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Only 15% of the global population has access to occupational safety and health services. In Africa, only 5% of employees working from major establishments have access to occupational health services (OHS). Access to primary health care (PHC) services is addressed in many settings and inclusion of OHS in these facilities might increase efficiency in preventing occupational diseases. A cross-sectional study was conducted in four Southern African Development Community (SADC) countries aiming at assessing the availability of OHS at PHC facilities and the organization of OHS. We conducted a literature review to assess the provision and organization of OHS services. In addition to the review, a total of 23 doctors from Zambia were interviewed using questionnaires in order to determine the availability of OHS and training. Consultations with heads of ministries were done in four SADC countries. Results showed that in the SADC region, OHS are fragmented and lack a comprehensive approach. In addition, out of 23 PHC facilities, only two (13%) provided occupational health and PHC. However, OHS provided at PHC facilities were limited to TB screening and audiometric testing. Our study showed a huge inadequacy of trained occupational health practitioners. This study supports the World Health Organization’s advocacy to integrate OHS at the PHC level.

It is crucial to comprehend factors associated to job dissatisfaction among healthcare workers (HCWs) in Malaysia’s primary health clinics, especially those working in ‘Type 2 Health Clinics’ which cater for populations of >50,000 and a daily average number of patients between 500 and 800. It is essential to ensure that effective strategies can be proposed to promote job satisfaction. A total of 314 HCWs from ‘Type 2 Health Clinics’ in north-eastern Malaysia consented to participate in this cross-sectional study, conducted between October 2020 and December 2021. The Job Satisfaction Survey was used to assess job dissatisfaction. The prevalence of job dissatisfaction was 35.7%. The significant factors associated with job dissatisfaction were younger age and those who were dissatisfied with their yearly performance mark. Targeted interventional activities for young HCWs and for those who are dissatisfied with their yearly performance mark are recommended to improve job satisfaction.

The majority of patients living with diabetes mellitus (PLWD) are diagnosed and managed at primary care level. Much research has focused on diabetes mellitus, its complications and the need for earlier referral from primary to higher levels of health care. Little research, however, has focused on down-referrals of PLWD. This study assessed whether down-referral letters of PLWD to primary healthcare clinics (PHCs) and community healthcare centres (CHCs) in the uMgungundlovu district of KwaZulu-Natal contained adequate information, were legible, had a follow-up plan and whether national guidelines were adhered to. Questionnaires were distributed to nurses and doctors working in PHCs and CHCs to assess their opinions of appropriateness of down-referrals of PLWD during November and December 2019. A total of 127 referral letters and 55 questionnaires were assessed. Referral letter assessment revealed that 81.1% of PLWD had no glucose control and 85% had no renal function documented. Diabetic complications were recorded infrequently (3.94%). One-third (33.6%) of the PLWD over the age of 40 years were not down-referred on a statin while 6.3% were on a medication combination that was not in accordance with the South African Essential Medicines List. A significant number of referral letters had no clear management plan other than medications listed (96.1%), with no follow-up appointments documented (95.3%). Less than two-thirds (60%) of letters were easily legible. The most common down-referrals were from district hospitals (98.43%). Questionnaire respondents agreed that referral letters generally contained information on the patient's medication and comorbidities but rarely contained information regarding glucose control or complications of diabetes, among which foot and eye complications were significantly omitted. Analysis of down-referral letters identified many omissions, in both clinical and biochemical data, that are needed by clinicians working at both CHCs and PHCs to optimally manage PLWD. It is imperative that findings of studies like this be used in developing intervention strategies targeting this level of diabetes care.

Background The burden of visual impairment and avoidable blindness has been attributed to the shortage and poor distribution of adequately trained eye care personnel. In the district health system, primary health care (PHC) nurses are the first point of contact for eye care patients. To provide adequate eye care, the nurses in PHC clinics apply their knowledge on basic eye health to ensure best practices and management for patients that present at their clinics. Anecdotal evidence regarding the knowledge and practices of these PHC professionals is scarce. The purpose of this study was to evaluate PHC nurses’ knowledge and practices on eye health. Methods A quantitative, cross-sectional study was conducted in a rural district of the Eastern Cape Province in South Africa. Stratified random sampling was used to select 28 from the 74 PHC clinics in the district. A researcher-administered questionnaire using a 5-point likert scale with options strongly disagree, disagree, neutral, agree and strongly agree, was developed, piloted and finalised for this study. The tool had four sections: demographic information, knowledge of eye health, practices on evaluating visual function and identification and management of presenting eye conditions. Data were collected, captured onto MSXcel, cleaned, coded and analysed descriptively, and for Chi-squared significance at 95%, using R statistical software. Results From 200 responses, 86.4% (n=172) were females of the African race. Most (93.5%, n=187) had never undergone formal training in eye care. Only 28% (n=56) correctly identified a mature cataract while 28% (n=56) correctly identified signs of glaucoma; the global leading causes of preventable blindness. A total of 94% (n=188) failed to accurately measure visual acuity on a patient. Conclusions PHC nurses showed poor knowledge and practices of common eye conditions. There is an urgent need for eye health training for PHC nurses, and the clear management protocols on eye care.

Purpose Type 2 diabetes mellitus (T2DM) is a considerable impact on physical health as well as on emotional and social wellbeing. This study aimed to investigate the quality of life and its associated factors among Palestinians with T2DM. Methods A cross-sectional study including 517 patients (68% female) was conducted in eleven primary health care clinics located in Ramallah and al-Bireh governorate of the West Bank. To assess socio-demographic data, risk factors and diabetes control, interviews, physical examinations, anthropometric measurements, and blood and urine tests were performed. The validated Arabic version of the Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire was carried out on all patients to measure Quality of Life (QoL). A multivariable regression analysis was performed. Results The average weighted impact (AWI) score was −3.38 (95% CI: −3.55 to −3.21, range: −9.00 to 0.12). This indicates that diabetes was perceived as having a considerable negative impact on the quality of life. The life domains ‘freedom to eat’, ‘physical activities’, and ‘work-life’ were the most negatively impacted. Males and individuals living with diabetes for a prolonged time were associated with a more significant negative impact on quality of life. Conclusion The study showed that diabetes generally had a negative impact on QoL and identified the demand for diabetes management programs tailored to patient needs and different patient groups, as well as health policies that put patients in the center of diabetes care.

Rotavirus (RV) induced diarrhea led to hospitalization and mortality prior to the introduction of the rotavirus vaccine (RVV). The estimated RVV coverage was 86% in children less than one year of age in Pakistan. To determine the difference in the number of diarrheal episodes among children who received and who did not receive RVV, along with the parental and physician’s perspectives on the barriers toward RV immunization in children aged less than 1 year in Karachi, Pakistan. A mixed-methods study design was conducted in three Primary Healthcare (PHC) private clinics located in different districts of Karachi, Pakistan. Data for RVV status and diarrheal episodes were collected, from medical records in June 2020 for children born between October 2019 to March 2020. Three In-depth Interviews (IDIs) with physicians and three focus group discussions (FGDs) with mothers were conducted for information on awareness and approach towards diarrhea, knowledge, and acceptance of RVV, and barriers towards RV immunization. A total of 430 infants visited the three PHC centres coded as A (n = 144), B (n = 146), and C (n = 140). The mean age of infants was 2.6 ± 0.2 months, 49.5 % were males and 87 (20.2 %) were partial/not vaccinated for RV. Reported diarrheal episodes were 104 (24.2 %), and of these 76 (73.1 %) were partially or not vaccinated, and 83 (79.8 %) were stunted. Recorded diarrhea was significantly associated with partial/not vaccinated status (p < 0.001), stunting (p < 0.001), and by PHC centre location (p < 0.001). PHC-C had the lowest percentage of reported diarrhea, stunting, and non/partially vaccinated status. Qualitative study (FGDs) showed that mothers had lack of awareness and knowledge on the prevention of diarrhea by RVV. Physicians’ IDIs pointed towards a lack of sufficient training on RVV. Diarrheal episodes in infants were associated with partial or unvaccinated for RVV, low nutritional status, and areas of residence. Low levels of knowledge and awareness in caretakers and lack of training for RVV in PHC physicians were perceived as barriers in controlling diarrheal diseases.

Background The healthcare system, particularly primary care, is constantly evolving to adapt to technological innovations and demographic changes. Quality improvement (QI) initiatives are a key strategy for optimizing care processes and better meeting patient needs. However, their success depends on several contextual factors, including alignment with organizational priorities, resource availability, and stakeholder engagement. While champions are widely recognized as important for change within organizations, the specific causal relationship of their impact remain unclear. This study aims to deepen understanding of champions’ behaviours in the QI process within interdisciplinary primary care settings. Method A multiple case study was conducted using a realist evaluation approach to refine and validate the program theory. Data collection involved document analysis and individual semi-structured interviews. Context-Mechanism-Outcome (CMO) configurations were constructed to explore relationships between context (pre-existing elements shaping interventions), mechanisms (processes activated in a given context), and outcomes to iteratively refine the program theory. The study was conducted in primary healthcare clinics, the predominant model of primary care clinics in Quebec, Canada. Data were collected between 2022 and 2023 from four cases of champions in Quebec and Ontario who had implemented a change using a QI approach. Results Seven CMO configurations were observed empirically. Findings highlight that a strong coalition of champions, facilitated by cohesion, collaboration, and a shared vision, enhances mobilization. Champions influence QI by prioritizing objectives, reducing perceived effort, and leveraging data to justify change. Their leadership and credibility increase motivation, while their on-site presence helps them anticipate barriers and adapt strategies. Champions initiate small-scale testing to refine interventions and engage peers. Effective communication of results sustains momentum. Ultimately, a champion’s ability to engage the right individuals at the right time, build trust, and provide mentorship determines the success and sustainability of QI initiatives. Conclusion This study underscores the complexity of implementing change in primary care organizations. The refined program theory enhances understanding of how champions contribute to successful change implementation and how their behaviours can be adapted to local contexts to optimize outcomes. These findings support a context-sensitive approach to leveraging champions as facilitators of change.

Background The World Health Organization recommends continued breastfeeding up to 2 years of age or beyond. This study assessed breastfeeding knowledge, attitudes, and practices among women residing on the island of Abu Dhabi and identified associated factors. Methods We conducted a cross-sectional study using a self-administered questionnaire among mothers visiting primary healthcare clinics in Abu Dhabi between November 2014 and 2015. Participants were women aged at least 18 years who had at least one child aged 2 years or younger at the time of the study. Breastfeeding knowledge, attitudes, and practices were assessed on the basis of experience with last child. Selected questions were used to develop a scaled scoring system to categorize these aspects as good, fair, or poor. Exclusive breastfeeding is defined as the act of feeding infants only breast milk since birth, without providing water, formula, or other liquid supplements. Results The participants were 344 women. Exclusive breastfeeding for 6 months was reported by only 46 (16.9%, 95% CI 0.10, 0.17, n  = 272). 79 (28.7%, n  = 275) of the participants were breastfeeding and planning to continue after the child was ≥24 months. Multivariate logistic regression analysis revealed that the following factors were associated with exclusive breastfeeding: mothers with female children (adjusted OR [AOR] 2.42; 95% CI 1.18, 4.97) and better breastfeeding knowledge scores (AOR 1.25; 95% CI 1.04, 1.50). The following factors were associated with less likelihood of exclusively breastfeeding: working mothers (AOR 0.29; 95% CI 0.12, 0.72), living with relatives (AOR 0.21; 95% CI 0.05, 0.81), no past exclusive breastfeeding experience (AOR 0.23; 95% CI 0.09, 0.58) and being offered readymade liquid formula in hospital (AOR 0.33; 95% CI 0.15, 0.72). The most common reason for stopping breastfeeding was insufficient breast milk production (68/89, 76%), and the most common work related reason was inadequate maternity leave (24/89, 15%). Conclusion Although breastfeeding knowledge was generally good, breastfeeding practice was still suboptimal. Modifiable factors found to predict exclusive breastfeeding included breastfeeding knowledge and mothers’ employment status.

Background This study examined the prevalence, timing, and factors associated with breastfeeding practices among Saudi mothers. Breastfeeding is integral to infant health, and understanding cultural and demographic influences on initiation timing is crucial for developing effective interventions. Methods A cross-sectional study was conducted, recruiting 449 Saudi mothers from four primary healthcare centers in Riyadh between January 2022 and January 2023. The inclusion criteria were mothers with children under the age of two. Data were collected via a validated self-administered questionnaire. The sample size calculation considered an anticipated prevalence of 43.6% based on previous research. Ethical approval was obtained from the IRB of the King Abdullah International Medical Research Center. Results Breastfeeding prevalence was high (86.6% of mothers), which aligns with global breastfeeding promotion efforts. However, variations were observed in the initiation timing, with only 46.0% of the patients initiating breastfeeding within the first hour. While no statistically significant factors influenced initiation, notable trends emerged. Older mothers and those with lower educational levels demonstrated higher rates of early initiation, suggesting cultural and generational influences. Working mothers faced challenges with breastfeeding continuation due to the lack of designated breastfeeding time at work. Conclusion This study provides insights into the prevalence of breastfeeding practices among Saudi mothers and the factors influencing them. High breastfeeding prevalence indicates a positive cultural commitment to breastfeeding, whereas variations in initiation timing and continuation underscore the need for targeted interventions such as implementing breastfeeding clinics that inhance practice and education among mothers. Workplace support and educational campaigns are recommended to enhance breastfeeding initiation, particularly among working mothers.

BackgroundThe use of herbal medicine (HM) as a self-management practice for treating various diseases has gained popularity worldwide. Consumers co-administer herbal products with conventional medicine without the knowledge of possible herb-drug interaction (HDI).AimThis study aimed to assess patients’ perception and use of HM and their knowledge of HDI.SettingParticipants attending primary health care (PHC) clinics in three provinces (Gauteng, Mpumalanga and Free State), South Africa, were recruited.MethodsFocus group discussions comprising a total of thirty (N = 30) participants were conducted using a semi-structured interview guide. Discussions were audio-recorded and then transcribed verbatim. Data were analysed using thematic content analysis.ResultsReasons for using HM, sources of information on HM, co-administration of HM and prescribed medicine, disclosure of the use of HM, PHC nurses’ attitudes and not having time to engage were frequently discussed. Respondents’ lack of knowledge and perceptions about HDI and their dissatisfaction with prescribed medicine because of experienced side effects were also discussed.ConclusionBecause of the lack of discussions and non-disclosure about HM in PHC clinics, patients are at risk of experiencing HDIs. Primary health care providers should regularly enquire about HM use on every patient, to identify and prevent HDIs. The lack of knowledge about HDIs by patients further compromises the safety of HM.ContributionThe results highlighted the lack of knowledge of HDI by patients thus assisting the healthcare stakeholders in South Africa to implement measures to educate patients attending PHC clinics.