Background: Primary care quality in Benin was assessed using various tools, but without a focus on the core functions. Aim: To assess the core functions of primary care in the health district Abomey-Calavi – So-Ava. Setting: The study was conducted in primary care facilities in the Abomey-Calavi – So-Ava health district, Benin. Methods: This was a descriptive cross-sectional survey that used the validated primary care assessment tool (PCAT) for sub-Saharan Africa. Data were collected from 399 randomly selected patients across 27 health facilities using the PCAT via the REDCap mobile application. Univariate and bivariate statistical analyses were conducted using R software. Results: Affiliation to the facilities was high among 47.1% of users. Users globally rated the health district’s primary care performance as average. Health system coordination was scored as poor. First-contact access, first-contact utilisation, comprehensiveness, continuity of care, and coordination – information system were scored as average. Only the person-centred care domain was scored as good. Those who rated their health as good or excellent tended to give higher scores. Also, users of private facilities reported slightly higher score than users of public facilities. Conclusion: The performance of primary care was globally scored as average. This PCAT looks useful for assessing the core functions of primary care and provided novel information on performance. Contribution: This study demonstrates how the sub-Saharan African version of the PCAT can be used to generate context-specific evidence on the performance of core primary care functions at district level.
Background: Distributed training in undergraduate health professions education offers challenges and opportunities. Benefits include integration into healthcare teams, continuity of care and meaningful contributions to local healthcare systems. However, challenges such as human resource constraints, limited clinical training expertise and social support issues persist. Interprofessional education (IPE) is often easier to implement in smaller rural clinical placements, although these challenges tend to be more pronounced in such contexts. Aim: This study aimed to explore IPE within rural training platforms and to develop an interprofessional person, people and place (IP3) framework to support collaborative practice. Setting: The study was conducted on two rural training platforms in South Africa involving undergraduate students from multiple health professions. Methods: A qualitative study with an interpretivist approach was used to explore IPE experiences. Sixteen semi-structured interviews were conducted with participants from five different health professions in 2022 and 2023. Data were analysed using thematic and narrative methods with support from an independent researcher to enhance reflexivity and rigour. Results: Students on rural multiprofessional training platforms experienced formal and informal interprofessional learning opportunities influenced by intersectionality and pedagogy that shaped their practice as graduates. Collaborative practice continued to be influenced by intersectionality in the workplace. Conclusion: The study resulted in the development of the IP3 framework, which emphasises contextual transformative learning and intersectionality across curricular, co-curricular and extracurricular levels. Contribution: This framework provides a foundation for institutions seeking to introduce or expand IPE during distributed clinical training. It also contributes to the theoretical understanding of intersectionality and transformative learning in IPE.
Background: Globally, 14.3 million children remain unvaccinated, with a large proportion residing in low- and middle-income countries, including Nigeria. Despite ongoing efforts to improve immunisation coverage, substantial gaps in uptake persist. Aim: This study assessed caregivers’ perceptions of routine immunisation service performance across five domains: availability, accessibility, quality of care, responsiveness and satisfaction in Adamawa State, Nigeria. Setting: Ten Local Government Areas in Adamawa State, Nigeria. Methods: A mixed-methods study combining a descriptive cross-sectional survey with qualitative in-depth interviews was conducted among caregivers of children under 5 years in 10 purposively selected local government areas (LGAs) in Adamawa State. Quantitatively, 685 caregivers were selected using probability proportional to size sampling from catchment settlements of supported facilities. Qualitatively, 120 caregivers (12 per LGA) were purposively selected for in-depth interviews. Data were collected using a community scorecard and a structured interview guide. Results: Routine immunisation performance varied across LGAs and domains. Guyuk recorded the highest scores for availability (81.3), quality of care (84.6), responsiveness (81.3), and satisfaction (89.2), while Toungo recorded the lowest scores across most domains. Accessibility demonstrated the greatest variability, with lower scores observed in Fufore, Numan and Toungo. Qualitative findings showed that respectful communication, perceived vaccine benefits and positive provider interactions enhanced caregiver satisfaction, while delays, travel burden and poor queue management reduced service experience. Conclusion: Improving session timeliness, health worker availability, vaccine supply and respectful communication may strengthen routine immunisation uptake and equity, particularly in lower-performing LGAs. Contribution: This study provides community-level evidence on routine immunisation service experience and satisfaction.
Background: Breast cancer, one of the most prevalent cancers worldwide, poses a significant health burden, particularly in low- and middle-income countries (LMICs). Despite advances in treatment, breast cancer survivors in LMICs face unique challenges, including post-mastectomy pain syndrome (PMPS). Aim: This systematic review synthesises evidence on PMPS prevalence, characteristics, and management in LMICs. Method: We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. We searched PubMed, CENTRAL, Embase, Web of Science, Global Index Medicus, and supplementary grey-literature sources for studies of PMPS conducted in LMICs. Eligible studies were screened in duplicate, data were extracted using a piloted form, and methodological quality was assessed using design-specific Joanna Briggs Institute critical checklists and the Mixed Methods Appraisal Tool for mixed-methods studies. Owing to substantial heterogeneity in study design, findings were synthesised narratively. Results: Findings revealed significant variability in its prevalence. Pain was mostly mild, located in the axilla, chest wall, and ipsilateral arm, neuropathic in nature, and exacerbated by physical exertion. Key risk factors include younger age, obesity, extensive surgical procedures, and adjuvant therapies. Treatment strategies encompass simple analgesics, nerve blocks, sympathetic denervation, and advanced techniques, highlighting a multifaceted approach to managing PMPS effectively. Conclusion: Post-mastectomy pain syndrome remains a complex challenge, requiring ongoing research to refine diagnostics, understand underlying mechanisms, and develop personalised treatments to improve patient outcomes. Contribution: This review synthesises evidence on the prevalence, characteristics, risk factors, and treatment options for PMPS, providing knowledge to guide evidence-based clinical interventions and improve patient outcomes.
