Perceptions regarding the scope of practice of family doctors amongst patients in primary care settings in Nairobi

Background: Primary care (PC) is the foundation of the Kenyan health care system, providing comprehensive care, health promotion and managing all illnesses across the lifecycle. In the private sector in Nairobi, PC is principally offered by the general practitioners, also known as family doctors (FDs). The majority have no postgraduate training. Little is known about how patients perceive their capability. Aim: To assess patients’ perceptions of the scope of practice of FDs working in private sector PC clinics in Nairobi and their awareness of the new category of family physicians (FPs) and the discipline of family medicine. Setting: Private sector PC clinics in Nairobi. Methods: A descriptive survey using a structured, self-administered questionnaire. Simple random sampling was used to recruit 162 patient participants. Results: Of the participants, 30% knew the difference between FPs and FDs. There was a high to moderate confidence that FDs could treat common illnesses; provide lifestyle advice; family planning (66%) and childhood immunisations (64%). In adolescents and adults, low confidence was expressed in their ability to manage tuberculosis (58%), human immunodeficiency virus (55%) and cancer (33%). In the elderly, there was low confidence in their ability to manage depression (55%), anxiety (57%), urinary incontinence (57%) and diabetes (59%). There was low confidence in their ability to provide antenatal care (55%) and Pap smears (42%). Conclusion: Patients did not perceive that FDs could offer fully comprehensive PC services. These perceptions may be addressed by defining the expected package of care, designing a system that encourages the utilisation of PC and employing FPs

Adverse Childhood Experiences and Changing Levels of Psychosocial Distress Scores Across Pregnancy in Kenyan Women

Background: Adverse childhood experiences (ACEs) have been associated with deleterious effects on mental health in pregnancy. Methods: The ACE International Questionnaire (ACE-IQ) was used to measure neglect, abuse, and household dysfunction. Longitudinal mixed effect modelling was used to test the effect of ACEs on pregnancy-related anxiety, depressive symptoms, and perceived stress at two time points (12–19 and 22–29 weeks) during pregnancy. Results: A total of 215 women who were predominantly married (81%) and had attained tertiary education (96%) were enrolled. Total ACEs were significantly associated with depressive symptoms (r = 0.23, p \u3c 0.05) and perceived stress (r = 0.18, p \u3c 0.05). As depressive symptoms decreased, t (167) = −8.44, p \u3c 0.001, perceived stress increased, t (167) = 4.60, p \u3c 0.001, and pregnancy-related anxiety remained unchanged as pregnancy progressed. Contact sexual abuse (p \u3c 0.01) and parental death or divorce (p = 0.01) were significantly associated with depression over time (p \u3c 0.01). Total ACEs in this study were associated with depressive symptoms early but not late in pregnancy. Conclusions: Higher total ACEs were positively associated with depressive symptoms and perceived stress during pregnancy, suggesting that mental disorders may have an impact on pregnancy outcomes and ought to be addressed. Further validation of the Edinburgh Postnatal Depression Scale (EPDS) tool in local settings is required

Perceptions regarding the scope of practice of family doctors amongst patients in primary care settings in Nairobi

CITATION: Mohamoud, G. et al. 2018. Perceptions regarding the scope of practice of family doctors amongst patients in primary care settings in Nairobi. African Journal of Primary Health Care & Family Medicine, 10(1),a1818, doi:10.4102/phcfm.v10i1.1818.The original publication is available at https://phcfm.orgBackground: Primary care (PC) is the foundation of the Kenyan health care system, providing comprehensive care, health promotion and managing all illnesses across the lifecycle. In the private sector in Nairobi, PC is principally offered by the general practitioners, also known as family doctors (FDs). The majority have no postgraduate training. Little is known about how patients perceive their capability. Aim: To assess patients’ perceptions of the scope of practice of FDs working in private sector PC clinics in Nairobi and their awareness of the new category of family physicians (FPs) and the discipline of family medicine. Setting: Private sector PC clinics in Nairobi. Methods: A descriptive survey using a structured, self-administered questionnaire. Simple random sampling was used to recruit 162 patient participants. Results: Of the participants, 30% knew the difference between FPs and FDs. There was a high to moderate confidence that FDs could treat common illnesses; provide lifestyle advice; family planning (66%) and childhood immunisations (64%). In adolescents and adults, low confidence was expressed in their ability to manage tuberculosis (58%), human immunodeficiency virus (55%) and cancer (33%). In the elderly, there was low confidence in their ability to manage depression (55%), anxiety (57%), urinary incontinence (57%) and diabetes (59%). There was low confidence in their ability to provide antenatal care (55%) and Pap smears (42%). Conclusion: Patients did not perceive that FDs could offer fully comprehensive PC services. These perceptions may be addressed by defining the expected package of care, designing a system that encourages the utilisation of PC and employing FPs.https://phcfm.org/index.php/phcfm/article/view/1818Publishers versio

Is HbA1c associated with birth weight? A multivariable analysis of Pakistani pregnant women

Aim: Globally, one in seven infants is born with low birth weight and 3%–7% of infants are born with high birth weight, with the greatest burden noted in low-and middle-income countries. This study investigated the association between maternal prenatal glucose regulation and birth weight and the moderating effect of fetal sex among Pakistani women. Methods: Secondary data from a prospective longitudinal study of healthy pregnant women from Pakistan (N=189) was used. Participants provided a blood sample (12–19 weeks \u27gestational age) for the assessment of HbA1c (%). Birthweight (g) was collected following delivery. Results: Higher maternal HbA1c was associated with higher birth weight(b=181.81,t[189]=2.15,p=0.03), which was moderated by fetal sex(b=-326.27,t[189]=-2.47,p=0.02), after adjusting for gestational age at birth, ethnicity, and pregnancy weight. Among women carrying a male fetus ,every 1% increase in HbA1c predicted a 182 g increase in birth weight(b=181.81,t[189]=2.15,p=0.03). Conclusions: Results extend research from high-income countries and indicate that fetal sex may have implications for glucose regulation in early to mid-pregnancy. Future research should examine sociocultural factors, which could elucidate potential mediating factors in the relation between HbA1c and birth weight in healthy pregnancie