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  1. Fulltext Use of complementary medicine amongst diabetic patients in a public primary care clinic in Ipoh
    Remli R, Chan SC
    Med J Malaysia, 2003 Dec;58(5):688-93.
    PMID: 15190655 MyJurnal
    The use of Complementary Medicine (CM) amongst diabetic patients attending the Diabetes/Hypertension, Clinic. Out Patient Department, Ipoh Hospital was studied: Forty-three patients were selected by systematic random sampling (1:5) over a one-week period starting 5/12/01. Data were collected by patient interview, from medical records and through a questionnaire. 56% were using CM together with conventional therapy. Most commonly used were herbal therapy, homeopathy and reflexology. The majority took CM daily with a mean duration of 7 years. Over half had subjective relief of pain with increased energy. Patients on CM or conventional therapy both showed poorly controlled FBS levels. There is a need to assess the effect of these therapies on diabetic outcome.
    Study site: Diabetes/Hypertension, Clinic. Out Patient Department, Hospital Ipoh, Perak, Malaysia
    Matched MeSH terms: Primary Health Care
  2. Fulltext Effectiveness of screening and brief intervention for alcohol misuse and risky drinking in Kota Kinabalu
    Wenda Riona Lamiri, Lily Shuzeen Kimin, Constance Liew Sat Lin, Alvin Oliver Payus, May Zaw Soe, May Honey Ohn, et al.
    Malaysian Journal of Medicine and Health Sciences, 2019;15(106):57-57.
    MyJurnal
    Introduction:Alcohol is a major factor that can affect many aspects of life. The prevalence of current drinker in Malaysia aged 13 years old and above was 7.7% as reported by NHMS 2015. Sabah was ranked the third in highest consumption of alcohol in Malaysia, at 18.4% after Kuala Lumpur 20.3% and Sarawak 19.7%. The aim of the study is to investigate prevalence of different types of drinkers and identify demographic characteristic of drinkers in Kota Kinabalu (KK). This study also aims to investigate the effectiveness of screening and brief intervention in reduction of alcohol consumption and risky drinking in KK. Methods: A cross-sectional study was done where the data were col-lected from seven different areas in KK, selected by stratified and simple randomized sampling. Alcohol Use Disorder Identification Test (AUDIT) questionnaire translated and validated in Malay version by Unit Terjemahan Universiti Malaya was used. AUDIT score was calculated and brief intervention was given accordingly and scoring was then repeated after three months. The intervention applied was based on Guideline on Risk Assessment and Primary In-tervention in Alcohol Harm, published by Ministry of Health Malaysia in 2010. Results: The age range of population studied is from 13 to 85 years old with 243 males and 230 females. Out of the 473 participants, 13.1% adolescent, 37.6% young adulthood, 36.4% middle adulthood and 12.9% in late adulthood. We observed that the male mean weight was 68.27±12.72kg versus 58.86±12.45kg mean weight in female. The prevalence of drinkers – 3.6% depen-dent drinkers, 22.2% high risk drinkers, 36.2% low risk drinker while the remaining 38.1% are abstainers. Majority of consumers were practicing low-risk drinking pattern which highlighted the need for prevention and harm minimiza-tion programme. Paired sample t-test shows that the decrease in AUDIT three months after intervention is statistically significant. Conclusion: This study conducted in KK suggests that screening coupled with brief intervention can help reduce alcohol misuse and risky drinking and should be practiced in all primary healthcare facilities.
    Matched MeSH terms: Primary Health Care
  3. A child with elbow pain
    Mat Yudin ZA, Wan Ahmed WA, Chanmekun SB
    Malays Fam Physician, 2019;14(2):44-45.
    PMID: 31827738
    Elbow injuries are common in children. Supracondylar fractures occurred in 16% of all pediatric fractures. Supracondylar fractures can be classified into 4 types according to the Gartland classification, depending on the degree of the fracture present in the lateral radiograph. This case highlights the case of a child with a Gartland Type I fracture. A misdiagnosis of this fracture will compromise the management of the injury with regards to immobilization and subsequent care. As this injury can be managed on an outpatient basis, primary care frontliners need to be aware of the condition.
    Matched MeSH terms: Primary Health Care
  4. Fulltext Intention to seek medical consultation for symptoms of upper respiratory tract infection – a cross-sectional survey
    Tan CE, Mohd Roozi AH, Wong WHR, Sabaruddin SAH, Ghani NI, Che Man Z
    International Medical Journal Malaysia, 2015;14(2):9-16.
    MyJurnal
    Introduction: The common cold is the commonest reason for primary care encounters worldwide. This paper aims to describe the reasons that influence patients to seek medical consultation for the common cold.
    Methods: This was a cross-sectional survey conducted among adult patients of an urban teaching primary care clinic. An adapted bilingual survey form was administered by the researchers to obtain data regarding their decision to seek medical consultation for a cold and the reasons for their decision. Quantitative analyses were done to describe the close-ended responses. Open-ended responses were analysed using a qualitative approach and
    the frequencies of the themes were reported. Results: A total of 320 respondents participated in this study, with a response rate of 91.4%. They were predominantly females (59.4%), Malay (70.9%), and had tertiary education (65.9%). More than half of the patients (52.5%) said they would seek consultation for cold symptoms. Fever was the commonest symptom (57-61%) which compelled them to seek consultation. The commonest reason for seeking consultation was to get medications (41.7%), whereas the commonest reason not to seek consultation was the practice of self-medication (44.2%). Ethnicity was found to be significantly associated with the decision to seek doctor’s consultation.
    Conclusion: Colds are usually self-limiting and do not result in complications. Empowering
    patients by providing appropriate self-care knowledge can help to reduce the burden of primary care services.
    Patients should be taught about red flag symptoms as well as drug safety for medications commonly taken for
    colds.
    Keywords: Upper respiratory tract infections, patient acceptance of health care, primary health care.
    Matched MeSH terms: Primary Health Care
  5. Health and nutrition of the Orang Asli: The need for primary health care amidst economic transformation
    Chee HL
    Indigenous Minorities of Peninsular Malaysia: Selected Issues and Ethnographies, 1996.
    Citation: Chee HL. Health and nutrition of the Orang Asli: The need for primary health care amidst economic transformation. In: Abd Rashid MR (editor). Indigenous Minorities of Peninsular Malaysia: Selected Issues and Ethnographies. Kuala Lumpur : Intersocietal and Scientific; 1995, p48-73
    Matched MeSH terms: Primary Health Care
  6. Fulltext Diabetes Care in Malaysia: Problems, New Models, and Solutions
    Hussein Z, Taher SW, Gilcharan Singh HK, Chee Siew Swee W
    Ann Glob Health, 2016 4 25;81(6):851-62.
    PMID: 27108152 DOI: 10.1016/j.aogh.2015.12.016
    BACKGROUND: Diabetes is a major public health concern in Malaysia, and the prevalence of type 2 diabetes (T2D) has escalated to 20.8% in adults above the age of 30, affecting 2.8 million individuals. The burden of managing diabetes falls on primary and tertiary health care providers operating in various settings.

    OBJECTIVES: This review focuses on the current status of diabetes in Malaysia, including epidemiology, complications, lifestyle, and pharmacologic treatments, as well as the use of technologies in its management and the adoption of the World Health Organization chronic care model in primary care clinics.

    METHODS: A narrative review based on local available health care data, publications, and observations from clinic experience.

    FINDINGS: The prevalence of diabetes varies among the major ethnic groups in Malaysia, with Asian Indians having the highest prevalence of T2D, followed by Malays and Chinese. The increase prevalence of overweight and obesity has accompanied the rise in T2D. Multidisciplinary care is available in tertiary and primary care settings with integration of pharmacotherapy, diet, and lifestyle changes. Poor dietary adherence, high consumption of carbohydrates, and sedentary lifestyle are prevalent in patients with T2D. The latest medication options are available with increasing use of intensive insulin regimens, insulin pumps, and continuous glucose monitoring systems for managing glycemic control. A stepwise approach is proposed to expand the chronic care model into an Innovative Care for Chronic Conditions framework to facilitate implementation and realize better outcomes in primary care settings.

    CONCLUSIONS: A comprehensive strategy and approach has been established by the Malaysian government to improve prevention, treatment, and control of diabetes as an urgent response to this growing chronic disease.

    Matched MeSH terms: Primary Health Care/methods*
  7. Fulltext Prevalence of overweight and obesity among primary healthcare workers in Perak, Malaysia
    Low, Pei Kit, Hazizi Abu Saad, Rosita Jamaluddin, Chee, Huei Phing
    IIUM Medical Journal Malaysia, 2020;19(1):23-30.
    MyJurnal
    Introduction: Overweight and obesity has been emerging as one of the most common and preventable
    nutritional problems worldwide. In 2016, 39% and 13% of the adult population worldwide was classified as
    overweight and obese, respectively. Materials and Methods: We conducted a cross-sectional study at 12
    selected health clinics in Perak, Malaysia, and we used multi-stage cluster random sampling to determine the
    prevalence of overweight and obesity among the primary healthcare workers and the associate factors of
    obesity indices. Each respondent was required to complete a self-administered questionnaire on their sociodemographic characteristics. In addition, we took anthropometric measurements, including height, weight,
    BMI, waist circumference, and body fat percentage, of the participants. Results: We recruited 261 primary
    healthcare workers. Overall, 49.9% of the healthcare workers were overweight or obese, 51.0% were at risk
    of having abdominal obesity, and 79.6% had a high body fat percentages. Age and self-reported health status
    were significantly associated with all the obesity indices. Educational level showed significant association
    with BMI and waist circumference, while occupational status showed an association only with BMI. Older age
    and professionals were predictors for high obesity indices. Conclusion: The prevalence of obesity among the
    primary healthcare workers was higher than among the general population. An immediate intervention
    programme is needed to reduce the prevalence of overweight and obesity among primary healthcare
    workers.
    Matched MeSH terms: Primary Health Care
  8. Fulltext Health care in Sarawak's jungles
    Chen PCY
    World Health Forum, 1989;10(2):190-2.
    PMID: 2610830
    A primary health care system is being developed in Baram District, Sarawak, Malaysia, for the benefit of the Penans, who, until recently, were largely nomadic. Many of them are now attempting to adopt a settled mode of existence, and this in itself creates special health problems because the people lack the skills needed for living in one place. Substantial progress has already been achieved in mother and child care and in immunization coverage.
    Matched MeSH terms: Primary Health Care*
  9. Developing primary health care for a nomad tribe: the Penans of the Baram
    Chen PCY
    Asia Pac J Public Health, 1987;1(1):34-7.
    PMID: 3452377 DOI: 10.1177/101053958700100109
    Unlike much of Peninsular Malaysia, the Baram District of Sarawak remains sparsely populated and underserved, one of the most underserved peoples being the nomadic and semi-nomadic Penans of the Baram. Until quite recently these Penans lived as small nomadic bands of hunter-gatherers. More recently, they have begun to settle in longhouses. However, lacking the necessary skills to live a settled mode of life, these Penans suffer a great deal of hunger, malnutrition, disease and death. Primary health care with its emphasis on the seven essential elements, including food production and nutrition, environmental sanitation, good maternal and child health, knowledge of disease and how it can be prevented as well as the treatment and control of locally endemic diseases, is of critical value in the survival of the semi-nomadic Penans. The specially designed primary health care programme for the Penans of the Baram is outlined briefly in this paper.
    Keyword: Baram, Penans, Primary Health Care, Sarawak, Village Health Promoter.
    Matched MeSH terms: Primary Health Care/organization & administration*
  10. People, behavioural patterns and disease problems
    Chen PCY
    Family Practitioner, 1977;2:36-38.
    In the behavioural conceptual model of health education, behavioural pattern is placed first in the chain of events which can lead from health to disease. If such a model is acceptable, it implies that primary health education must be directed at those behavioural patterns that pre-dispose to diseases. There are obviously numerous behavioural patterns that one is familiar with which would pre-dispose to diseases. The paper discussed some of the more important examples to illustrate the role of behavioural patterns in the causation of disease and the consequential need for health education directed at such behavioural patterns. In relation to nutritional diseases, behavioural patterns in many areas of the developing world are a major contributory factor to the prevalence of protein calorie malnutrition. Such dietary restrictions may even cause the sick individual to be denied the very food he requires. Examples of behavioural patterns in relation to communicable and non-communicable diseases and to medical care were also discussed.
    Matched MeSH terms: Primary Health Care
  11. A Case of Severe Falciparum Malaria in a Returned Traveler
    Low QJ, Lau WK, Lim TH, Lee RA, Cheo SW
    Malays Fam Physician, 2020;15(3):86-89.
    PMID: 33329868
    Primary care providers should be alert to travel-related infections. Around 10-40% of returning travelers from all destinations and 15-70% of travelers from tropical settings experience ill health, either overseas or upon returning home.1 A systematic approach concentrating on possible infections should be undertaken based on the patient's travel location, immunization history, presence of malaria chemoprophylaxis at the destination, other potential exposures, incubation period, and clinical presentation.2-3 The World Health Organization (WHO) website is constantly being updated on specific travel-related infections and recent geographical outbreaks. In this paper, we report a case of severe falciparum malaria in a returned traveler.
    Matched MeSH terms: Primary Health Care
  12. Fulltext Delay in diagnosis of lung cancer: a case report
    Ching SM, Chia YC, Cheong AT
    Pertanika Journal of Science & Technology, 2014;22(2):587-592.
    MyJurnal
    This case report highlights delay in the diagnosis of adenoma carcinoma of the lung in a female patient who has never smoked. It took three months to reach the diagnosis of stage IV lung carcinoma despite the presence of symptoms and an abnormal chest radiograph finding from the beginning. The clinical characteristics and predictors of missed opportunities for an early diagnosis of lung cancer are discussed. In this case, patient and doctor factors contributed to the delay in diagnosis. Thus, early suspicions of lung cancer in a woman with the presence of respiratory symptoms despite being a non-smoker are important in primary care setting.
    Matched MeSH terms: Primary Health Care
  13. Fulltext Prevalence and related factors of depression among healthcare personnel at primary healthcare centers
    Eusof Izzudin MP, Al–Bedri A, Subramaniam V, Matthews P, Cheong AT
    Malaysian Journal of Medicine and Health Sciences, 2018;14(Special 2):32-36.
    MyJurnal
    Depressive disorders are common. As compared to the general population, healthcare personnel are hypothesized to have an above than average risk to develop this condition. The aim of this study is to assess the prevalence of this condition and its contributing factors amongst primary healthcare personnel.
    Methods: A cross-sectional study was conducted by universally sampling 179 primary healthcare personnel at nine primary healthcare centers across Kuala Lumpur and Selangor in May 2015. Depressive symptoms were screened using self-administered Patient Health Questionnaire-9 (PHQ-9) questionnaire. Socio-demographic and work profile data were also assessed.
    Results: 92.7% of the 179 personnel agreed to participate. Near half of the respondents were staff nurses (49%), followed by doctors (22%), assistant medical officers (10%), attendants (10%) and the remaining were pharmacists, dieticians, and laboratory technicians (9%). Depression was found to be present in 38% of the participants with one-third found to have moderate to severe depression. Bivariate analysis show that males (p=0.043), assistant medical officers (p=0.048), and working more than 10 hours per day (p=0.019) are significant risk factors. Further analysis by logistic regression shows that working more than 10 hours per day increases the odds of depression by 3.1 (OR 3.1, 95% CI 1.1-8.7, p=0.03).
    Conclusions: A high prevalence of depression was found within the healthcare personnel population at the primary healthcare centres studied. Being a male, employed as an assistant medical officer, and, prolonged hours at the workplace is a significant risk factor for depression.
    Matched MeSH terms: Primary Health Care
  14. Fulltext Prevalence of microvascular complications in newly diagnosed type 2 diabetes mellitus in primary healthcare clinics
    Wong WL, Valliappan VN, Leong MC, Aminudin SNA, Chew SCJ, Cheong AT
    Malaysian Journal of Medicine and Health Sciences, 2020;16(2):237-243.
    MyJurnal
    Introduction: Delayed diagnosis of type 2 diabetes mellitus (T2D) increases the risk of presenting late with microvas- cular complications due to untreated long-standing hyperglycaemia. This study aimed to determine the prevalence of microvascular complications in newly diagnosed T2D patients in primary healthcare clinics.
    Methods: This was a cross-sectional study carried out in three government primary healthcare clinics in the state of Selangor, Malaysia. Malaysian aged 18 years and above with newly diagnosed T2D (<6 months of diagnosis) were invited to participate in the study. Data collected included the sociodemographic characteristic and the clinical profile (weight, height, waist circumference, blood pressure, lipid, glycaemic, urine albumin, microalbuminuria and renal profile). The assessment of nephropathy, peripheral neuropathy and retinopathy were performed using standard protocol. Multivariate logistic regression analysis was used to identify the significant factors that contribute to the presence of microvascular complications.
    Results: A total of 162 newly diagnosed patients were recruited. The majority was women (64%). The mean age was 51 (SD 11) years. About one-third of the patients (27.7%) had developed at least one microvascular complication. Nephropathy was the commonest microvascular complication (19.2%), followed by peripheral neuropathy (8.6%) and retinopathy (6.5%). Poor glycaemic control was found to be a significant factor contributing to the presence of microvascular complications (OR 5.8, 95%CI:1.466, 23.288).
    Conclusion: There is a high prevalence of microvascular complications among the newly diagnosed T2D. There is a need to develop appropriate strategies to increase the awareness and early detection of T2D.
    Study site: three Klinik Kesihatan, Selangor, Malaysia
    Matched MeSH terms: Primary Health Care
  15. Fulltext Metabolic control and cardiovascular risk factors among type 2 diabetes in a primary care clinic
    Cheong AT, Ahmad Z, Chew BH
    Malaysian Journal of Medicine and Health Sciences, 2012;8(1):5-12.
    MyJurnal
    Prevalence of diabetes is escalating both globally as well as in Malaysia. With the epidemic of diabetes and its related morbidities and mortalities, health care professionals are facing an unprecedented challenges in controlling the disease. Objective: To determine the metabolic control and the cardiovascular risk factors among type 2 diabetic patients in a primary care setting. Method: This was a cross sectional study conducted in a primary care clinic in Selangor, Malaysia. Inclusion criteria were all type 2 diabetic patients aged 18 and above and were being followed-up for more than six months prior to the recruiting period in May 2009. The demographic data were obtained through face- to-face interview. Height, weight and blood pressure of the patients were taken during the day of data collection. The co-morbidities and laboratory results were obtained from the medical records. Results: Two-hundred patients were recruited. The mean age was 58.6 (SD=10.5) with 79.0% of the patients aged more than 50 years old. The majority of the patients were female (62.5%). One-tenth (11.5%) were smokers. More than half of the patients (64.0%) had co-morbid of hypertension and half of them (50.5%) had dyslipidaemia. A total of 72.5% of the patients had 3 or more cardiovascular risk factors. Less than one fifth of the patients had achieved the target of control for glycaemia, blood pressure, LDL and BMI. Those age 60 and above had significantly higher proportion of patients achieving fasting blood glucose control (p=0.033). Conclusion: The majority of type 2 diabetic patients had multiple cardiovascular risk factors (3 or more risk factors) and had not achieved the recommended goals in
    metabolic control.
    Matched MeSH terms: Primary Health Care
  16. Fulltext Detection of airflow limitation using a handheld spirometer in a primary care setting
    Ching SM, Pang YK, Price D, Cheong AT, Lee PY, Irmi I, et al.
    Respirology, 2014 Jul;19(5):689-93.
    PMID: 24708063 DOI: 10.1111/resp.12291
    BACKGROUND AND OBJECTIVE: Early diagnosis of chronic obstructive pulmonary disease (COPD) in primary care settings is difficult to achieve chiefly due to lack of availability of spirometry. This study estimated the prevalence of airflow limitation among chronic smokers using a handheld spirometer in this setting.
    METHODS: This is a cross-sectional study performed on consecutive patients who were ≥40 years old with ≥10 pack-years smoking history. Face-to-face interviews were carried out to obtain demographic data and relevant information. Handheld spirometry was performed according to a standard protocol using the COPd-6 device (Model 4000, Vitalograph, Ennis, Ireland) in addition to standard spirometry. Airflow limitation was defined as ratio of forced expiratory volume in 1 s (FEV1 )/forced expiratory volume in 6 s <0.75 (COPd-6) or FEV1 /forced vital capacity <0.7. Multiple logistic regression analyses were used to determine predictors of airflow limitation.
    RESULTS: A total of 416 patients were recruited with mean age of 53 years old. The prevalence of airflow limitation was 10.6% (n = 44) with COPd-6 versus 6% as gauged using standard spirometry. Risk factors for airflow limitation were age >65 years (odds ratio (OR) 3.732 95% confidence interval (CI): 1.100-1.280), a history of 'bad health' (OR 2.524, 95% CI: 1.037-6.142) and low to normal body mass index (OR 2.914, 95% CI: 1.191-7.190).
    CONCLUSIONS: In a primary care setting, handheld spirometry (COPd-6) found a prevalence of airflow limitation of ∼10% in smokers. Patients were older, not overweight and had an ill-defined history of health problems.
    KEYWORDS: Malaysia; chronic obstructive pulmonary disease; prevalence; primary care; smoke
    Study site: Public primary health‐care clinic (Klinik Kesihatan), Sepang District, Selangor, Malaysia
    Matched MeSH terms: Primary Health Care/methods*
  17. Fulltext Healthcare in Asia: a perspective from primary care at the gateway to a continent
    Jiwa M, Othman S, Hanafi NS, Ng CJ, Khoo EM, Chia YC
    Qual Prim Care, 2012;20(5):317-20.
    PMID: 23113999
    Malaysia has achieved reasonable health outcomes even though the country spends a modest amount of Gross Domestic Product on healthcare. However, the country is now experiencing a rising incidence of both infectious diseases and chronic lifestyle conditions that reflect growing wealth in a vibrant and successful economy. With an eye on an ageing population, reform of the health sector is a government priority. As in other many parts of the world, general practitioners are the first healthcare professional consulted by patients. The Malaysian health system is served by public and private care providers. The integration of the two sectors is a key target for reform. However, the future health of the nation will depend on leadership in the primary care sector. This leadership will need to be informed by research to integrate care providers, empower patients, bridge cultural gaps and ensure equitable access to scarce health resources.
    Matched MeSH terms: Primary Health Care/economics; Primary Health Care/standards; Primary Health Care/trends*
  18. Primary care medicine training in the undergraduate curricula--the UM experience
    Chia YC
    Med J Malaysia, 2002 Dec;57 Suppl E:83-5.
    PMID: 12733199
    Matched MeSH terms: Primary Health Care*
  19. Communication skills teaching in primary care medicine
    Hanafi NS, Chia YC
    Med J Malaysia, 2002 Dec;57 Suppl E:74-7.
    PMID: 12733197
    The teaching of clinical communication skills to undergraduate medical students in the Faculty of Medicine, University of Malaya is described. It is a continuous process throughout the five-year medical curriculum which is divided into Phases I, II and III. Students are introduced to communication skills early in Phase I through an interactive session as well as a workshop on general communication skills. In Phase II, small-group two-day workshops cover the basic principles of clinical communication skills using videotapes, group discussion and role-plays. Direct contact between students and patients in actual clinical setting begin in Phase IIIA. Communication skills teaching with feedback training is carried out by videotaping the consultations. In Phase IIIB the two-way mirror is utilized as well as having workshops on certain difficult areas such as 'breaking bad news' and 'taking a sexual history'. Formal assessment is done by evaluating the behavior, language and actual interview content.
    Matched MeSH terms: Primary Health Care*
  20. Fulltext The prevalence of diabetic peripheral neuropathy in an outpatient setting
    Mimi O, Teng CL, Chia YC
    Med J Malaysia, 2003 Oct;58(4):533-8.
    PMID: 15190629
    This study was undertaken to clinically estimate the prevalence of diabetic peripheral neuropathy amongst patients attending an outpatient clinic and to evaluate their risk factors for developing peripheral neuropathy. It was a cross-sectional study of 134 diabetes mellitus patients who attended the Primary Care Clinic, University Hospital, Kuala Lumpur. The patients were interviewed for their demographic data, past and present medical/surgical history, social history, personal habits and symptoms of peripheral neuropathy. Foot examination and clinical neurological tests were conducted and the presence of peripheral neuropathy was assessed. The main outcome measures were the Neuropathy Symptom Score and the Neuropathy Disability Score. The prevalence of diabetic peripheral neuropathy was found to be 50.7%. Peripheral neuropathy was related to the age of the patient and the duration of diabetes but did not seem to be significantly related to diabetic control. To conclude, there was a high prevalence of peripheral neuropathy amongst the diabetics in this study. These patients developed peripheral neuropathy at a younger age and shorter duration of diabetes compared to a similar study that was done in the UK.
    Study site: Primary care clinc, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    Matched MeSH terms: Primary Health Care
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