Prevalence and factors associated with burnout among primary health-care workers in China during COVID-19: a national survey.

BACKGROUND: Primary health-care workers (PHWs) managed increased workloads and pressure during the COVID-19 pandemic. This study conducted a national survey examining burnout among PHWs at the end of the COVID-19 pandemic, and identifies related factors. By doing so, it addresses the gap in understanding the burnout situation among PHWs at a national level, taking into account urban-rural disparities. METHODS: We conducted a nationwide cross-sectional survey of PHWs in China from May to October 2022, covering 31 provinces. The MBI-HSS was used to measure overall burnout and emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). We used multivariable logistic regression to identify risk factors, and subgroup analyses to identify differences between rural and urban areas. RESULTS: 3769 PHWs from 44 primary health-care institutions completed the survey. Overall, 16.6% reported overall burnout, and the prevalence of EE, DP, and reduced PA was 29.7%, 28.0%, and 62.9%, respectively. The prevalence of overall burnout (17.6% vs. 13.7%, P = 0.004) and EE (31.5% vs. 24.8%, P < 0.001) was higher in urban than rural areas (AOR = 1.285; 95%CI, 1.021-1.617). Job satisfaction was a protective factor against burnout in both settings. The protective factors of overall burnout, EE and DP vary between urban and rural areas. CONCLUSIONS: The Mental Health Status Questionnaire-Short Form (MSQ-SF) score functioned as a protective factor against burnout across both rural and urban locales, highlighting the intrinsic link between job satisfaction and burnout. Other influencing factors differed between urban and rural areas, so interventions should be tailored to local conditions. Rural married PHWs experienced the lower prevalence of burnout indicates the support structure may play a significant role. In urban settings, it is recommended to strategically pre-emptively stock essential supplies like PPE.

Differences in Vaccination Consultation Preferred by Primary Health Care Workers and Residents in Community Settings.

OBJECTIVE: To evaluate the preference of primary HCWs and residents on vaccination consultation in community health services to provide evidence for vaccine hesitancy intervention strategies. METHODS: A discrete choice model (DCM) was constructed to evaluate the preference difference between primary HCWs and residents on vaccination consultation in community health services in China during May-July 2022. RESULTS: A total of 282 residents and 204 HCWs were enrolled in this study. The residents preferred consulting with an HCW-led approach (ß = 2.168), with specialized content (ß = 0.954), and accompanied by telephone follow-up (ß = 1.552). In contrast, the HCWs preferred face-to-face consultation (ß = 0.540) with an HCW-led approach (ß = 0.458) and specialized content (ß = 0.409), accompanied by telephone follow-up (ß = 0.831). College residents and residents with underlying self-reported disease may be near-critically inclined to choose traditional consultation (an offline, face-to-face consultation with standardized content and more prolonged duration) rather than a new-media consulting group (an online consultation with specialized content within 5 min). Urban HCWs preferred long-term consultation groups (the resident-led offline consultation with follow-up lasting more than 5 min). In contrast, rural HCWs preferred efficient consultation (the HCW-led, short-duration, standardized offline consultation mode). CONCLUSION: The selection preference for vaccine consultation reveals a gap between providers and demanders, with different groups exhibiting distinct preferences. Identifying these targeted gaps can help design more acceptable and efficient interventions, increasing their likelihood of success and leading to better resource allocation for policymakers to develop targeted vaccination policies.

Primary health care providers' views on managing substance use among people living with HIV.

BACKGROUND: The growing culture of substance use among people living with human immunodeficiency virus (PLWH) is a serious threat to the human immunodeficiency virus (HIV) pandemic. As the gatekeepers of comprehensive care, primary care providers are responsible for screening, assessing, and managing individuals who use substances. AIM: This study aimed to evaluate primary care providers' views and approaches to substance use management among PLWH who attend primary care services in Mthatha. SETTING: This study was conducted at Ngangelizwe and Mbekweni Community Health Centres (CHCs) in the Eastern Cape province's King Sabata Dalindyebo (KSD) sub-district municipality. METHODS: This qualitative phenomenological study involved the views of primary care providers. This study included 32 primary health care (PHC) providers. All participants were female except one male with a mean age of 48.6 years (range 27-64 years). Semi-structured interviews were conducted until saturation of the theme was reached. Then, the data from the transcribed interview were analysed with a thematic framework. RESULTS: Substance use among PLWH was reported to be associated with poor clinical outcomes and disruption of antiretroviral therapy (ART) adherence. The significant barriers reported for substance use management in PHC settings were a lack of resources, skilled providers and poor community participation. CONCLUSION: Substance use management programmes are not commonly offered in PHC because of the lack of human and infrastructural resources, the lack of skilled providers and poor community engagement.Contribution: This study provides a context-specific PHC providers' approach to substance use management.

The mediating role of job satisfaction and presenteeism on the relationship between job stress and turnover intention among primary health care workers.

BACKGROUND: Turnover problems among primary health care workers are a significant contributor to the shortage of health human resources. This study aims to determine the relationship between job stress and turnover intention among primary health care workers, as well as to examine the mediating effects of job satisfaction and presenteeism on this relationship. METHODS: Stratified random sampling and quota sampling were used to select 703 primary health care workers in Jilin Province, China in January 2020. Validated scales were used to measure turnover intention, job stress, job satisfaction, and presenteeism among primary health care workers. The study utilized a partial least squares structural equation modeling (PLS-SEM) approach to test the research hypotheses. RESULTS: The turnover intention score of primary health care workers in Jilin Province was 2.15 ± 1.03, and 19.5% of respondents reported a higher turnover intention. Significant sex and occupation differences were found, with a higher rate of turnover intention for male and doctor groups among primary health care workers. This study also revealed a positive correlation between job stress and turnover intention (ß = 0.235, P < 0.001), a significant negative correlation between job satisfaction and turnover intention (ß= -0.347, P < 0.001), and a significant positive correlation between presenteeism and turnover intention (ß = 0.153, P < 0.001). Moreover, the study revealed a significant indirect effect of job stress on turnover intention which was mediated by job satisfaction (ß = 0.183, P < 0.001) and presenteeism (ß = 0.078, P < 0.001). CONCLUSION: We confirmed the positive association between job stress and presenteeism with turnover intention, as well as the negative association between job satisfaction and turnover intention. Moreover, our study confirmed the mediating role of job satisfaction and presenteeism in the relationship between job stress and turnover intention. This study provides scientific evidence to address the turnover problem among primary health care workers.

Assessing the staffing needs for primary health care centers in Cross River State, Nigeria: a workload indicators of staffing needs study.

BACKGROUND: A major human resources for health challenge for Nigeria is ensuring the availability and retention of adequate competent health workers in the right mix to provide health care particularly at primary health care facilities in remote and rural communities. This study applied the Workload Indicators of Staffing Need (WISN) method to determine the numbers of nurses, midwives, community health officers (CHOs), community health extension workers (CHEWs), and junior community health extension workers (JCHEWs) required to cope with health care service delivery at primary health care facilities in Cross River State; compare workloads of different cadres at selected health facilities, and identify facilities with highest workload pressure. METHODS: Cross River State in Nigeria has 18 local governments, 196 wards, and an estimated population of over three million people. We used the WISN method to estimate the numbers of nurses/midwives, CHOs/CHEWs, and JCHEWs required to cope with the workload in the 196 ward-level primary health care facilities. FINDINGS: Basic services provided by nurses/midwives, and CHOs/CHEWs were typical of the primary health care level. They are antenatal care, routine immunization, child welfare clinic, family planning, treatment of minor ailments, assisted and normal deliveries, postnatal care, emergencies, care of tuberculosis patients, and referrals. Findings show that available nurses/midwives for the 196 PHC facilities were 79, and the calculated requirement was 209, WISN ratio of 0.4 and difference of - 130; the existing number of CHOs/CHEWs was 808, the calculated requirement was 1,258, WISN ratio of 0.6, with a difference of - 450; and the number of existing JCHEWs was 258, the calculated requirement was 203, WISN ratio of 1.3 with a difference of 55. Cross River State had only 40% of required nurses and midwives; and 60% of CHOs/ CHEWs needed to provide health services in the ward-level PHC facilities. CONCLUSION: The findings from this study indicated marked shortages of needed health workforce particularly nurses and midwives at the primary level of care; and overlap in some of the tasks performed by nurses/midwives, CHO/CHEWs, and JCHEWs.

Primary health care workers perspective towards cancer in Fiji: a qualitative study.

BACKGROUND: By 2040, the predicted global cancer burden is expected to be more than 27 million new cancer cases per year. Understanding primary health care workers' (HCWs) perception on cancer can highlight new ways in which cancer advocacy can be increased. This study aimed to explore the perceptions of primary HCWs in Lautoka, Fiji, towards common cancers with focus on knowledge, risk perceptions, barriers and preventive approaches. METHODS: The study used a qualitative method approach. The study was conducted among primary HCWs at four purposively selected health centres in Lautoka Subdivision, Fiji, from 1 March 2021 to 1 April 2021. Focus group discussions (FGDs) were conducted with primary HCWs. A semi-structured open-ended questionnaire was used to collect data, and the FGDs were audio-recorded. These audio recordings were transcribed and analysed using thematic analysis. RESULTS: The responses from the four FGDs with six primary HCWs in each group emerged four major themes. These themes were cancer knowledge, health professional training, barriers and challenges and awareness strategies. Primary HCWs were not fully aware about common cancers and were not confident to discuss about cancer with their patients which is an important role of primary HCWs in cancer management. This lack of knowledge was attributed to less training received in primary care setting. Barriers to accessing cancer screening included misconceptions about cancer, negative attitudes from patients, stigmatization, lack of resources at health facility and less informed health staff. Community outreach programmes, opportunistic screening, community HCWs and the concept of a cancer hub centre were awareness strategies highlighted by primary HCWs. CONCLUSIONS: Lack of knowledge about common cancers among primary HCWs is a concern that is depicted well in this study. This low knowledge was attributed to lack of training on cancers received by primary HCWs. Guidelines on cancer screening and diagnosis can be developed by the health ministry to assist primary HCWs in detecting patients at pre-cancerous stage.

Awareness about role of health literacy and self efficacy in tobacco cessation among primary health care workers: A quantitative questionnaire study.

Background: The purpose of this study was to measure primary health care providers' understanding of the significance of health literacy and self-efficacy in cigarette quitting. Material and Methods: The current study used a quantitative descriptive questionnaire to collect data. The research was carried out among primary health care providers in a rural location near the Azamgarh Dental College in Uttar Pradesh. Medical officials, nursing personnel, and dental practitioners, if existent, are examples of primary health professionals. Azamgarh district is divided into 22 blocks. 22 primary health facilities were selected from these 22 blocks. 54 medical officers and 98 other primary health workers (ANMs, GNMs, and Asha workers) were questioned at these primary health facilities. Results: The majority of study participants {132 (86.84%)} were aware of the bad effects of tobacco consumption. Most of the study participants don't know about health literacy {115 (75.65%)} and self-efficacy {78 (51.32%)}. The majority of them did not know the questionnaire to test health literacy {114 (75.02%)} and self-efficacy {150 (98.68%)}. poor mean awareness score (20.77 ± 3.33) was significant (p = 0.001) in the age group 25-35 years. Anganwadi workers were having significantly (p = 0.002) highest poor awareness score (22.67 ± 2.34). Conclusion: From the above results, it was concluded that awareness of the role of health literacy and self-efficacy in tobacco cessation among primary health workers was poor. Almost all study participants had not attended any training programs on tobacco cessation.

Improving symptom assessment and management in the community through capacity building of primary palliative care: A study protocol of exploratory research.

Aim: To determine the effectiveness of capacity building program on palliative care (PC) in enhancing the capacity of the primary health care workers in need assessment and symptom management of cancer patients. Background: In India, less than one percent of people living with cancer have access to palliative care since most are from low- and middle-income groups. Accredited social health activist (ASHA) and primary health care workers are grassroots workers who are the first contact with family members and are seldom aware of PC in India. It is essential to train them to give practical and efficient care to needy people. Design: A quasi-experimental design with follow-up will be conducted using an evaluative approach. Methods: The study population consists of 1440 Primary Health Care Workers (staff nurses, ANMs, and ASHA workers) of three taluks of Udupi District, Karnataka State, India. Training on PC will be provided for ASHA workers for one day and ANM/Staff nurses for three days. After their training, they are expected to demonstrate the gain in knowledge & skill in providing PC for cancer patients by identifying and implementing PC services using a mobile app at the primary healthcare level. Discussion: Palliative home care can give comfort and reduce patients' financial burden, and this training may help to improve the quality of life of needy patients. Impact: If this palliative care training program succeeds, it can be integrated into the healthcare continuum, making it an essential component of primary healthcare delivery to achieve universal health coverage. Moreover, home-based PC supports patients who want to die at home even though it reduces hospital stay costs. Trial registration: CTRI/2020/04/024792.

The effect of training and supervision on primary health care workers' competence to deliver maternal depression inclusive health education in Ibadan, Nigeria: a quasi-experimental study.

BACKGROUND: Health workers lack the competence to address maternal depression in the routine health education in Nigeria. Hence, awareness among maternal-child health clients is low. We assessed the effect of training and supervision on knowledge, skills, and self-efficacy of primary healthcare workers in delivering health talks and the clients' knowledge on maternal depression. METHODS: A quasi-experimental study design was adopted. Five Local Government Area (LGAs) in the Ibadan metropolis were grouped according to geographical proximity and randomly assigned to experimental (Group A = two LGAs) and control (Group B = three LGAs) with 12 primary health centres in each group. All primary health care workers recruited in group A received a one-day training on maternal depression. Good Knowledge Gain (GKG), Good Skill Gain (GSG) and Self-Efficacy (SEG) were assessed in both groups. 1-week post-training, the knowledge of all the PHCs' attendees in the two groups was assessed. Two weeks post- training, a half of experimental group's PHCs received supportive supervision and a clinic-based health education delivery skill assessment was conducted. The knowledge of clients and their health seeking were also assessed. Fisher's exact test, independent t test and Poisson regression were used to analyze differences in percentages and mean/ factors associated with GKG, GSG and SE, using SPSS 25. RESULTS: Training improved gains in the experimental versus controls as follows: GKG (84.3% vs. 15.7%), GSG (90.7% vs 9.3%) and SEG (100% vs 0%). Training contributed to the good gain in knowledge (RR = 6.03; 95%CI =2.44-16.46; p < 0.01); skill (RR = 1.88; CI = 1.53-2.33; p < 0.01).) and self-efficacy (RR = 2.74; CI = 2.07-2.73; p < 0.01). Clients in the experimental group had higher knowledge gain score than in the control (7.10 ± 2.4 versus - 0.45 ± 2.37); p < 0.01). The rater supervisor observed better motivation in the supervised group than the not supervised. Forty clients sought help in the intervention group while none in the control group. Thirty-five clients sought help in the supervised group while only five did in the not supervised. CONCLUSIONS: Training followed by supervision improved the competence of health workers to transfer knowledge to clients. This intervention is recommended for primary healthcare settings to improve uptake of maternal mental health services.

Nationwide Seroprevalence of SARS-CoV-2 IgG Antibodies among Four Groups of Primary Health-Care Workers and Their Household Contacts 6 Months after the Initiation of the COVID-19 Vaccination Campaign in France: SeroPRIM Study Protocol.

BACKGROUND: The protocol study will focus on the seroprevalence of IgG antibodies to SARS-CoV-2 achieved by vaccination and/or natural protection as well as the history, symptoms, and risk factors for SARS-CoV-2 in four primary health-care workers (PHCWs) and their household contacts in metropolitan France. METHODS: Here, we propose a protocol for a nationwide survey to determine the seroprevalence of IgG antibodies to SARS-CoV-2 achieved by vaccination and/or natural protection in four PHCW populations (general practitioners, pediatricians, pharmacists and assistants, and dentists and assistants) and their household contacts. Participants will be included from June to July 2021 (Phase 1) among PHCW populations located throughout metropolitan France. They will be asked to provide a range of demographic and behavioral information since the first SARS-CoV-2 wave and a self-sampled dried blood spot. Phase 1 will involve also a questionnaire and serological study of PHCWs' household contacts. Seroprevalence will be estimated using two ELISAs designed to detect specific IgG antibodies to SARS-CoV-2 in humoral fluid, and these results will be confirmed using a virus neutralization test. This study will be repeated from November to December 2021 (Phase 2) to evaluate the evolution of immune status achieved by vaccination and/or natural protection of PHCWs and to describe the history of exposure to SARS-CoV-2.

Assessing baseline knowledge and practices of injection safety among primary health care workers in Cross River State, Nigeria: a cross-sectional urban-rural comparative study.

INTRODUCTION: unsafe injection practices are commonplace in low-income countries, and place health care workers at risk of blood-borne infections. A safe injection strategy requires a synchronized approach to deal with change in behavior of users and service providers towards safer practice. There is general lack of data on injection safety practices in Cross River State. This was a baseline study to compare the knowledge and practice of safe injection practices among primary health care (PHC) workers in urban and rural health facilities in Cross River State, Nigeria. METHODS: this was a cross-sectional comparative study among PHC workers in randomly selected rural and urban Local Government Areas (LGAs). Using multistage sampling technique, a total of 320 respondents: 160 from the urban LGAs and 160 from the rural LGAs were interviewed. Semi-structured interviewer administered questionnaires were used to obtain data. Data analysis was done using STATATM version 14.0. Associations were tested using Chi square, and multivariate logistic regression analysis. RESULTS: in this study, there was no difference in the baseline knowledge (58.8% vs. 55.0%, P=0.499) and practice (33.1% vs. 34.4%, P=0.813) of injection safety between PHC workers in the urban and rural locations. In the multivariate logistic regression model, the senior health workers had a two-fold increased odds of practicing safe injection compared to their junior counterparts [OR=2.21 (95% CI: 1.28,3.84)]. CONCLUSION: in both the urban and rural locations, there was good knowledge but poor practice of injection safety among respondents in the LGAs; hence, the need to organize periodic injection safety training and retraining of PHC workers targeting junior workers to improve on the practices of injection safety.

What do we mean by individual capacity strengthening for primary health care in low- and middle-income countries? A systematic scoping review to improve conceptual clarity.

BACKGROUND: Capacity strengthening of primary health care workers is widely used as a means to strengthen health service delivery, particularly in low- and middle-income countries. Despite the widespread recognition of the importance of capacity strengthening to improve access to quality health care, how the term 'capacity strengthening' is both used and measured varies substantially across the literature. This scoping review sought to identify the most common domains of individual capacity strengthening, as well as their most common forms of measurement, to generate a better understanding of what is meant by the term 'capacity strengthening' for primary health care workers. METHODS: Six electronic databases were searched for studies published between January 2000 and October 2020. A total of 4474 articles were screened at title and abstract phase and 323 full-text articles were reviewed. 55 articles were ultimately identified for inclusion, covering various geographic settings and health topics. RESULTS: Capacity strengthening is predominantly conceptualised in relation to knowledge and skills, as either sole domains of capacity, or used in combination with other domains including self-efficacy, practices, ability, and competencies. Capacity strengthening is primarily measured using pre- and post-tests, practical evaluations, and observation. These occur along study-specific indicators, though some pre-existing, validated tools are also used. CONCLUSION: The concept of capacity strengthening for primary health care workers reflected across a number of relevant frameworks and theories differs from what is commonly seen in practice. A framework of individual capacity strengthening across intra-personal, inter-personal, and technical domains is proposed, as an initial step towards building a common consensus of individual capacity strengthening for future work.

Preparedness of primary health care workers and audit of primary health centres for newborn resuscitation in Port Harcourt, Rivers State, Southern Nigeria.

INTRODUCTION: Nigeria still has high newborn deaths and birth asphyxia remains a major cause. Birth attendants´ readiness to perform newborn resuscitation depends largely on their competence in basic resuscitation and availability of newborn resuscitation equipment to enable the various steps outlined in resuscitation guidelines to be applied quickly and appropriately. This study aimed to assess primary health care workers´ experience of neonatal resuscitation and audit primary health centres for availability of neonatal resuscitation equipment. METHODS: this descriptive cross-sectional study surveyed 106 primary health care workers (22 doctors, 84 nurses) randomly selected from 28 Primary Health Centres to document their experiences in newborn resuscitation and appraise the centres for availability of newborn resuscitation equipment. Experience in newborn resuscitation was obtained using a semi-structured questionnaire and audit was with a Proforma following on-site facility visits. Data was analysed using SPSS v20 and displayed in tables and graphs. RESULTS: all health care workers had resuscitated newborns but only 58(57.4%) had ever used a bag and mask, 53(50%) used stethoscopes and 19(17.9%) had resuscitation protocol in their facilities. Fifteen (53.6%) health centres had functional newborn-specific bag and masks, 11(39.3%) had suction machines and 5(25%) had empty oxygen cylinders. CONCLUSION: primary health care workers´ experience of newborn resuscitation is very limited and some primary health centres were grossly unequipped. Neonatal resuscitation training interventions and supplies of neonatal resuscitation equipment are urgently needed.

Could the connectedness of primary health care workers involved in social networks affect their job burnout? A cross-sectional study in six counties, Central China.

BACKGROUND: This study aimed to reveal the effects of the connectedness of primary health care (PHC) workers in social networks on their job burnout. METHODS: Cross-sectional survey data of rural PHC workers in China were analyzed. A total of 663 respondents were enrolled. Chi-square and cumulative logistic regression were used to determine the effects of the connectedness of PHC workers in social networks on their job burnout. RESULTS: PHC workers in rural China had high levels of emotional exhaustion (24.1%), depersonalization (15.7%), and lack of personal accomplishment (34.7%). More than half of the participants were in the middle connectedness level in terms of their advisory (70.4%) and friendship (70.3%) networks. The degree of emotional exhaustion seemed to increase when participants had a low connectedness in their friendship networks (ß = 0.769, 95% CI = 0.080-1.458, P = 0.029). Respondents with the middle level of connectedness in advisory networks had higher levels of depersonalization (ß = 0.739, 95% CI = 0.130-1.348, P = 0.017) and lack of personal accomplishment (ß = 0.583, 95% CI = 0.111-1.055, P = 0.015) than those with the high degree of connectedness in advisory networks. CONCLUSIONS: The connectedness of PHC workers in social networks influenced their job burnout. Thus, organizations should establish an informal communication platform and information feedback mechanism, promote and manage friendship networks, and help PHC workers overcome emotional exhaustion. Managers should also encourage individuals with a high level of connectedness in advisory networks play the role of "opinion leader" so that they can help others mitigate burnout.

Mental health and psychosocial support services in primary health care in Nepal: perceived facilitating factors, barriers and strategies for improvement.

BACKGROUND: The barriers and facilitating factors for integrating mental health into primary health care have been well documented in the literature, but little is known about the perspectives of primary health care workers (who provide integrated mental health care) on barriers and facilitating factors of the health system for scaling up mental health interventions in low and middle income countries. This study aimed to explore these perspectives of primary health care workers within the health system, and identify possible strategies to optimize the integration of mental health in primary health care. METHODS: The study was conducted in the Chitwan district of Nepal with 55 purposively selected primary health care workers representing prescribers (N = 35), non-prescribers (N = 12) and Female Community Health Volunteers (N = 8). Using a semi-structured interview guide, experienced qualitative researchers collected data between September 2016 and May 2017. The interviews were audio-taped, transcribed and then translated into English. The transcripts were coded using Nvivo 10 software and themes were generated for the thematic analysis. RESULTS: According to the health workers, the facilitating factors for scaling up mental health services in primary health care setting in Nepal included; (1) availability of guidelines, protocols and awareness raising materials, (2) provision of supervision, (3) referral systems being in place, (4) patient record keeping, (5) community sensitizations and home visits, and (6) provision of psychosocial counseling. The barriers identified included; (1) shortage of psychotropic medicines, (2) lack of private space for counseling, (3) workload and health workers' grievances regarding incentives, and (4) perceived stigma causing dropouts. CONCLUSIONS: The findings suggest that implementation of mental health services through primary health care workers in resource-poor setting is possible when health system level barriers are addressed and facilitating factors are strengthened. In order to address these barriers the health workers suggested a few strategies which included; ensuring dedicated staff available at health facility, allocating dedicated and confidential space for counseling, improving on incentives and motivational benefits to existing health staff, organizing policy level advocacy for mental health, improving medicine supply chain management and strengthening systems for supervision, referral and mental health information management.

Primary health care workers' understanding and skills related to cervical cancer prevention in Sango PHC centre in south-western Nigeria: a qualitative study.

AIM: The study explored the knowledge and service delivery skills of primary health care (PHC) workers to conduct cervical cancer screening programmes in Sango primary health centre in Sango town, Ado-Odo Ota, Ogun State in Nigeria. BACKGROUND: Cervical cancer is the second most common cancer affecting women. The prevention and control services in Nigeria are provided mainly at post-primary health facilities. Authorities have advocated the integration of cervical cancer prevention into reproductive health services provided at PHC centres. The service delivery capabilities of PHC workers are critical for successful implementation of screening programmes. METHOD: Exploratory qualitative research design was used. Data were collected among 10 PHC workers who were purposively sampled at Sango PHC. Semi-structured interview guide with broad items and a checklist were used to assess participants' cervical cancer screening knowledge and service delivery skills using visual inspection screening methods. Data were analysed thematically and triangulated. FINDINGS: A range of roles were represented in the interviews of the health care workers at the PHC studied. They had poor knowledge and skills about cervical cancer screening using visual inspection with acetic acid and visual inspection with Lugol's iodine. Study participants perceived nurses as most equipped PHC workers to conduct screening at PHC level, followed by the community health officers. Participants reported no cervical cancer services at the centre and community. The findings provided useful insight that guided the training of primary health workers and the development of a community-based cervical cancer screening model for women in rural communities. CONCLUSION: Nurses and other PHC workers should be trained on visual inspection screening method. This low-cost but effective methodology could be incorporated into their training curricula as a strategy for scaling up cervical cancer prevention programmes across Nigeria.

Need Assessment for Health Education Service Provision on Maternal Depression Among Primary Health Care Service Providers.

Maternal depression is gradually becoming a prevailing condition among women of reproductive age in Nigeria but there are little efforts towards addressing this problem. Need assessment for health education service provision on maternal depression therefore becomes necessary. Hence, this study assessed the needs of Primary Health Care (PHC) workers regarding the provision of routine health talk on maternal depression. This study was descriptive in design and it adopted a mixed method. Four Key Informant Interviews (KII) and a survey which involved 100 Health Workers (HWs) were carried out. KII participants were purposively selected from the 4 LGAs where volunteers were found and the 100 HWs were conveniently selected from all the Comprehensive Clinics (CCs) in the 5 LGAs. A KII guide and structured questionnaire were used to collect data and data were analyzed thematically, with descriptive statistics and chi-square. The mean age of the key informant's interviewees was 54±6.1years and the mean age of the survey respondents was 42±5.2 years. The interviewees identified HWs' inability to communicate maternal depression to the service users in appropriate local terms and non-availability of Information, Education and Communication (IEC) materials as barriers to giving health talk on maternal depression. Survey respondents identified certain needs with a statistical significance across cadres. Eighty-three (88.3%) identified training need, education aid materials 61.7%; p<0.05, maternal depression health education guide 27.7%; p<0.05 and need for more staff 22.3%. Training need, non-availability of maternal depression targeted educational materials and the need for more staff were the primary identified needs.

Provider and patient perceptions of malaria rapid diagnostic test use in Nigeria: a cross-sectional evaluation.

BACKGROUND: Nigeria commenced a phased programmatic deployment of rapid diagnostic tests (RDT) at the primary health care (PHC) facility levels since 2011. Despite various efforts, the national testing rate for malaria is still very low. The uptake of RDT has been variable. This study was undertaken to determine the provider and patient perceptions to RDT use at the PHC level in Nigeria with their implications for improving uptake and compliance. METHODS: A cross-sectional survey was conducted in 120 randomly selected PHCs across six states, across the six-geopolitical zones of Nigeria in January 2013. Health facility staff interviews were conducted to assess health workers (HW) perception, prescription practices and determinants of RDT use. Patient exit interviews were conducted to assess patient perception of RDT from ten patients/caregivers who met the eligibility criterion and were consecutively selected in each PHC, and to determine HW's compliance with RDT test results indirectly. Community members, each selected by their ward development committees in each Local Government Area were recruited for focus group discussion on their perceptions to RDT use. RESULTS: Health workers would use RDT results because of confidence in RDT results (95.4%) and its reduction in irrational use of artemisinin-based combination therapy (ACT) (87.2%). However, in Enugu state, RDT was not used by health workers because of the pervasive notion RDT that results were inaccurate. Among the 1207 exit interviews conducted, 549 (45.5%) had received RDT test. Compliance rate (administering ACT to positive patients and withholding ACT from negative patients) from patient exit interviews was 90.2%. Among caregivers/patients who had RDT done, over 95% knew that RDT tested for malaria, felt it was necessary and liked the test. Age of patients less than 5 years (p = 0.04) and "high" educational status (p = 0.0006) were factors influencing HW's prescription of ACT to RDT negative patients. CONCLUSION: The study demonstrated positive perception to RDT use by HW and among community members with good compliance rate among health workers at the PHC level. This positive perception should be explored in improving the current low level of malaria testing in Nigeria while addressing the influence of age on HW administration of ACT to RDT negative cases.

Effect of health education intervention conducted by Primary Health Care workers on oral health knowledge and practices of nursing mothers in Lagos State.

Educational interventions on oral health care is traditionally carried out mainly by oral health workers in Nigeria. Despite the introduction of the National Oral Health Policy, oral health services/education is virtually non-existent in PHC centres in Nigeria. This study sought to determine the effect of a health education intervention delivered by Community Health Officers (CHO) on the oral health knowledge and practices of mothers attending a PHC centre in Lagos State. A pre-experimental, Before- After study design was employed. An interviewer- administered questionnaire was administered at baseline to assess the oral health care knowledge and practices of 267 mothers who enrolled in the programme. After enrolling the participants, CHO's previously trained commenced a health education intervention on oral health. The intervention, which consisted of 2 lecture sessions, a demonstration session and a return demonstration session, utilising flipcharts and health information leaflets spanned a six-month period. Oral health knowledge and practices of participating mothers was evaluated 3 and 6 months after the intervention commenced using a standardised checklist. Data entry and analysis was done using SPSS version 20, P-value of <0.05 was considered significant. The mean oral health knowledge score at baseline was 4.58 (±1.37) while at 3-month and 6-month postintervention the mean scores were 4.68 (±0.97) and 4.96 (±0.49), respectively. There was a statistically significant increase (P=0.000) in the mean knowledge scores at 6 months post-intervention. Mothers who were 36 years or older and those with more than 12 years education displayed significantly better knowledge scores (P<0.05). Most (78.3%) reported using cotton wool or foam with water for their infants' oral hygiene. By the second post-intervention visit, there was a significant change in the perception of the mothers on correct oral hygiene tool for infants (52.3%; P=0.000). Furthermore the percentage of mothers actually using toothbrush to clean their child's mouth (98.1%; P=0.000) had increased. The oral health knowledge of the participants increased significantly following the intervention especially at the 6-month evaluation. PHC workers can successfully carry out oral health educational interventions at PHC level. The greatest value will occur with reinforced repetition of the messages.

Mental health training for primary health care workers and implication for success of integration of mental health into primary care: evaluation of effect on knowledge, attitude and practices (KAP).

BACKGROUND: Mental disorders are always remained a neglected public health problems in low and middle-income countries (LMICs), most people with mental disorders never receive effective care and there is a large treatment gap. In order to solve the problem integration of mental health into primary health care is recommended and in Ethiopia implementation of the scale of mental health services at primary health care level was started in 2014. For the success of the integration of mental health into primary health care, primary care health professionals are the key personnel who are responsible for the management of mental, neurologic and substance use disorders. However, proper training and education of primary care health professionals is mandatory for an optimal performance and success of integration. This interventional study was conducted to assess the effectiveness of mental health training course for scale up of mental health services at primary health care level in Ethiopia. METHODS: This quasi-experimental pre- and post-study design was conducted in Ethiopia from October to December 2016 using quantitative data collection methods. A total of 94 primary health care professionals were included in the study. The intervention was conducted by psychiatry professionals using standardized World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) guide prepared for scaling up of mental health care through integration into primary health care (PHC) and general medical services. Pre- and post intervention assessment was done for knowledge, attitude and practice (KAP); and statistically analyzed. A paired sample t test with p values was performed to test the differences between the pre- and post-test. In additions mean and standard deviation of the responses were calculated. Overall the response rate was 100% at the end of the intervention. RESULTS: The study resulted in a significant improvement in knowledge, attitude and practice (KAP) of PHC workers about all the four mental, neurologic and substance use disorders during the post intervention survey (p < 0.05). Post intervention the knowledge of health professionals increased by 53.19% for psychosis, 42.56% for depression, 19.25% for epilepsy and 54.22% for alcohol use disorders. Similarly, post intervention attitude increased by 55.32% for psychosis, 40.42% for depression, 36.17% for epilepsy and 43.6% for alcohol use disorders. In addition, post intervention case identification rate increased by 62.78% for psychosis, 55.46% for depression, 21.35% for epilepsy and 41.49% for alcohol use disorders with significant p value (p < 0.05). CONCLUSIONS: The study results suggest that mental health training could be an effective intervention for improving knowledge, attitudes, and practices among primary health care professionals regarding mental, neurologic and substance use disorders. Training is a prerequisite and vital to enhance the knowledge, attitude, and practice of primary care professionals which plays a significant role for the easy success of integrated care and treatment of mental, neurologic and substance use disorders into the existing general health care services.