primary health centres

A pre designed schedule was used for the generation of primary data from each PHC considering the first 25 patients as respondents to know their perception regarding the services provided. When the numbers of patients interviewed were less than twenty five in the first day, the survey was continued further in the same PHC until the target had reached. The collected information was compiled, tabulated and analysed by using standard statistical methods. The base map of Haripad Block along with the Panchayat boundaries was collected from Information Kerala Mission, Trivandrum. The layer of rail and road transport network was over laid with the Panchayat of Haripad Block and then layout of the study area was prepared. The GPS readings of the PHCs were taken during the field visit for primary data collection. The map of spatial distribution of Primary Health Centres was prepared integrating with the transport network layer of the Block in a GIS environment.

An attempt has been made to map the pattern of hospital facilities in Solapur district in the years 2011 that in general high population density areas of study region and some tahsil of the solapur district lacked adequate health centres facilities in comparison to show to low population density areas. Barring tourist resort or regional spot such as Akkalkot, pandharpur, most of these areas were not having adequate health facilities. Malshiras tahsils has highest number of PHCs followed by Akkalkot, Madha and Pandharpur tahsil having each eight PHC centres. Barshi and Mohol tahsil seven primary health centres located in the year 2011. Sangola and south solapur have six primary health centres. North solapur and karmala lowest number of health centres which are five centres.

This study was an interventional, continuous, prospective and multicentre study which included 5 PHC and 5 UHCs which accounted to approximately 10% of the total 43 PHCs and 57 UHCs in Ahmedabad district. The study was carried out from September 2012 to June 2014 over a period of 22 months. Adult patients of either gender, who were willing to participate in the study, who gave informed consent and who were prescribed antimicrobial agents were included. Patients who were not willing to participate in the study and give informed consent and pregnant females were excluded. A prior permission was obtained from Chief District Health Officer (CDHO) for conducting the study at Primary Health Centres. To conduct study at Urban Health Centres permission was taken from Family Welfare Officer (FWO). Prior permission from Institutional Ethics Committee (IEC) of Civil Hospital, Ahmedabad was also obtained before the conduct of the study. As per the inclusion and exclusion criteria the patients were enrolled after taking written informed consent. The study was divided into 3 phases: pre-intervention, intervention and post-intervention phases.

Urinary tract infections (UTIs) are one of the most prevalent extra-intestinal bacterial infections. It is a common disease encountered in medical practice affecting people of all ages, from neonate to geriatric age group. These infections are on the increase for outpatients attending Primary Health Centres in Anambra State, Nigeria, therefore the need for this study. The prevalence rate of urinary tract infection, age distribution and influence of sex were determined. Susceptibility pattern of the infectious organisms to antimicrobial agent were examined. Clean-catch midstream urine samples were collected and examined. Out of 3000 urine samples examined, 528 bacterial isolates were re- covered and characterized. These include: Escherichia coli (24.2%), Klebsiella spp. (18.2%), Staphy- lococcus aureus (18.2%), Proteus mirabilis (9.1%), Pseudomonas aeruginosa (9.1%), Enterococcus faecalis (9.1%), Citrobacter intermedius (6.1%) and Staphylococcus saprophyticus (6.1%). More fe- males (52%) were infected than males (48%) and in both sexes, the highest incidence was found amongst the age group, 26 - 38 years. Gram negative rods had the highest incidence in both sexes. Among the towns in Anambra state, Umunya in southern province was observed to have the highest incidence rate of UTI. Susceptibility test of the bacterial isolates to antimicrobial agents showed that Staphylococcus aureus was sensitive to Cephalexin, Penicillin V, Erythromycin and Gentamycin while Pseudomonas aeruginosa was resistant to all the antibiotics. Escherichia coli and Klebsiella spp. were resistant to all the antibiotics except Gentamycin while Citrobacter intermedius was resistant only to Cephalexin and Erythromycin. This study provides the evidence of urinary tract infections amongst outpatients of primary health centres and the drugs for their control.

Since the present study was a perception based questionnaire study, the reliability of the questionnaire data was checked by resurveying 10% of the participants on the next day, which was found about 90%. The preference of urban areas (74%) over the rural areas (24%) was seen in our study which is similar to the studies in other countries by Peter Agyei-Baffour in Ghana (Baffour et al., 2011), Geoffrey Wandiraa et al. in Uganda (Wandira G, Everd Maniple 2009), and Shomikho Raha et al in Uttar Pradesh, India (Raha et al., 2009). A similar study carried out in Croatia, concluded that the majority of final year medical students would like to work in Zagreb, the capital of Croatia (Polasek et al., 2006). It is not surprising that most young doctors seek their future in major cities, since urban areas edge over rural areas in terms of better opportunities, work infrastructure, lucrative lifestyle, health care and education for children and job prospects for the spouses. When asked regarding major driving factors for attraction towards rural/remote primary health centre jobs, higher salary (48.5%) emerged as the top priority followed by intention to serve poor, needy and helpless people (38%). According to the Neoclassic Wage Theory, it is universal that the choice of any human worker mobility is driven largely by financial motives (Carmen et al., 2010; Bärnighausen and Bloom 2009; Huicho et al., 2010). And the major trend seen in health professionals to Table 1. Factors to join rural/remote primary health centres in percentages

et al., 2014) In India, the primary health care is provided by the complex of primary health centres and their sub centre’s through the agency with multipurpose health workers, health guides and trained dais. Besides providing primary health care, the village “health teams” bridge a cultural communication gap between the rural People and organized health sector. The anganwadi worker in the Integrated Child Development Services (ICDS) scheme also provides important health related services at village level. Since India opted for 'Health for All" by 2000 AD, the primary health care system has been reorganized and strengthened to make the primary health care delivery system more effective. WHO defines health as a state of complete physical, mental and social well

The study was part of a formative research project intended to identify elements to include in the design of an intervention for improving the access of rural women to skilled pregnancy care in rural Nigeria. An interpret- ive description design was used given the exploratory nature of the study, while the analysis and presentation followed the Standards for Reporting Qualitative Research (SRQR). The study was conducted in Esan South East (ESE) and Etsako East (ETE) Local Government Areas (LGA) of Edo State in southern Nigeria. Both LGAs are located in the rural areas of the state, adjacent to River Niger, with Estako East in the northern part of the Edo State part of the river, while Esan South East is in the southern part. Administratively, each LGA comprises of 10 political/health wards and there are several communi- ties in each ward. Subsistence farming is the major source of livelihood in the communities. The two LGAs have a total population of 313,717persons, with ESE accounting for 167,721 and ETE accounting for 145,996. PHC centres are the principal source of maternity health care in the two LGAs. However, ESE LGA has one General Hospital in Ubiaja (headquarters of the LGA) while ETE has one General Hospital in Agenebode (the LGA administrative headquarters) and another in nearby Fugar City. Several private hospitals also exist in both LGAs that offer mater- nal and child health services of various degrees of quality and cost. These public and private facilities are used as additional to the existing PHC centres or for referral maternal health services.

Drug use is a complex subject influenced by factors such as health budget, prescriber’s experience, drug availability, knowledge of dispenser, cultural factors and many more. The main objective of this study was to find out drug use as per the WHO core drug indicators; i.e. prescribing indicators, patient-care indicators and health facility indicators. These WHO indicators were used to investigate drug use that may help to resolve the problem regarding drug therapy. This study reports; a higher number of drugs prescribed per prescription, over-use of antibiotics and injections, moderate rate of prescribing by generic name while short consulting and dispensing

These questionnaires were constructed based on Adil Ali Nassir Ayed's research on knowledge, attitude, and practice regarding exclusive breastfeeding among mothers attending primary health centers in Abha City. It is translated into Malay and Chinese language and then being validated by a Malay and Chinese teacher respectively because most of the sample population were Malay or Chinese educated. A pretest of the questionnaires was done among eligible mothers and yielded an internal consistency reliability coefficient (Cronbach’ alpha) of .75.

The performance of the centre was assessed using the Primary Care Assessment Tool [40, 41, 43]. This tool was validated in a developing country for family health- care [41, 47]. It is interesting to note that this instru- ment could be used to assess the performance from the consumer’s as well as from the provider’s perspective. This tool provides an extensive list of surveys on differ- ent attributes of PHC. Based on the requirement of the evaluation, one could consider specific components. In other studies, measures such as costs, patients served and effectiveness along with the client satisfaction were identified. Cost effectiveness is an appropriate measure that can be used across all PHCs [48] and thus, helps in making right choices by identifying the most effective service or intervention or centre [48].

Taluk-wise BMWM Practice Scores (PSs) before the intervention shows that the highest mean PS was 21.86 which is 14.34% in Devanahalli taluk and the lowest mean PS was 13.38 which is 8.8% in Doddaballapur taluk. Further, overall mean score was 16.34 which is 10.73% of maximum PSs revealing very poor practice on BMWM in all the PHCs under the four taluks (Table 4). It is supported by Hosny and El-Zarka (2005) who have stated that the most common problems associated with biomedical wastes are the absence of waste management, lack of awareness about their health hazards, insufficient financial and human resources for proper management, and poor control of waste disposal [10]. Tsakona, Anagnostopoulou, Gidarakos also stated that negligence was observed at every stage of the waste management practices in most of the health care centres [11].

Departments, NGOs and private professionals. District Health Societies are responsible for preparing perspective plans for the entire period (2005-12), annual plans of all NRHM components and for integrating public health plans with those for water, sanitation, hygiene and nutrition. Block level health plans on the basis of district plans are formulated to integrate the village plans. Rogi Kalyan Samitis (RKS) at the block level are responsible for the day-to-day management of hospitals. In each village, a Village Health and Sanitation Samiti is accountable to the panchayat and is comprised of a female Accredited Social Health Activist (ASHA) who is the bridge for the village, an ANM, a teacher, a panchayat representative, and community health volunteers. Primary Health Centres are staffed by a medical officer and fourteen paramedical staff, and provide integrated curative and preventive care. PHCs are the first point of contact with a medical officer. At the block level, CHCs, serving as referral units for four PHCs, are manned by four medical specialists (surgeon, physician, gynaecologist and paediatrician) and provide obstetric care and specialist consultations. NRHM seeks to bring CHCs and PHCs on par with Indian Public Health Standards (IPHS) and makes the provision of adequate funds and powers to enable these committees to reach desired levels.

Methods: This was across-sectional study. Totally 496 subjects were selected from 4 different Primary Health Centres (PHCs) who attended outpatient department during the study period. The patient health questionnaires (PHQ- 9) were used to estimate the prevalence of depression among hypertensive subjects. Basic demographic and behavioral details were also collected. This study was carried out from April to August in 2016 in Tirunelveli district, Tamilnadu, India.

Background: Globally, hypertensive disorders of pregnancy, particularly pre-eclampsia and eclampsia, are the leading cause of maternal and neonatal mortality, and impose substantial burdens on the families of pregnant women, their communities, and healthcare systems. The Community Level Interventions for Pre-eclampsia (CLIP) Trial evaluates a package of care applied at both community and primary health centres to reduce maternal and perinatal disabilities and deaths resulting from the failure to identify and manage pre-eclampsia at the community level. Economic evaluation of health interventions can play a pivotal role in priority setting and inform policy decisions for scale-up. At present, there is a paucity of published literature on the methodology of economic evaluation of large, multi-country, community-based interventions in the area of maternal and perinatal health. This study protocol describes the application of methodology for economic evaluation of the CLIP in South Asia and Africa. Methods: A mixed-design approach i.e. cost-effectiveness analysis (CEA) and qualitative thematic analysis will be used alongside the trial to prospectively evaluate the economic impact of CLIP from a societal perspective. Data on health resource utilization, costs, and pregnancy outcomes will be collected through structured questionnaires embedded into the pregnancy surveillance, cross-sectional survey and budgetary reviews. Qualitative data will be collected through focus groups (FGs) with pregnant women, household male-decision makers, care providers, and district level health decision makers. The incremental cost-effectiveness ratio will be calculated for healthcare system and societal perspectives, taking into account the country-specific model inputs (costs and outcome) from the CLIP Trial. Emerging themes from FGs will inform the design of the model, and help to interpret findings of the CEA.

G and Dharmaraj A, (p=36; q=64; d=15% of p=5.4) in Coimbatore, Tamil Nadu, India, in 2013 by consecutive sampling (non-probability sampling) [17]. Every consecutive person visiting the three primary health centres that satisfied the inclusion criteria were included in the study. The three primary health care centres involved in the study were the Singanallur, Irugur and Sarkarsamakulam primary health centres, as these were included in the field practice area of Coimbatore Medical College. Individuals aged 18-years and above of both genders, who were both outpatients and normal accompanying persons visiting three PHCs, irrespective of whether they had been affected by Dengue in the past and those who were willing to participate in the study voluntarily and had given written informed consent regarding the same were included in the study. People aged <18-years and people who were not able to understand the questionnaire were excluded from the study. The study was conducted after obtaining clearance from the Institutional Human Ethics Committee, Coimbatore Medical College, Coimbatore (Ethics approval number: 0124/2018).

In the present study, in 60% of PHCs the number of deliveries conducted per month was more than 10. New born care services on 24 hours×7 days/week basis were offered in 90% of the PHCs. These were consistent with the findings of DLHS-4,in which our state had 64.2% of PHCs where at least 10 deliveries were conducted in the last one month and 96.6% of PHCs where Newborn care services on 24hours×7days/week basis. 6 MTP facility was not there in any PHC due to lack of trained staff. Primary health centres were still dependent on peripheral blood smear for diagnosis. This might delay the treatment of malaria. Facilities for CT, BT and blood grouping and Rh typing were available in 60% of the PHCs, thus hampering and delaying services to cases like post- partum hemorrhage, complications of dengue, etc. Another study was carried out to find out and compare to what extent the IPHS were followed by the PHCs in the selected districts of both the empowered action group (EAG) state of Assam and non EAG state of Karnataka in 2008 revealed basic laboratory facilities, for routine blood, urine and stool examination were available in 80% of the studied PHCs in the non-EAG state of Karnataka, while it was only in 20% of the studied PHCs of the state of Assam. 9

From a public health angle, the Saharevo experience nicely illustrates once more that an adequate malaria care, with a confirmed diagnosis and early effective treatment prevent deaths. This must be routinely extended to the whole foothills and to the entire country in Madagascar. These foothill areas are potentially considered as "the entrance gate" of malaria parasites from low land (with high transmission) to highlands (with low transmission). For instance, the use of fixed-dose combination of artesu- nate + amodiaquine to treat malaria in the primary health centres, improved community case management of malaria in remote areas – which has been already part of the Malagasy malaria control policy [34], combined with an active vector control plan, should be the efficient part- ners to tackle directly malaria endemicity in the foothills and indirectly epidemics in the highlands. As soon as vec- tor control will be initiated, regular surveys will be funda- mental (i) to up-date malariometric indexes including parasite rate among villagers, uncomplicated malaria cases at the primary health centres, and severe malaria trends at the hospitals; and (ii) to adjust the local strate- gies for an optimal application of the national policy. Competing interests

Frequent visits of such key health workers, carrying kits and distribution of common medicines And proper counselling makes significant impact in motivating pregnant women to visit nearby SCs and PHCs for the antenatal care. Further, important role of ASHAs in motivating pregnant Women to make use of public health care facilities for delivery care. For delivery care primarily FRUs, implying District Hospitals and Community Health Centers, are getting utilized and seem to be responsible for improvements in institutional deliveries. As FRUs are supposed to be adequately equipped and staffed for emergency obstetric care because of having proper operation. Theatres, surgeons, gynaecologists and paediatricians, accessibility to emergency transport, ready Availability of blood in case of emergency operations, etc. The analysis clearly highlights that utilization of public health facilities for the delivery care is also primarily increasing because of motivational efforts and support of key health workers like ASHAs/ANMs/VHNs. Also ASHA’s home visits and counselling promotes utilization of family planning services primarily from public health facilities. Further, the visits and counselling promotes utilization of chronic disease control services for which most of the patients visit District Hospitals for the treatment. Holding of village health and nutrition days and meetings of village health and sanitation committees facilitates increased utilization of public health facilities for delivery care, postnatal care, children’s immunization, family planning services, chronic disease control services, antenatal care. Similarly proximity to public health facility depicts strong impact on its utilization. Since peripheral health facilities like Sub Centres and Primary Health Centres are primarily utilized for antenatal and postnatal care, family planning services and children’s immunization, thus further training and retraining of key health workers like ASHAs, ANMs and VHWs would further promote their utilization. Many a times ASHAs had expressed their desire to include vaccinating also in their training schedules and thus it would further strengthen children’s immunizations and antenatal care programme. Since, utilization of FRUs, District Hospitals and Community Health Centers, is predominantly for institutional deliveries and seeking treatment of chronic ailments, thus further strengthening and consolidation of adequate facilities in such institutions and provision of referral or emergency transport in peripheral areas and centers would further promote wider utilization of public health facilities for

Three primary partners identified were the government through the MOH structures, NGOs and communities (through CBOs) but their main supporters of the health facilities were dominated by NGOs as was indicated by 59.8% of the respondents. The findings of the study show that development partners’ support had a very significant impact on the management and operations of services within the centres through their support in financial and technical resources. The contribution of the partners was in terms of training of medical staff, drugs, training of management committees, funds, construction and expansion health centre buildings, employment of qualified staff provision of equipments. This enhanced the performance of the centres.

Delays could be in health care-seeking, diagnosis, treatment or a combination of them all [44, 45]. In a re- view of 45 studies across 17 Asian countries, consult- ation with a public hospital was associated with lower risk of treatment delay [46]. A systematic review of diag- nosis and treatment delays in India showed that use of Government health care providers was a risk factor for patient-related delays while use of private health care providers were associated with health system delays [45]. Reports from sub-Saharan Africa indicate that delay was associated with prior consultation of traditional healers, private or rural public facilities [47–49]. Although spu- tum smear microscopy is provided to patients free by the National TB programme, additional investigations for diagnosis of TB such as radiographs and histology, and other co-morbidities such as diabetes have to be paid for by the patient and may also contribute to delays and disease progression [50–53]. In a study of platinum miners in South Africa, although high death rates were also observed in the first month of treatment irrespect- ive of HIV/ART status and previous treatment, death rates were still lower than present study. However, the miners were covered by a free comprehensive medical care including HIV care, reducing the likelihood of diag- nostic and treatment delays and possibly improving early likelihood of detecting and managing co-existing condi- tions. The majority of treatment services in Nigeria are provided by lower cadre health workers at the primary care level, with limited capacity for diagnosis of sputum-