lockdowns had affected the provision of essential reproductive, maternal, child, and adolescent health (RMCAH) services in primary health care facilities across the Nigerian States. Methods This was a cross-sectional study of 307 primary health centres (PHCs) in 30 Local Government Areas in 10 States, representing the six geopolitical regions of the country. A semi-structured interviewer-administered questionnaire was used to obtain data on issues relating to access and provision of RMCAH services before, during and after COVID-19 lockdowns from the head nurses/midwives in the facilities. The questionnaire was entered into Open Data Kit mounted on smartphones. Data were analysed using frequency and percentage, summary statistics, and Kruskal–Wallis test. Results Between 76 and 97% of the PHCS offered RMCAH services before the lockdown. Except in antenatal, delivery and adolescent care, there was a decline of between 2 and 6% in all the services during the lockdown and up to 10% decline after the lockdown with variation across and within States. During the lockdown. Full-service delivery was reported by 75.2% whereas 24.8% delivered partial services. There was a significant reduction in clients’ utilization of the services during the lockdown, and the difference between States before the pandemic, during, and after the lockdown. Reported difficulties during the lockdown included stock-out of drugs (25.7%), stock-out of contraceptives (25.1%), harassment by the law enforcement agents (76.9%), and transportation difficulties (55.8%). Only 2% of the PHCs reported the availability of gowns, 18% had gloves, 90.1% had hand sanitizers, and a temperature checker was available in 94.1%. Slightly above 10% identified clients with symptoms of COVID-19. Conclusions The large proportion of PHCs who provided RMCAH services despite the lockdown demonstrates resilience. Considering the several difficulties reported, and the limited provision of primary protective equipment more effort by the government and non-governmental agencies is recommended to strengthen delivery of sexual and reproductive health in primary health centres in Nigeria during the pandemic.

Measuring oxygen access: lessons from health facility assessments in Lagos, Nigeria

The COVID-19 pandemic has highlighted global oxygen system deficiencies and revealed gaps in how we understand and measure ‘oxygen access’. We present a case study on oxygen access from 58 health facilities in Lagos state, Nigeria. We found large differences in oxygen access between facilities (primary vs secondary, government vs private) and describe three key domains to consider when measuring oxygen access: availability, cost, use. Of 58 facilities surveyed, 8 (14%) of facilities had a functional pulse oximeter. Oximeters (N=27) were typically located in outpatient clinics (12/27, 44%), paediatric ward (6/27, 22%) or operating theatre (4/27, 15%). 34/58 (59%) facilities had a functional source of oxygen available on the day of inspection, of which 31 (91%) facilities had it available in a single ward area, typically the operating theatre or maternity ward. Oxygen services were free to patients at primary health centres, when available, but expensive in hospitals and private facilities, with the median cost for 2 days oxygen 13 000 (US$36) and 27 500 (US$77) Naira, respectively. We obtained limited data on the cost of oxygen services to facilities. Pulse oximetry use was low in secondary care facilities (32%, 21/65 patients had SpO2 documented) and negligible in private facilities (2%, 3/177) and primary health centres (<1%, 2/608). We were unable to determine the proportion of hypoxaemic patients who received oxygen therapy with available data. However, triangulation of existing data suggested that no facilities were equipped to meet minimum oxygen demands. We highlight the importance of a multifaceted approach to measuring oxygen access that assesses access at the point-of-care and ideally at the patient-level. We propose standard metrics to report oxygen access and describe how these can be integrated into routine health information systems and existing health facility assessment tools.

Correlation between the level of knowledge of drug managers and drug management in several primary health centres in Malang regency

Background: Drug management is one of the primary health centre management activities that aims to ensure the continuity and affordability of pharmaceutical preparations. Aim: This study aims to determine the relationship between the level of knowledge of drug managers and drug management in several primary health centres of Malang regency. Method: The study was observational analytic using questionnaire instruments to analyse the level of knowledge of drug managers and three checklists to analyse drug management through three indicators of drug management: (1) conformity of stock to the national formulary, (2) conformity of stock to the disease patterns, and (3) the percentage of expired drugs. Result: There was no significant relationship between the level of knowledge and the first (p = 0.842), second (p = 0.236), and the third indicator (p = 0.361). Conclusion: Not all drug lists in the national formulary are required by each primary health centre. The inventory is adjusted to the consumption and epidemiology.

A Study to assess the effectiveness of Lamaze Breathing Technique on reduction of labour pain among primigravida mothers at Primary Health Centres, Coimbatore

Statement of the Problem: A study to assess the effectiveness of Lamaze breathing technique on reduction of labour pain among primigravida mothers at primary health centres kovilpalayam Coimbatore. Study Objectives: (a) To assess the pain among primigravida mothers. (b) To assess the effectiveness of Lamaze breathing technique among primigravida mothers. (c) To reassess the pain among primigravida mothers. (d) To associate the effectiveness of Lamaze breathing technique with selected demographic and obstetrical variables among primigravida mothers. Methodology: one group pretest post test design was adopted. The samples for this study consist of 30 samples selected by non probability convenient sampling technique. A numerical pain intensity scale was used to assess the pain level among primigravida others in first stage of labour. Results: The pretest mean score of pain level among primigravida mothers was 7. The post test mean score of pain level among primigravida mothers was 3.1 the paired‘t’ value of experimental group was 12.806. Conclusion: The study shows that the pain during first stage of labour was reduced after performing Lamaze breathing technique.