Modularity of PRC1 composition and chromatin interaction define condensate properties.

Polycomb repressive complexes (PRCs) play a key role in gene repression and are indispensable for proper development. Canonical PRC1 forms condensates in vitro and in cells that are proposed to contribute to the maintenance of repression. However, how chromatin and the various subunits of PRC1 contribute to condensation is largely unexplored. Using a reconstitution approach and single-molecule imaging, we demonstrate that nucleosomal arrays and PRC1 act synergistically, reducing the critical concentration required for condensation by more than 20-fold. We find that the exact combination of PHC and CBX subunits determines condensate initiation, morphology, stability, and dynamics. Particularly, PHC2's polymerization activity influences condensate dynamics by promoting the formation of distinct domains that adhere to each other but do not coalesce. Live-cell imaging confirms CBX's role in condensate initiation and highlights PHC's importance for condensate stability. We propose that PRC1 composition can modulate condensate properties, providing crucial regulatory flexibility across developmental stages.

A Finer Print Than TADs: PRC1-Mediated Domains.

Polycomb proteins are well-known epigenetic repressors with unexplained roles in chromatin folding. In this issue of Molecular Cell, Kundu et al. (2017) investigate the structures of PRC1-mediated domains in stem cells and probe their changes upon differentiation and in PRC knockouts.

Kerala's progress towards universal health coverage: the road travelled and beyond.

BACKGROUND: Kerala has initiated many Universal Health Coverage (UHC) reforms in the last decade. The Aardram Mission launched in 2017 stands out owing to its scope, objectives, and commitments for strengthening Primary Health Care (PHC) in the State. The current study proposes to explore access and financial protection through the lens of equity in Kerala especially in the context of major UHC reforms carried out during the last decade. This paper will also highlight the key lessons from Kerala's approach towards UHC and health systems strengthening through a political economy approach. METHODS: Data from the Kerala state sample of 75th Round (2017-18) National Sample Survey is used for this study. Comparison is also drawn from the 71st Round Sample Survey, 2014, to measure the state's progress in terms of access and financial protection. Logistic regression was used for the calculation. The findings were further explored through a political economy approach. RESULTS: The share of public facilities for outpatient care is 47.5%, which is a significant increase from 34.0% (in 2014) in the state. The share of public sector for out-patient care has increased for the lower socio-economic population in the state. The share of public sector for in-patient care has also increased to 37.3% in 2017-18 from 33.9% in 2014, but not to the extent as the increase shown in outpatient care. The average out-of-pocket-expenditure during hospitalization has increased more in private facilities as compared to public for both outpatient care and hospitalization. CONCLUSIONS: Overall increase in the share of public facilities for both outpatient care and hospitalization is indicative of the enhanced trust among the people at large of the public healthcare delivery system in Kerala, post the launch of UHC reforms in the State. The insurance linked UHC reforms would be insufficient for the State to progress further towards UHC. Kerala with a long and successful history in 'public provisioning' should focus more on strengthening PHC through Aardram Mission in its journey towards pursuit of UHC.

Uneven primary healthcare supply of rural doctors and medical equipment in remote China: community impact and the moderating effect of policy intervention.

BACKGROUND: Unequal access to primary healthcare (PHC) has become a critical issue in global health inequalities, requiring governments to implement policies tailored to communities' needs and abilities. However, the place-based facility dimension of PHCs is oversimplified in current healthcare literature, and formulating the equity-oriented PHC spatial planning remains challenging without understanding the multiple impacts of community socio-spatial dynamics, particularly in remote areas. This study aims to push the boundary of PHC studies one step further by presenting a nuanced and dynamic understanding of the impact of community environments on the uneven primary healthcare supply. METHODS: Focusing on Shuicheng, a remote rural area in southwestern China, multiple data are included in this village-based study, i.e., the facility-level healthcare statistics data (2016-2019), the statistical yearbooks, WorldPop, and Chinese GDP's spatial distribution data. We evaluate villages' PHC service capacity using the number of doctors and essential equipment per capita, which are the major components of China's PHC delivery. The indicators describing community environments are selected based on extant literature and China's planning paradigms, including town- and village-level factors. Gini coefficients and local spatial autocorrelation analysis are used to present the divergences of PHC capacity, and multilevel regression model and (heterogeneous) difference in difference model are used to examine the driving role of community environments and the dynamics under the policy intervention. RESULTS: Despite the general improvement, PHC inequalities remain significant in remote rural areas. The village's location, aging, topography, ethnic autonomy, and economic conditions significantly influence village-level PHC capacity, while demographic characteristics and healthcare delivery at the town level are also important. Although it may improve the hardware setting in village clinics (coef. = 0.350), the recent equity-oriented policy attempts may accelerate the loss of rural doctors (coef. = - 0.517). Notably, the associations between PHC and community environments are affected inconsistently by this round of policy intervention. The town healthcare centers with higher inpatient service capacity (coef. = - 0.514) and more licensed doctors (coef. = - 0.587) and nurses (coef. = - 0.344) may indicate more detrimental policy effects that reduced the number of rural doctors, while the centers with more professional equipment (coef. = 0.504) and nurses (coef. = 0.184) are beneficial for the improvement of hardware setting in clinics. CONCLUSIONS: The findings suggest that the PHC inequalities are increasingly a result of joint social, economic, and institutional forces in recent years, underlining the increased complexity of the PHC resource allocation mechanism. Therefore, we claim the necessity to incorporate a broader understanding of community orientation in PHC delivery, particularly the interdisciplinary knowledge of the spatial lens of community, to support its sustainable development. Our findings also provide timely policy insights for ongoing primary healthcare reform in China.

Implementation research on registering cancer cases in primary health centres of Puducherry through community health workers.

Background & objectives Hospital-based cancer registry does not represent the true burden of cancer in the community. Initiating a Primary Health Centre (PHC)-based cancer registry may better estimate population-level data for cancer cases in an area. This study aimed to set up a system for facilitating a PHC-based cancer registry and to assess the registration status of cancer cases in various PHCs of Puducherry. The facilitating and limiting factors while setting up this registry were also assessed. Methods A quasi-experimental study with an embedded mixed-method design was conducted in 31 PHCs/Community Health Centres (CHCs) from March 2021 to November 2022. The interventions were implemented in all PHCs/CHCs of Puducherry with the involvement of the State Non-Communicable Diseases (NCD) cell. The line list of cancer cases from the Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) Hospital-based cancer registry was shared with all PHCs/CHCs. Sensitization sessions for all Community Health Workers (CHWs) were conducted, and feedback on cancer registration status was given to the State NCD cell. Focus group discussion (FGD)/Key informant interview (KII) was undertaken to understand strengths, challenges, and suggestions. The logic model was used to understand the various indicators while setting up this PHC-based cancer registry. Results Over a one-year intervention period, 1270 cancer cases were registered at Puducherry's PHCs/CHCs, 1203 (88%) from the shared list and 67(5%) from other facilities. However, only 53 per cent of the expected living cases were captured in the various PHCs. Major limitations for registration were the COVID-19 pandemic, stigma, inadequate manpower, infrastructure issues, and privacy concerns during screening. Interpretation & conclusions It was feasible to set up a PHC-based cancer registry in all PHCs of Puducherry. However, registration of cancer cases was suboptimal, as population-based screening of cancer cases, as recommended in the National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) programme, was weak due to the COVID-19 pandemic. Once this is strengthened, the PHC-based cancer registry will better represent the population.

Primary health care in Nigeria: best practices and quality of care in Nigeria.

INTRODUCTION: The significance of Primary Healthcare Centers (PHCCs) in fostering health equity and enhancing health outcomes cannot be overstated, especially in low and middle-income countries. This paper's primary area of interest is to create evidence and innovation for PHCs, with a particular emphasis on underserved groups. Thus, the study aimed to investigate the state of primary health care in Nigeria, with a particular emphasis on best practices, challenges to best practices, and quality of care. METHODOLOGY: A cross-sectional quantitative study was conducted to collect secondary data from 29 primary healthcare facilities. The data was collected using staff and facility activity indicators over a year (2022). Descriptive statistics and chi-square tests were used to analyze the collected data. RESULT: Our study data showed that all of the PHCCs have service rosters that can be utilized for follow-up with patients. About 85 (84.1%) respondents have reported that deliveries were taken by the reporting midwife, and 55 (54.5%) respondents indicated that their facilities provided on-the-job training to their staff. This is considered as the best practice in the facility. However, the majority of the PHCCs (71.3%) lacked assessment teams, which was found to have a negative impact on the quality of healthcare provided at these facilities (p < 0.05). CONCLUSION: Our study underscores the pressing need for primary healthcare services in Nigeria. Government authorities and healthcare providers must take action to overcome the challenges of limited capacity, service delivery, and quality of care. By adopting effective strategies and ensuring access to primary healthcare, citizens' health outcomes can be greatly enhanced. Thus, it is essential to revamp and optimize healthcare facilities to establish an efficient healthcare system that caters to the needs of all citizens.

Knowledge, attitudes, and barriers: Palliative Care services for women with HIV in resource-limited settings.

BACKGROUND: Women living with HIV (WLWH) in low- middle-income countries (LMICs) face increased mortality risks from comorbidities despite progress in antiretroviral therapy. Palliative care (PC) is vital for these patients, yet its integration in LMICs, such as Nigeria, is suboptimal due to unique challenges. OBJECTIVE: This study investigated the knowledge, perceived barriers, and facilitators influencing PC integration into routine HIV care within healthcare (HC) settings. METHODOLOGY: A cross-sectional survey was conducted among WLWH in twelve HC facilities throughout Nigeria. Data collection involved surveys focused on PC knowledge, attitudes, facilitators, and barriers. Logistic regression analyses were employed to examine the data. RESULTS: This study revealed significant gaps in knowledge and attitudes towards PC among HIV + women at NISA-MIRCs. Over 90% were unaware of PC services, but many saw its potential to offer hope (55%) and improve quality of life (56.5%). The key predictors of PC knowledge included education, occupation, religion, having fewer children, urban residence, type of residence, and having a high income (p < .05). Despite the willingness to access PC, barriers such as negative HC worker attitudes, perceived high cost, and limited decision autonomy could hinder integration. Facilitators included low-cost services, positive HCW attitudes, physician recommendations, and perceived necessity for personal well-being. CONCLUSION: Knowledge gaps, diverse attitudes, and significant barriers highlight the need for targeted PC interventions for WLWH. Tailoring educational programs, addressing cost barriers, and improving healthcare infrastructure are crucial to enhancing PC accessibility and quality. These findings can guide policymakers and HC practitioners toward more effective and inclusive care strategies.

Enhancing Primary Health Care through Interprofessional education: Insights from a Training Workshop.

Introduction: Strengthening primary care services with a focus on comprehensive Primary Health Care principles necessitates collaborative work practices within interprofessional teams. In Italy, the Local Health District of Florence embodies a comprehensive Primary Health Care -inspired model of primary care, prominently featuring the House of Community concept. This work presents findings and insights from a multidisciplinary, interprofessional education activity tailored for healthcare professionals, researchers, and students actively participating in the primary care reorganization. Methods: The activity was structured using a four-phase learning model (imaginative, analytical, common sense, and dynamic), aligning with four distinct activities (brainstorming, lecture, case study, and group project). Results: Key themes that emerged encompassed the significance of nurturing relationships among team members, the aspiration for an inclusive work environment, the vital role of community engagement and collaboration across various services, disciplines, and sectors beyond healthcare. Discussion: These themes highlight the essential attributes of successful primary care practices built on the principles of comprehensive comprehensive Primary Health Care. Throughout the innovation process of primary care services, interprofessional education training events emerged as indispensable components for bolstering implementation and ensuring sustainability. This study underscores the crucial role of interprofessional education in bridging the gap between theoretical constructs and practical application, emphasizing that comprehensive Primary Healthcare principles find tangible manifestation in real-world scenarios.

Clinical Efficacy and Safety of transarterial chemoembolization Combined with Targeted Therapy for primary hepatocellular carcinoma.

Objective: To explore the clinical efficacy and safety of transarterial chemoembolization (TACE) combined with targeted therapy for primary hepatocellular carcinoma (PHC). Methods: This was a retrospective study. Retrospective selection of 150 PHC patients admitted to the Renmin Hospital, Hubei University of Medicine January 2019 and June 2021 were included. The patients were divided into the control group and the experimental group according to their treatment regimens. The control group received TACE treatment, while the experimental group received TACE combined with targeted therapy. We analyze the relevant data of two groups of patients and evaluate the clinical efficacy and safety of TACE combined with targeted therapy. Results: The tumor remission rate and control rate in the control group were 41.89% and 75.68%, respectively, while those in the experimental group were 77.63% and 90.79%, with statistically significant differences (p<0.05). The 1-year and 3-year recurrence rates in the control group were 52.71% and 98.65%, respectively, while those in the experimental group were 39.47% and 61.84%, with statistically significant differences (p<0.05). After treatment, the AFP, VEGF, ALT, and AST in the experimental group were significantly reduced compared to the control group (p<0.05). During the treatment period, the incidence and severity of nausea, vomiting, and fever in the experimental group were significantly lower than those in the control group (p<0.05). Conclusion: The clinical efficacy of TACE combined with targeted therapy for PHC is superior to that of TACE alone, with improved disease control rate, improved long-term survival rate, and good safety.

Implementation considerations for non-communicable disease-related integration in primary health care: a rapid review of qualitative evidence.

BACKGROUND: Integrated delivery of primary health care (PHC) services is a health reform recommended for achieving ambitious targets of the Sustainable Development Goals and Universal Health Coverage, responding to growing challenges of managing non-communicable and multimorbidity. However, more evidence is needed on effective implementation of PHC integration in different country settings. OBJECTIVE: This rapid review synthesized qualitative evidence on implementation factors affecting integration of non-communicable disease (NCD) into PHC, from the perspective of implementers. The review contributes evidence to inform the World Health Organizations' guidance on integration of NCD control and prevention to strengthen health systems. METHOD: The review was guided by standard methods for conducting rapid systematic reviews. Data analysis was guided by the SURE and WHO health system building blocks frameworks. We used Confidence in the Evidence of Reviews of Qualitative Research (GRADE-CERQual) to assess the confidence of the main findings. RESULTS: The review identified 81 records eligible for inclusion, from 595 records screened. We sampled 20 studies for analysis (including 3 from expert recommendations). Studies covered a wide range of countries (27 countries from 6 continents), the majority from low-and middle-income countries (LMICs), with a diverse set of NCD-related PHC integration combinations and implementation strategies. The main findings were categorised into three overarching themes and several sub-themes. These are, A: Policy alignment and governance, B: Health systems readiness, intervention compatibility and leadership, and C: Human resource management, development, and support. The three overarching findings were assessed as each having a moderate level of confidence. CONCLUSION: The review findings present insights on how health workers responses may be shaped by the complex interaction of individual, social, and organizational factors that may be specific to the context of the intervention, the importance of cross-cutting influences such as policy alignment, supportive leadership and health systems constraints, knowledge that can inform the development of future implementation strategies and implementation research.

The effect of transformation policies on healthcare providers' satisfaction in primary healthcare centers: the case of Eastern Saudi Arabia.

BACKGROUND: The Saudi Arabian Vision 2030 encompasses the Health Sector Transformation Program (HSTP), an initiative aimed at enhancing the accessibility, affordability, and quality of healthcare, with a strong emphasis on patient-centered care. To achieve this vision, the government has been providing training to Primary Healthcare (PHC) centers on patient-centered care, recognizing that spending quality time with patients is crucial for making informed clinical decisions. Therefore, it is essential to evaluate provider satisfaction with the quality of services they provide and assess the impact of organizational factors on care quality. This study represents the first comprehensive assessment of job satisfaction among PHC providers in the Eastern region of Saudi Arabia. It seeks to gauge job satisfaction among PHC providers and explore its associated impact on the quality of care they deliver. METHODS: This study employed a quantitative cross-sectional design. Data were collected using a modified version of the Job Satisfaction Survey (JSS), supplemented by three newly added dimensions. Additionally, questions addressing general characteristics were incorporated into the survey instrument. Data analysis involved calculating frequencies and percentages for univariate analysis, employing t-tests for comparisons between two groups, and utilizing ANOVA for comparisons among multiple groups (bivariate analysis). RESULTS: A total of 143 PHC providers took part in this study. Of these, 48% reported high satisfaction, while the rest were either dissatisfied or neutral. PHC providers were highly satisfied with supervision (17%, N=94). On the other hand, they were dissatisfied with contingent rewards (3%, N=15). There was a significant difference found between the intention to leave the job (yes, no) and job satisfaction scores (mean (SD)= 83.58 (16.174) vs. mean (SD)=101.64 (16.209), p-value < 0.001). There were also significant relationships between general characteristics and the dimensions such as co-workers, promotion, responsibility, nature of work, operating procedure, and communication (p-value< 0.05). CONCLUSION: The main findings of this study suggest that PHC providers working in PHC centers in the Eastern region were satisfied with their work, especially with supervision and patient care. However, the findings also revealed that there are many areas of the job of PHC providers that require planned reform, such as contingent reward and communication. Furthermore, intention to leave the job was significantly related to job satisfaction score and all the dimensions. The study findings will help policymakers and the Ministry of Health to develop an employee engagement and satisfaction program to track the PHC providers' levels of satisfaction.

Strengths, Weaknesses, Opportunities, and Threats Analysis of the Use of Digital Health Technologies in Primary Health Care in the Sub-Saharan African Region: Qualitative Study.

BACKGROUND: Digital health technologies (DHTs) have become increasingly commonplace as a means of delivering primary care. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how the implementation of DHTs has been realized in the sub-Saharan Africa (SSA) health care environment remains inadequately explored. OBJECTIVE: This study aims to capture the multidisciplinary experiences of primary care professionals using DHTs to explore the strengths and weaknesses, as well as opportunities and threats, regarding the implementation and use of DHTs in SSA primary care settings. METHODS: A combination of qualitative approaches was adopted (ie, focus groups and semistructured interviews). Participants were recruited through the African Forum for Primary Care and researchers' contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework. Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. RESULTS: A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and hastening progress toward universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline expenditure, and provide a means to learn international best practices. Threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and data protection. CONCLUSIONS: The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and health care equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle.

Determining the top research priorities in UK prehospital critical care: a modified Delphi study.

BACKGROUND: Prehospital critical care is a rapidly evolving field. There is a paucity of evidence relating to its practice, with limited progress in answering those research questions identified over a decade ago. It is vital that evidence gaps are identified and addressed. This study aimed to define the current research priorities in UK prehospital critical care. METHODS: This modified national Delphi study was coordinated by the Pre-HOspital Trainee Operated research Network and conducted in four rounds between October 2021 and April 2022. Rounds 1 and 2 were conducted online with clinicians involved in prehospital critical care delivery and non-clinical prehospital researchers. Rounds 3 and 4 were completed online by a subject matter expert (SME) panel. RESULTS: In round 1, 78 participants submitted 394 research questions relating to prehospital critical care delivery in the UK. These were refined and categorised into 192 questions, which were scored for importance in round 2. Fifty questions were discussed and scored by the SME panel in round 3. Round 4 created a ranked top 20 list. The top research priority was 'Which cardiac arrest patients should critical care teams be dispatched to; how do we identify these patients during the emergency call?'. Other priorities included dispatch optimisation, out-of-hospital medical cardiac arrest management, optimising resuscitation in haemorrhagic shock, improving traumatic brain injury outcomes and optimising management of traumatic cardiac arrest. CONCLUSIONS: This modified Delphi study identified 20 research priorities where efforts should be concentrated to develop collaborative prehospital critical care research within the UK over the next 5 years.

Hospital-administered ECPR for out-of-hospital cardiac arrest: an observational cohort study.

BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment method for refractory out-of-hospital cardiac arrest (OHCA) requiring a complex chain of care. METHODS: All cases of OHCA between 1 January 2016 and 31 December 2021 in the Helsinki University Hospital catchment area in which the ECPR protocol was activated were included in the study. The protocol involved patient transport from the emergency site with ongoing mechanical cardiopulmonary resuscitation (CPR) directly to the cardiac catheterisation laboratory where the implementation of extracorporeal membrane oxygenation (ECMO) was considered. Cases of hypothermic cardiac arrest were excluded. The main outcomes were the number of ECPR protocol activations, duration of prehospital and in-hospital time intervals, and whether the ECPR candidates were treated using ECMO or not. RESULTS: The prehospital ECPR protocol was activated in 73 cases of normothermic OHCA. The mean patient age (SD) was 54 (±11) years and 67 (91.8%) of them were male. The arrest was witnessed in 67 (91.8%) and initial rhythm was shockable in 61 (83.6%) cases. The median ambulance response time (IQR) was 9 (7-11) min. All patients received mechanical CPR, epinephrine and/or amiodarone. Seventy (95.9%) patients were endotracheally intubated. The median (IQR) highest prehospital end-tidal CO2 was 5.5 (4.0-6.9) kPa.A total of 37 (50.7%) patients were treated with venoarterial ECMO within a median (IQR) of 84 (71-105) min after the arrest. Thirteen (35.1%) of them survived to discharge and 11 (29.7%) with a cerebral performance category (CPC) 1-2. In those ECPR candidates who did not receive ECMO, 8 (22.2%) received permanent return of spontaneuous circulation during transport or immediately after hospital arrival and 6 (16.7%) survived to discharge with a CPC 1-2. CONCLUSIONS: Half of the ECPR protocol activations did not lead to ECMO treatment. However, every fourth ECPR candidate and every third patient who received ECMO-facilitated resuscitation at the hospital survived with a good neurological outcome.

Integrating physiotherapy into primary health care in Nigeria: Perceptions of primary health care practitioners.

The perception of Primary Health Care (PHC) practitioners about integrating physiotherapy into PHC in Nigeria is still unknown. The aim of this study was to examine the knowledge and attitude of PHC practitioners in Nigeria regarding the integration of physiotherapy into PHC. The participants in this cross-sectional study were 183 PHC practitioners (physicians, nurses, and community health workers). A content-validated, semi-structured questionnaire was used to obtain information about history of exposure to physiotherapy, knowledge, and attitudes toward integrating physiotherapy into PHC. Data was analyzed using Pearson's product moment correlation and Analysis of Variance at α = 0.05. Participants were mostly females (n = 154; 84.2%) and aged 39.97 ± 9.38 years. The mean years of work experience was 14.41 ± 8.68 years. Participants had limited knowledge about the role and scope of physiotherapy but were willing to learn more about physiotherapy. Less than half of the participants however, had favorable attitude toward integrating physiotherapy into PHC. Knowledge differed significantly across healthcare professions (p < .05) and was significantly correlated with attitude (p < .01). Our findings underscore the importance of interprofessional education and teamwork among healthcare providers. This might enhance understanding, modify attitudes and facilitate the inclusion of physiotherapy into PHC in Nigeria. Additionally, this could improve access to physiotherapy services for Nigerians.

Case study of a model primary health care program in Nigeria: History, evolution, challenges, and future perspectives.

This short report describes the historical evolution of a pioneer Model PHC programme located in Ogun State, southwest Nigeria, as a direct result of the vision and effort of Professor Olikoye Ransome-Kuti, and his drive to entrench the delivery of primary health care (PHC) in Nigeria. It describes some of the programmes inspired by the PHC philosophy at the Model PHC Centre, some of the challenges faced over the years, and the need to reposition the programme. It exemplifies key principles in PHC and its philosophy that are instructive for health practitioners, policymakers and development practitioners, especially those with interest in resource-poor countries.

KNOWLEDGE OF MPOX AMONG PRIMARY HEALTH CARE (PHC) WORKERS IN JOS NORTH LOCAL GOVERNMENT AREA, PLATEAU STATE. NIGERIA.

Introduction: Mpox (MPX) is a viral zoonotic (a virus transmitted to humans from animals) disease caused by Mpox virus currently spreading across the world. Primary healthcare workers are fundamental in the provision of healthcare at the grassroots level. They are the front-line health managers who are expected to meet the needs of their community and prevent the spread of Mpox in Nigeria. This study aims to assess the knowledge of Mpox among Primary Health Care (PHC) Workers in Jos North Local Government Area, Plateau State. Methodology: The study is a descriptive cross-sectional study to assess the knowledge, attitude, and perception of Mpox among 152 Primary Health Care (PHC) workers in Jos North, LGA. A multistage sampling technique and a structured interviewer-administered questionnaire were used to collect data. Results: Majority of the participants, 118 (77.6%) were females, while 34 (22.4%) of the participants were males. Most of the participants 46 (30.3%) were within the age group of 31 to 40 years, Most Respondents had poor knowledge on Mpox in general 70 (46.1%), 19 (12.5%) demonstrated a good knowledge of Mpox; 63 (41.4%) had moderate knowledge in terms of clinical presentations, prevalence, and vaccine availability. Most respondents were knowledgeable with regards to Mpox being preventable (89.5%) and the knowledge of some preventive measures. Conclusion: Government and Primary Healthcare Development Agency (PHCDA) should intensify efforts to sensitize the PHC workers on Mpox infection through seminars and workshops, as well as on preventive measures already in place. The PHC workers should make a personal effort to learn more about Mpox infection, its prevention, and control.

Knowledge and Compliance with Malaria National Treatment Guidelines among Primary Health Care Workers in a Rural Area in Northern Nigeria.

BACKGROUND: Knowledge and compliance with malaria treatment guidelines are among the major issues affecting treatment outcome for malaria in Nigeria. Primary health care (PHC) facilities are the first point of contact with the national health system for patients with malaria and other diseases. OBJECTIVE: This study assessed the knowledge and compliance with malaria National Treatment Guidelines (NTG) among PHC workers in Lere local government area of Kaduna State, North western Nigeria. METHODS: This was a descriptive cross-sectional study conducted among 42 community health workers. The total population of all eligible participants was used for subject selection. Data were analysed with SPSS IBM version 25.0 and STATA/SE 12. The level of statistical significance p-value was set at p<0.05. RESULTS: The mean age of the respondents was 38.02±9.23 years. Majority of the respondents were males (25; 59.5%) and community health extension workers (CHEWs) (24; 57.1%). Almost one-third (28.6%) of the PHC workers had poor knowledge of the recommendations of the NTG for malaria, while 14.3% had poor compliance with the NTG. Bivariate analysis showed a significant relationship between older age and good knowledge of the NTG ( χ2 =0.03, p=0.04). Multivariate analysis further revealed that the odds for poor knowledge of NTG was 40% higher among CHEWs compared to other health workers (AOR=1.40, 95% CI=0.25-7.93). The odds for good knowledge was lower by 55% among those who had practiced for <10 years compared to >10 years (OR=0.45, 95% CI=0.06-3.32). CONCLUSION: Poor knowledge and compliance to malaria NTG were commoner among lower cadre (CHEWs) staff with relatively fewer years in PHC practice. There is a need for training, retraining and equitable distribution of the NTG to ensure access and also improve knowledge and utilisation of the NTG for malaria by rural PHC workers.

CONTEXTE: La connaissance et le respect des directives de traitement du paludisme sont parmi les principaux problèmes qui affectent les résultats du traitement du paludisme au Nigéria. Les établissements de soins de santé primaires (SSP) sont le premier point de contact avec le système national de santé pour les patients atteints de paludisme et d'autres maladies. OBJECTIF DE L'ÉTUDE: Cette étude a évalué les connaissances et le respect des directives nationales de traitement du paludisme (NTG) parmi les travailleurs des SSP dans la zone de gouvernement local de Lere de l'État de Kaduna, dans le nord-ouest du Nigeria. MÉTHODES: Il s'agit d'une étude descriptive transversale menée auprès de 42 agents de santé communautaires. La population totale de tous les participants éligibles a été utilisée pour la sélection des sujets. Les données ont été analysées avec SPSS IBM version 25.0 et STATA/SE 12. Le niveau de signification statistique a été fixé à p<0,05. RÉSULTATS: L'âge moyen des personnes interrogées était de 38,02±9,23 ans. La majorité des personnes interrogées étaient des hommes (25 ; 59,5%) et des agents de vulgarisation en santé communautaire (24 ; 57,1%). Près d'un tiers (28,6 %) des agents de santé publique connaissaient mal les recommandations de la NTG pour le paludisme, tandis que 14,3 % ne respectaient pas la NTG. L'analyse bivariée a montré une relation significative entre l'âge avancé et la bonne connaissance du NTG ( χ2=0,03, p=0,04). L'analyse multivariée a également révélé que la probabilité d'une mauvaise connaissance de la NTG était 40% plus élevée chez les CHEW que chez les autres agents de santé (AOR=1,40, 95% CI=0,25-7,93). La probabilité d'une bonne connaissance était inférieure de 55% chez ceux qui avaient pratiqué pendant <10 ans par rapport à >10 ans (OR=0,45, 95% CI=0,06-3,32). CONCLUSION: Le manque de connaissances et d'observance des NTG sur le paludisme était plus fréquent parmi le personnel des cadres inférieurs (CHEWs) ayant relativement moins d'années de pratique dans les soins de santé primaires. Il est nécessaire de former, de recycler et de distribuer équitablement les NTG pour garantir l'accès et améliorer la connaissance et l'utilisation des NTG pour le paludisme par les travailleurs des SSP en milieu rural. Mots clés: Connaissance, Observance, Personnel de soins de santé primaires, Directives, Paludisme.

Contribution of portable obstetric ultrasound service innovation in averting maternal and neonatal morbidities and mortalities at semi-urban health centers of Ethiopia: a retrospective facility-based study.

BACKGROUND: The maternal and neonatal mortalities in Ethiopia are high. To achieve the Sustainable Development Goals, innovations in ultrasound scanning and surveillance activities have been implemented at health centers for over 2 years. This study aims to estimate the contribution of obstetric ultrasound services on averted maternal and neonatal morbidities and mortalities in Ethiopia. METHODS: A retrospective facility-based cross-sectional study design was conducted in 25 selected health centers. Data were extracted from prenatal ultrasound registers. SPSS version 25 was used for analysis. To claim statistically significant relationship among sartorial variables, a chi-square test was analyzed and P < 0.05 was the cut-off point. RESULTS: Over the 2 years, 12,975 pregnant women were scanned and 52.8% of them were residing in rural areas. Abnormal ultrasound was reported in 12.7% and 98.4% of them were referred for confirmation of diagnosis and treatment. The ultrasound service has contributed to the prevention of 1,970 maternal and 19.05 neonatal morbidities and mortalities per 100,000 and 1,000 live births respectively. The averted morbidities and mortalities showed a statistically significant difference among women residing in rural and semi-urban areas, X,2 df (10) = 24.07, P = 0. 007 and X,2 df (5) = 20.87. P = 0.00, 1 respectively. CONCLUSION: After availing the appropriate ultrasound machines with essential supplies and capacitating mid-level providers, significant number of high-risk pregnant women were identified on time and managed or referred to health facilities with safe delivery services. Therefore, scaling-up limited obstetric ultrasound services in similar setups will contribute to achieving the Sustainable Development Goals by 2030. It is recommended to enhance community awareness for improved utilization of ultrasound services by pregnant women before the 24th week of gestational age.

Current status of prevention and treatment of respiratory diseases in primary care in China: a cross-sectional study.

BACKGROUND: China launched its new round of health care reform to develop primary care in 2009, establishing 954,390 primary care institutions that employed over 10 million staff by 2019. However, some studies have shown that the prevention and management of respiratory diseases is inadequate in these institutions. METHODS: We conducted a cross-sectional survey of grassroots institutions throughout China between September and December 2020 based on the standardized Prevention and Treatment System and Capacity Building Project of Respiratory Diseases in primary care settings. The operation of the respiratory department in primary health care institutions was evaluated in terms of facilities, drugs, personnel and management of chronic diseases by means of questionnaires. Descriptive analyses were performed to calculate percentages and frequencies of key parameters. RESULTS: A total of 144 primary health care institutions were surveyed, including 51 in the east, 82 in the west, 9 in the central and 2 in the northeast. Approximately 60% of institutions had spirometers and pulse oximeters. The majority had short-acting bronchodilators, theophylline, systemic corticosteroids, antibiotics, and traditional Chinese medicine. More than half had at least one respiratory physician and operator for spirometry. Half of the institutions carried out screening of chronic obstructive pulmonary disease within the jurisdiction. The institutions in the east were superior to those in the west regarding the equipment, common drugs, medical staff, and management of respiratory diseases. CONCLUSIONS: The study reveals that the overall operation of the respiratory department in primary care settings needs to be further strengthened. It is crucial to provide adequate essential equipment, medical professionals, and medicines for proper diagnosis and treatment of chronic respiratory diseases, as well as improving the management of diseases.