Primary health care in Africa: do family physicians fit in?

Maeseneer, Jan De; Flinkenflögel, Maaike

doi:10.3399/bjgp10x483977

Cited by 37 publications

(26 citation statements)

References 27 publications

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“…A likely reason for this similarity may be that they also used microcopy for assessment of gametocyte in their study. PQ on the other hand, has gametocytocidal effects on the mature gametocytes and accelerates their clearance from the circulation [16] [28]. This study showed that by day 7, gametocytes were not detected in all patients (0%) taking DHP + PQ compared to 13% (3 patients) taking DHP alone.…”

Section: Discussionmentioning

confidence: 82%

Effect of Primaquine on Gametocyte Carriage in the Case-Management of Uncomplicated Falciparum Malaria with Acts: Nigerian Perspective

Tsuung¹,

Pitmang²,

Dassak³

2018

AID

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Background: Drugs that kill or inhibit sexual stages of Plasmodium such as Primaqiune (PQ) could potentially amplify or synergize the impact of first line antimalarials by blocking transmission to mosquitoes. This study examined the effect of Primaquine on gametocyte carriage in the case management of uncomplicated falciparum malaria with artemisinin-based combination therapy (ACT) with the overall purpose of possibly recommending it as an adjunct drug for malaria control. Methods: A total of 181 patients with uncomplicated falciparum malaria, normal glucose-6-phosphate dehydrogenase (G6PD) enzyme levels, and haemoglobin levels ≥ 8 g/dL completed this two-arm randomized blinded clinical trial to test the efficacy of a single dose PQ (0.75 mg/kg) on falciparum gametocytaemia. 88 subjects were assigned to a standard 3-day course of Dihydroartemisinin-Piperaquine (DHP) alone (n = 88) while 93 others had DHP combined with a single dose of PQ on day 3 (n = 93). A 28-day follow-up schedule carried out in the outpatient clinic of a Primary health facility in Vom, Plateau State Nigeria where study participants were seen on days 1, 3, 7 and then weekly to assess the presence of asexual parasites and gametocytes by microscopy. A Kaplan-Meier analysis was employed to determine the survival function of gametocytes on day 3. The data was analyzed using Epi info version 7.1.5. Results: With a gametocyte prevalence of 27.1%, gametocyte carriage rate was lower in the PQ group due to higher probability of clearing gametocytes (Breslow test χ 2 = 8.306, df = 1, p = 0.004) and significantly less likely to harbor gametocytes by day 7 when compared to the DHP-alone group (χ 2 = 6.218, df = 1, p = 0.013). Conclusion:Addition of single-dose 0.75 mg/kg PQ was associated with reduced gameto-

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Section: Discussionmentioning

confidence: 82%

Effect of Primaquine on Gametocyte Carriage in the Case-Management of Uncomplicated Falciparum Malaria with Acts: Nigerian Perspective

Tsuung¹,

Pitmang²,

Dassak³

2018

AID

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“…45,[52][53][54] A Delphi study among African family medicine leaders demonstrated consensus and commitment toward realizing the principles of primary health care and core values of family medicine, such as person-centeredness, continuity, and coordination of care. 55 The application of these principles may differ, however, in African health systems where family physicians do not usually provide first-contact care and must acquire contextually defined competencies, such as the extended range of procedural skills required for working at the district hospital.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Family Physicians Within the South African District Health System: A Cross-Sectional Study

et al. 2018

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PURPOSE Evidence of the influence of family physicians on health care is required to assist managers and policy makers with human resource planning in Africa. The international argument for family physicians derives mainly from research in high-income countries, so this study aimed to evaluate the influence of family physicians on the South African district health system. METHODSWe conducted a cross-sectional observational study in 7 South African provinces, comparing 15 district hospitals and 15 community health centers (primary care facilities) with family physicians and the same numbers without family physicians. Facilities with and without family physicians were matched on factors such as province, setting, and size.RESULTS Among district hospitals, those with family physicians generally scored better on indicators of health system performance and clinical processes, and they had significantly fewer modifiable factors associated with pediatric mortality (mean, 2.2 vs 4.7, P = .049). In contrast, among community health centers, those with family physicians generally scored more poorly on indicators of health system performance and clinical processes, with significantly poorer mean scores for continuity of care (2.79 vs 3.03; P = .03) and coordination of care (3.05 vs 3.51; P = .02).CONCLUSIONS In this study, having family physicians on staff was associated with better indicators of performance and processes in district hospitals but not in community health centers. The latter was surprising and is inconsistent with the global literature, suggesting that further research is needed on the influence of family physicians at the primary care level.

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“…8 By doing so, family medicine may contribute to important developments, such as the development of primary health care in Africa. 9 The discipline of general practice/family medicine plays an important role in the choice between the horizontal versus vertical approach in health care. This integration between horizontal (personaland community-oriented care) and vertical (disease-oriented) care is increasingly important in developing countries.…”

Section: The Role Of Family Medicinementioning

confidence: 99%