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Poor knowledge among caretakers of how to work with disability-related disorders could also be an issue. For example, poor knowledge of how to correctly position a child with severe cerebral palsy could lead to inadequate feeding; at worst, these efforts can cause aspiration and even death. Social and cultural beliefs and practices can lead to or exacerbate an already fragile nutritional state. For example, the choice not to breastfeed neonates with visible disabilities is a form of traditional infanticide practised in some communities. In other communities, stigma and discrimination mean that a child or adult with a disability is denied food or offered less food than other household members. Some disabilities might increase nutritional needs (eg, nutritional supplementation is associated with reduced pressure sores after stroke).
Paradoxically, although primary care is the setting in which most care is provided, in the context of deliberations on patients\' safety and reduction of the burden of iatrogenic harm, most attention has hitherto been focused on specialist care settings. Promotion of universal health coverage has recently emerged as a key priority for WHO and its member states, and provision of accessible and safe primary care is regarded as essential to meet this important international policy goal. The release of the deliberations from WHO\'s inaugural Safer Primary Care Expert Working Group is intended to help redress this imbalance by signifying WHO\'s intention to stimulate international action to support the delivery of safer primary care. This begs the question of why, more than a decade after the issue was raised, so little progress has been made in primary care. This situation can partly be explained by the fact that the findings from original studies showing the high frequency of medical errors and associated morbidity were all undertaken in hospital settings. These landmark epidemiological investigations first alerted the international buy GSK1324726A to key areas of concern in hospital care provision and resulted in a range of government-backed policy and research initiatives, which have in turn helped to create an important new discipline of enquiry. Studies have evolved from initial descriptive work aiming to assess the frequency of errors to, more recently, randomised controlled trials, which are now testing interventions designed to enhance patients\' safety. A second key reason for the inattention to primary care is that it is sometimes perceived as less risky than secondary care. This situation is indicative of a failure to distinguish between relative and absolute measures of risk. Thus, although it is reasonable to conclude that complex procedures such as emergency hip replacement surgery in an elderly patient with related comorbidities run a greater risk of iatrogenic harm than do antibiotics issued to a young woman with a urinary tract infection in a general practice consultation, there is a failure to appreciate that, in view of the fact that most care takes place in community care settings, the overall burden of iatrogenic harm is likely to be substantially higher in these settings than in specialist care settings. Additionally, an increased proportion of error in primary care is likely to arise from misjudgments and misdiagnoses, a complex field conceptually, which is difficult to study in circumstances in which extensive follow-up and true diagnosis needs to be established as a comparison. Up to now, most work on safety has been dominated by an economically developed country agenda, and, moreover, one in which the focus has been on errors of commission. Low-income and middle-income country participants of the WHO Safer Primary Care Expert Working Group made clear the policy need for local data on the burden of unsafe primary care in their countries. In view of restricted universal access to health care, these participants especially highlighted the need to broaden the focus of enquiry so that the risk of preventable harm associated with errors of omission is also studied.