Perceptions of Primary Care Providers on Public Health Services in Primary Care in Oman: A Qualitative Study.

Background The integration of public health functions in primary care is not well-defined in the literature. This paper examines the perceptions of healthcare workers on public health services in primary care, as well as the challenges and views on strengthening the integration of public health functions in a primary care setting in Oman. Methodology This qualitative study (employing a face-to-face interview) was conducted in a primary healthcare setting in Muscat from January 1, 2022, to May 31, 2022. This study is based on interpretative phenomenological analysis using purposeful sampling. Participants were interviewed to answer the study questions. The targeted participants included directors and other official personnel, physicians, nurses, pharmacists, nutritionists, health educators, and lab technicians. Verbal consent was obtained from the participants before the interview, and all responses were anonymously audio recorded, transcribed verbatim, and analyzed using thematic analysis. Results A total of 10 primary care providers were interviewed once for 30 minutes over a two-week period. All participants were females apart from one male participant. The study included three physicians, five nurses, one pharmacist, and one nutritionist. All participants had over 10 years of experience as primary care providers at the time of the interview. The main themes were a lack of awareness of public health services in a primary care setting, challenges to practicing public health in a primary care setting, and recommendations to strengthen the integration of public health services in primary care. In general, there were inconsistent views on public health services in a primary care setting, and the interactions between the functions were not clear. Participants reported an absence of clear guidelines, training, and competencies for public health in a primary care setting. Building public health capacities and reforming the health system were highly recommended to integrate public health into primary health care. Conclusions Understanding how public health and primary care interact is crucial to improve population health. Building competencies and supportive health systems are required for the effective integration of public health in primary care settings.

Depressive symptoms among primary healthcare workers during the novel SARS-CoV-2 coronavirus pandemic in the Muscat governorate.

BACKGROUND: With the unprecedented spread of the novel SARS-CoV-2 coronavirus, primary healthcare workers (PHCWs) are having to shoulder the increasing weight of this ongoing pandemic. AIMS: This study explored the rate and covariates of depressive symptoms among PHCWs in the Muscat governorate. METHODS: A cross-sectional online survey was conducted from 10 May to 10 June 2020 among PHCWs working in all primary healthcares across the Muscat governorate. Data on sociodemographic and risk factors of having at least one underlying physical health condition, a psychiatric history, family history of psychiatric disorders, and direct involvement with COVID-19 positive patients were sought. The Patient Health Questionnaire (PHQ-9) was then used to solicit the presence of depressive symptoms. Those with a cutoff point ≥10 were considered as showing depressive symptoms. Logistic regression was used to determine risk factors associated with depressive symptoms in PHCWs after adjusting for all sociodemographic factors. FINDINGS: A total of 432 (72%) out of 600 PHCWs with an average age of 39.2 years (SD = 7.8 years) ranging between 25.0 and 75.0 years responded to the survey. There were more females (n = 281, 65.3%) than males, and more than 45% (n = 195) of them were physicians. Additionally, more than 78% (n = 338) had been in contact with COVID-19 patients. There was a significant association between different age groups and profession (P < .001), having at least one underlying physical health condition (P = 0.001) and depressive symptom status (P = 0.038). A total of 78 out of the 423 subjects (18.1%) were considered to have depressive symptoms. After adjusting for all factors, the logistic regression model showed that an age of 34 years or below (OR = 2.079, P = 0.021) and having at least one underlying physical health condition (OR = 2.216, P = 0.007) were factors contributing significantly to depressive symptoms among the PHCWs.

Reporting at Least One Adverse Effect Post-COVID-19 Vaccination From Primary Health Care in Muscat.

Introduction Vaccinations against COVID-19 were licensed with limited testing assurances to the public triggering a widespread hesitancy around expected adverse reactions. Limited data was reported from Arabian Gulf countries on vaccine adverse effects. Objectives This study looked at the rate of reporting at least one side effect post-COVID-19 vaccination and its associated factors (sociodemographic characteristics, clinical condition, and type of vaccines). Additionally, questions about safety and willingness to recommend them were included. Study design Phone interviews on post-COVID-19 vaccination adverse effects were utilized to record responses related to reporting at least one side effect post vaccinations across the studied variables. Data collection continued for two months (from 1st March to 30th April 2021). Methodology Participants were adults (Omani citizens and non-citizens) who received AstraZeneca (AZ) or Pfizer (PF) vaccines from primary care facilities in Muscat and were randomly selected from the health information system. Responses were saved in a bespoke Google form/questionnaire. Chi-squared tests were utilized to determine potential factors associated with the dependent variable. Results A total of 753 participants completed the phone interviews. The mean age was 52 (3.5), males (54.1%), and 65.1% were Omanis. Hypertension (39.7%), diabetes (34.1%), and asthma (16.7%) were the commonest comorbidities. AZ and PF were administered to 78% and 22% of the participants. Of them, 49.8% reported at least one adverse effect post-COVID-19 vaccination. The proportion of participants with at least one adverse effect was significantly more in individuals who were younger, females, with more than secondary education, and employed (p value < 0.001, 0.01, <0.001, and <0.001, respectively). There was no severe reaction (anaphylactic shock) to the vaccines, and most adverse effects were mild-moderate. The proportion of individuals who reported adverse effects were higher with AZ vs PF (53% vs 38.6, p = 0.001). The most common reported localized adverse effects were pain and tenderness (28.3% and 12.1%). Fever and body aches were the commonly reported systemic adverse effects (33.5% and 29.2%). The safety of COVID-19 vaccines was well perceived, and most participants were willing to recommend them to others. Conclusions The current study confirms findings from existing literature on the mild to moderate adverse effects of AZ and PF vaccines. Despite the subjective nature of this study, it is reassuring that the studied COVID-19 vaccines can be administered safely. However, more longitudinal studies are needed to test their efficacy in disease prevention.

Study protocol: behaviour change intervention to promote healthy diet and physical activity in overweight/obese adults with diabetes attending health care facilities in Muscat: a cluster rendomised control trial.

BACKGROUND: Healthy behavior is an essential component in type 2 diabetes (T2D) management. Promoting healthy lifestyle is one of the priorities of primary health care in Oman. This study aims to evaluate the effectiveness of a multi-component intervention in promoting physical activity (PA) and healthy diet and its implications on body mass index and glycemic control in adults with diabetes attending primary care. METHODS: A one year 1:1 cluster randomized controlled trial will be utilized to compare the use of phone consultations, a multi component interactive phone application and pedometers with the usual diabetes care on promoting PA and healthy diet. Participants will be screened for inactivity and should be T2D, aged18-65 years, and overweight or obese. Eight primary centers will be randomly selected in each arm (n = 375). The primary outcome is the between arms differences in PA and diet scores, BMI and HbA1c over 12 months from baseline. Additionally, secondary outcomes will include cardiovascular outcomes (BP, and lipids). The trial has received ethical approval from the Omani Research and Ethical Review and Approval Committee. All eligible participants will be invited to their respected health centers to provide informed consent. DISCUSSION: This study will contribute to the integration of healthy lifestyle approach using artificial intelligence to primary diabetes care. Results from this study will be disseminated through workshops, policy briefs, and peer-reviewed publications, local and international conferences. TRIAL REGISTRATION: Trial registration number ISRCTN71889430 . Date applied: 28/11/2020. Date assigned: 01/12/2020.

Prevalence of celiac disease in omani children with type 1 diabetes mellitus: a cross sectional study.

OBJECTIVE: Published studies on the prevalence of celiac disease in type 1 diabetes mellitus from the Arab World are scant. We aim to report the prevalence of celiac disease in Omani children with type 1 diabetes mellitus. METHODS: Children with type 1 diabetes mellitus were prospectively screened for celiac disease, at Sultan Qaboos University Hospital, Muscat, Oman over a period of one year (June 2011 - May 2012). Serum anti tissue transglutaminase IgA, endomysial IgA antibodies and total IgA were measured for screening of celiac disease. Children with positive anti-tissue transglutaminase and/or endomysial IgA antibodies underwent endoscopy. RESULTS: A total of 103 children with type 1 diabetes mellitus were initially included. Ten patients were lost to follow up. Ninety-three patients aged 2-17 years underwent screening for celiac disease. Sixteen patients had positive anti-tissue transglutaminase (17%). Fourteen patients underwent endoscopy with duodenal biopsies, while two were lost to follow-up. Five patients with positive anti-tissue transglutaminase had intestinal biopsy proven celiac disease. The prevalence of celiac disease is 5.5% in our cohort of children and adolescents with type 1 diabetes mellitus. CONCLUSIONS: The prevalence of celiac disease in Omani children and adolescents with type 1 diabetes mellitus is similar to the World's reported prevalence, but is less than that reported for Middle Eastern Arab children. To our knowledge, this is the first reported study on the prevalence of celiac disease in Omani children with type 1 diabetes mellitus.