International Posters 900 – 906
900 Testing for parasitic infections in travellers and migrants with eosinophilia in primary care
Background and Aim Despite the high prevalence of helminth parasitic infections worldwide and a highly diverse international and mobile population in London, we neglect testing for parasitic infections in primary care. Previous research has demonstrated the significance of eosinophilia in these groups with 10-73% having a parasite infection despite a majority being asymptomatic. National guidelines regarding this are available however remain unknown or not used. The purpose of this project was to assess the impact of introducing parasitic testing in high risk groups (travellers and migrants) with eosinophilia in a medium sized London GP practice.
Methodology A retrospective audit of all patients with eosinophilia demonstrated that none had been tested as per guidelines despite a large proportion having travelled or born outside the UK. Practice guidelines and a patient pop alert were introduced as well as an educational event. The audit was repeated six months later to assess impact.
Results Since the implementation of the guidelines, 33 immigrants or travellers with eosinophilia have been tested and a resulting 12 patients (36.4%) had positive parasitic serology. Three patients had combined infections, one had positive schistomiasis serology and eight patients had positive stronglyoides serology.
Conclusions Eosinophilia combined with a positive travel history is strongly indicative of asymptomatic parasitic infections and can be easily investigated in primary care. With an increasing migrant and travelling populations, there is a need to screen these high risk groups who have curable but if untreated, potentially fatal conditions.
901 Voting for better health in deprived communities
Aims/Objectives The Global Health Exchange Fellowship is a pilot project, with the aim of making global health real through experiential learning for Kenyan and UK trainees in family medicine/general practice and public health.
Content The fellows performed health needs analyses in two deprived areas- a rural Maasai community in Kenya and an inner city area in the UK. After categorising health issues into themes, these were prioritised by the community using an innovative voting methodology. The same methods were applied in both countries.
Relevance/Impact The voting methodology allowed each community a voice, on the prioritisation of themes, using the Capability Approach to source sustainable solutions. Findings were presented to local health authorities and the communities.
Outcomes A methodology of community voting was established, providing insight to the true health needs of each community.
Discussion This methodology provided new understanding from the perspective of two apparently disparate communities on challenges to health, including social determinants of health. There is potential for widespread use for community engagement. In Kenya, access to healthcare was the main priority. Had we taken an epidemiological approach, we may have found ourselves tackling specific diseases. However, the voting method identified needs, much closer to those of the community. This was particularly important in Kenya, where there was no data available. In the UK there is a wealth of numerical data, therefore this project sought to address the “Why” and the “How”, thus developing sustainable strategies to address health needs, whilst encouraging community ownership through Sen’s Capability Approach.
902 Global Health challenges- similarities between two deprived communities in a high and low income country
Background The Global Health Exchange Fellowship was a six month pilot project aimed at making global health real through experiential learning for UK and Kenyan trainees in General Practice/Family Medicine and Public Health. The multi-professional team had two consecutive placements in areas of deprivation- within a rural Maasai community in Kenya, and an inner city in the UK.
Content Using Qualitative methods, a health needs analysis was carried out in each community with the aim of improving health and reducing inequalities. Challenges to health, including socio-economic determinants, were identified and organised into themes. These themes were prioritised by the communities using an innovative voting methodology developed by the fellows. Findings were presented to the local health authorities and fed back to the communities. The Capability Approach was incorporated to encourage community ownership of solutions.
Outcomes Access to healthcare was voted as the number one priority in rural Kenya, while Education was the top priority in inner city UK. Surprisingly there were a number of similarities in the results from both communities. For instance, Gender Inequality and Culture gave us cause for concern as healthcare professionals, but these themes received the fewest votes in the “Very Important” category.
Relevance Through their participation, each fellow experienced remarkable personal and professional development.
Discussion We learned that the challenges to health facing deprived communities globally are complex but similar, and require context specific solutions which incorporate social determinants like culture and poverty. This calls for improved interdisciplinary collaboration to improve health and reduce inequalities.
903 Reasons for adherence and barriers to compliance with patient referral: Evidence from a Primary Health Care Service in a developing country
Rabia Mahmood Khan
AIMS: Identify reasons for adherence to referral and barriers to compliance by low socioeconomic patients in a developing country.
CONTENT: 500 patients, from 8 primary health clinics located in squatter areas, were referred to the referral clinic from January to May 2014. The data, updated in an electronic database, helped in coordinating appointments for specialist referrals and to assess barriers encountered and reasons for referral compliance through telephonic interviews.
OUTCOMES: 63.8% patients adhered to referral recommendations. The type of specialist referred to had significant association with referral compliance; highest for surgical subspecialists (30.7%). Most common obstacle for referral non-compliance for private and government hospitals was the unavailability of funds (17.2%) and presence of long queues (25.9%) for specialist appointments respectively. Presence of contact person at the referral facility was significantly associated with more attendance at private as compared to government hospitals.
RELEVANCE: Continuity of care is promoted through an efficient tracking system and by assisting appointment scheduling for referral compliance. This will improve healthcare delivery to the masses and decrease the burden of specialists at the tertiary care level especially in developing countries.
DISCUSSION: The referral compliance in our study is equivalent to that of developed countries 63%. The reason is the development of an electronic database to coordinate and update referral appointments. Liaison with other nonprofit organizations as well as specialists and staff at tertiary hospitals ensured better referral completion from our organisation as compared to other places in developing countries where these factors were missing.
904 RCGP skills exchange makes progress with family planning in Uganda – USHAPE
We report on exciting progress with this THET funded partnership between the RCGP and a community hospital in Uganda. The project USHAPE (Ugandan Sexual Health and Pastoral Education), aims to disseminate positive messages about modern contraception, so as to dispel fears and misconceptions and meet need for family planning.
Our published qualitative research showed that limited availability and lack of confidence in modern contraception contribute to the high rates of maternal and infant mortality. Fifteen GPs, including six long-term volunteers, have been working alongside Ugandan health workers and teachers, helping them develop their skills, so as to create a scalable model of in-service training.
Our cascade model of training equips health workers, teachers and village health teams to deliver youth outreach and sex education in schools. Our initiative is spreading: so far 86 nurses have been trained to a level equivalent to DFSRH, while 250 other health workers and 100 teachers have attended USHAPE seminars. 2,500 young people have benefitted from enhanced sex education. We are working towards the ambitious target of reducing unmet need for contraception from the current level – 40% of patients contacting a health facility, to just 10%.
We have published several papers, including an evaluation of our novel ‘Whole Institution Approach’ to training, and are undertaking research into the significant barriers to uptake of postpartum contraception. Our work has attracted the attention of both USAID and WHO who have featured our work as a ‘Success Story’ on their training resources website.
905 USHAPE – a skills exchange to address unmet need for family planning in Uganda
The Challenge Only 24% of Ugandan women use modern contraceptionTeenage pregnancy rates are highest in the world25% of maternal deaths are due to unsafe abortions. Uganda’s population is growing exponentially.
Response Since 2013, GP volunteers have been creating a cascade model whereby the health staff we train disseminate positive messages about family planning through village health workers and community leaders.
Achievements We have developed a comprehensive set of material for both basic and an advanced level of training, which have been delivered to 165 health workers. Sixty teachers receive regular training for pastoral work, and three thousand young people have benefitted from sex education lessons in schools and churches. USHAPE has started to spread to other health facilities. Over 100 staff have now been trained at Kisiizi Mission Hospital. Our work has been commended as a ‘success story’ on the WHO www.fptraining.org
The Role of Volunteers USHAPE has been evolving over the past 4 years with contributions from over 20 UK doctors and teachers, each contributing their expertise. Volunteers deliver training alongside their Ugandan USHAPE trainers, so as to equip nurses and midwives to become confident family planning providers. Want to get involved? Contact through our website www.ushape.org.uk.
906 Doctors in the Mist
Claire Marie Thomas
Aims In 2003 an outreach clinic was started in rural Uganda to serve the Batwa pygmy population, after they were displaced from the forest due to gorilla conservation. The clinic developed into a 112 bed hospital, now serving a population of 100,000. The hospital places great emphasis on primary care and community orientated interventions.In 2012 the RCGP’s Junior International Committee developed a partnership with this rural hospital (not named in this abstract due to submission guidelines) in South West Uganda to promote and support primary health care within the healthcare system. The RCGP sends two GP volunteers (one qualified, one trainee) each year.
Impact This collaboration provides the hospital with additional clinical and educational support, as well as sustainable contributions to the development of their systems and services. What makes this volunteer programme innovative is the focus on building the capacity of staff and the health system alongside clinical responsibilities.
Outcomes Volunteers are provided with unique opportunities for developing their clinical acumen whilst enhancing their skills in leadership, quality improvement, change management, research, mentoring and teaching. Perhaps most beneficial of all is the wealth of experience gained in complex communication, consultation and team building skills, as volunteers learn to navigate and manage intercultural, socioeconomic and psychosocial challenges.
Discussion Such partnerships are not merely about strengthening overseas health systems; inevitably they add strength and value to the NHS. These GPs return to the workforce with enhanced personal and professional skills, benefiting their future practice, the development of systems and services and ultimately patient care. Encouraging volunteering through institutional partnerships offers sustainable capacity building for both sendingg and receiving health systems.