Strengthening Primary Healthcare in Kosovo Requires Tailoring Primary, Secondary and Tertiary Prevention Interventions and Consideration of Mental Health

Katrina Ann Obas; Ariana Bytyci-Katanolli; Marek Kwiatkowski; Qamile Ramadani; Nicu Fota; Naim Jerliu; Shukrije Statovci; Jana Gerold; Manfred Zahorka; Nicole Probst-Hensch

doi:10.3389/fpubh.2022.794309

Strengthening Primary Healthcare in Kosovo Requires Tailoring Primary, Secondary and Tertiary Prevention Interventions and Consideration of Mental Health

Front Public Health. 2022 Apr 5:10:794309. doi: 10.3389/fpubh.2022.794309. eCollection 2022.

Authors

Katrina Ann Obas^{1

2}, Ariana Bytyci-Katanolli^{1

2}, Marek Kwiatkowski^{1

2}, Qamile Ramadani³, Nicu Fota³, Naim Jerliu^{4

5}, Shukrije Statovci⁶, Jana Gerold^{2

7}, Manfred Zahorka^{2

7}, Nicole Probst-Hensch^{1

2}

Affiliations

¹ Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
² University of Basel, Basel, Switzerland.
³ Accessible Quality Healthcare Project, Prishtina, Kosovo.
⁴ National Institute of Public Health, Prishtina, Kosovo.
⁵ Medical Faculty, University of Prishtina, Prishtina, Kosovo.
⁶ University Clinical Centre of Kosovo, Prishtina, Kosovo.
⁷ Swiss Center for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.

Abstract

Objectives: Kosovo has the lowest life expectancy in the Balkans. Primary healthcare (PHC) plays an essential role in non-communicable disease (NCD) prevention. We described primary, secondary and tertiary prevention indicators in Kosovo and assessed their association with depressive symptoms.

Methods: PHC users (n = 977) from the Kosovo NCD cohort baseline study were included. Depressive symptoms were assessed using the Depressive Anxiety Stress Scale-21. Cross-sectional associations between depressive symptoms and prevention indicators were quantified with mixed logistic regression models.

Results: Poor nutrition (85%), physical inactivity (70%), obesity (53%), and smoking (21%) were common NCD risk factors. Many cases of hypertension (19%), diabetes (16%) and Chronic Obstructive Pulmonary Disease (COPD) (45%) remained undetected by a PHC professional. Uncontrolled hypertension (28%), diabetes (79%), and COPD (76%) were also common. Depressive symptoms were positively associated with physical inactivity (OR 1.02; 95% CI 1.00-1.05 per 1-point increase in DASS-21) and undetected COPD (OR 1.07; 95% CI 1.00-1.15), but inversely with undetected diabetes (OR 0.95; 95% CI 0.91-1.00).

Conclusions: Continued attention and tailored modifications to primary, secondary and tertiary prevention in Kosovo are needed to narrow the Balkan health gap.

Keywords: COPD; depressive symptoms; diabetes; hypertension; prevention; public health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Depression / diagnosis
Depression / epidemiology
Diabetes Mellitus* / epidemiology
Diabetes Mellitus* / prevention & control
Humans
Hypertension*
Kosovo / epidemiology
Mental Health
Noncommunicable Diseases*
Primary Health Care
Pulmonary Disease, Chronic Obstructive* / complications
Pulmonary Disease, Chronic Obstructive* / epidemiology
Pulmonary Disease, Chronic Obstructive* / prevention & control
Tertiary Prevention