Global Public Health and Primary Care, Universitetet i Bergen Det medisinsk-odontologiske fakultet, Bergen, Norway.
Department of Family Medicine, School of Family Medicine and Public Health, University of Malawi, Malawi.
BMJ Open. 2019 Jul 18;9(7):e029579. doi: 10.1136/bmjopen-2019-029579.
In most African countries, primary care is delivered through a district health system. Many factors, including staffing levels, staff experience, availability of equipment and facility management, affect the quality of primary care between and within countries. The purpose of this study was to assess the quality of primary care in different types of public health facilities in Southern Malawi.
This was a cross-sectional quantitative study.
The study was conducted in 12 public primary care facilities in Neno, Blantyre and Thyolo districts in July 2018.
Patients aged ≥18 years, excluding the severely ill, were selected to participate in the study.
We used the Malawian primary care assessment tool to conduct face-to-face interviews. Analysis of variance at 0.05 significance level was performed to compare primary care dimension means and total primary care scores. Linear regression models at 95% CI were used to assess associations between primary care dimension scores, patients' characteristics and healthcare setting.
The final number of respondents was 962 representing 96.1% response rate. Patients in Neno hospitals scored 3.77 points higher than those in Thyolo health centres, and 2.87 higher than those in Blantyre health centres in total primary care performance. Primary care performance in health centres and in hospital clinics was similar in Neno (20.9 vs 19.0, p=0.608) while in Thyolo, it was higher at the hospital than at the health centres (19.9 vs 15.2, p<0.001). Urban and rural facilities showed a similar pattern of performance.
These results showed considerable variation in experiences among primary care users in the public health facilities in Malawi. Factors such as funding, policy and clinic-level interventions influence patients' reports of primary care performance. These factors should be further examined in longitudinal and experimental settings.
在大多数非洲国家，初级保健服务通过区卫生系统提供。许多因素，包括人员配备水平、员工经验、设备和设施管理的可用性，都会影响国家之间和国家内部的初级保健质量。本研究旨在评估马拉维南部不同类型的公立初级保健机构的初级保健质量。
这是一项横断面定量研究。
本研究于 2018 年 7 月在楠鄂、布兰太尔和蒂约罗区的 12 个公立初级保健设施进行。
选择年龄≥18 岁的患者（不包括重病患者）参与研究。
我们使用马拉维初级保健评估工具进行面对面访谈。采用 0.05 显著性水平的方差分析比较初级保健维度平均值和初级保健总评分。采用 95%置信区间的线性回归模型评估初级保健维度评分、患者特征和医疗保健环境之间的关联。
最终共有 962 名受访者，应答率为 96.1%。楠鄂医院的患者在初级保健总表现方面比蒂约罗卫生中心的患者高 3.77 分，比布兰太尔卫生中心的患者高 2.87 分。楠鄂的卫生中心和医院诊所的初级保健表现相似（20.9 比 19.0，p=0.608），而在蒂约罗，医院的表现高于卫生中心（19.9 比 15.2，p<0.001）。城乡设施的表现模式相似。
这些结果表明，马拉维公立初级保健机构的初级保健使用者的体验存在相当大的差异。资金、政策和诊所层面的干预等因素会影响患者对初级保健绩效的报告。这些因素应在纵向和实验环境中进一步研究。
