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

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

Katrina Ann Obas  1   2 , Ariana Bytyci-Katanolli  1   2 , Marek Kwiatkowski  1   2 , Qamile Ramadani  3 , Nicu Fota  3 , Naim Jerliu  4   5 , Shukrije Statovci  6 , Jana Gerold  2   7 , Manfred Zahorka  2   7 , Nicole Probst-Hensch  1   2
Affiliations

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

Katrina Ann Obas et al. Front Public Health. .

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.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Conceptual framework. Primary care participants exist on a disease continuum, from a healthy person to disease onset, to disease progression. Primary healthcare aims to prevent people from moving forward along the continuum. Primary, secondary and tertiary prevention strategies target people at different stages of the disease continuum. To evaluate gaps in primary, secondary and tertiary prevention in Kosovo's PHC system, our study assesses negative indicators of each stage of prevention. Specifically, it describes the prevalence of lifestyle risk factors (targets if primary prevention), as well as undetected hypertension, diabetes and chronic obstructive pulmonary disease (COPD) (targets of secondary prevention) and uncontrolled hypertension, diabetes and COPD (targets of tertiary prevention) among Kosovo PHC users. It further assesses the association between depressive symptoms and these indicators to evaluate whether depressive symptoms act as a barrier to disease prevention.
Figure 2
Figure 2
Association between depressive symptoms (continuous score) and primary, secondary and tertiary prevention negative indicators. Squares indicate the odds ratio per one-point increase in depressive symptoms. Lines indicate the 95% confidence interval. Depressive symptoms were assessed using the Depression, Anxiety, Stress Scale-21. Mixed ordinal logistic regression models quantified the association between depressive symptoms and lifestyle index. The associations between depressive symptoms and all other outcomes were quantified with mixed logistic regression models. All models included municipality as a random effect and were adjusted for age, sex, work status, education level, living in a rural or urban setting, and ethnicity with exception of alcohol, which was reduced to adjustment for only age, sex and ethnicity.
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