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Mwandacha N, Dau H, AboMoslim M, Naguti P, Sheehan M, Booth A, Smith L, Orem J, Ogilvie G, Nakisige C. Investigating the healthcare-seeking behaviors of mobile phone users to improve cervical cancer screening in rural Uganda. Int J Gynaecol Obstet 2024; 167:223-229. [PMID: 38702957 DOI: 10.1002/ijgo.15577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/30/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Cervical cancer is the leading cause of cancer in low- and middle-income countries, despite being preventable. Uganda, which lacks an effective screening program, has one of the highest global cervical cancer incidence rates. Mobile health (mHealth) technology has the potential to improve healthcare-seeking behaviors and access. The present study describes the connection between mobile phone access and healthcare-seeking behaviors in rural Uganda. METHODS Women were eligible for this cross-sectional study if they had no prior screening or treatment for cervical cancer in the past 5 years, were aged 30 to 49 years old, and were residents of the South Busoga Forest reserve. Survey data was analyzed using descriptive statistics and chi-square tests. RESULTS Of the 1434 participants included in the analysis, 91.4% reported having access to a mobile phone. Most respondents were aged 30-40 years, had a partner, had ≤primary education, and were farmers. Participants with mobile phone access were significantly more likely to report attending a healthcare outreach visit (access = 87.3%, no access = 72.6%, P < 0.001) or visiting a health center (access = 96.9%, no access = 93.5%, P < 0.001). Participants in both groups had largely positive attitudes around and good knowledge of cervical cancer screening. CONCLUSION While attendance to healthcare services was high amongst participants, those with mobile phone access were more likely to seek healthcare services. Further inquiry into this association between mobile phone access and healthcare-seeking behavior is needed to optimize the improvements to cervical cancer screening when implementing interventions such as mHealth technology.
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Affiliation(s)
- Nelly Mwandacha
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Hallie Dau
- Women's Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maryam AboMoslim
- Women's Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Mia Sheehan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Amy Booth
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Laurie Smith
- Women's Health Research Institute, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | | | - Gina Ogilvie
- Women's Health Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- BC Center for Disease Control, Vancouver, British Columbia, Canada
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Ngere S, Maixenchs M, Khagayi S, Otieno P, Ochola K, Akoth K, Igunza A, Ochieng B, Onyango D, Akelo V, Blevins J, Barr BAT. Health care-seeking behavior for childhood illnesses in western Kenya: Qualitative findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) Study. Gates Open Res 2024; 8:31. [PMID: 39310789 PMCID: PMC11413273 DOI: 10.12688/gatesopenres.14866.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2024] [Indexed: 09/25/2024] Open
Abstract
Background Child mortality in Kenya is 41 per 1,000 live births, despite extensive investment in maternal, newborn, and child health interventions. Caregivers' health-seeking for childhood illness is an important determinant of child survival, and delayed healthcare is associated with high child mortality. We explore determinants of health-seeking decisions for childhood illnesses among caregivers in western Kenya. Methods We conducted a qualitative study of 88 community members between April 2017 and February 2018 using purposive sampling in an informal urban settlement in Kisumu County, and in rural Siaya County. Key informant interviews, semi-structured interviews and focus group discussions were performed. We adopted the Partners for Applied Social Sciences model focusing on factors that influence the decision-making process to seek healthcare for sick infants and children. The discussions were audio-recorded and transcribed. Data management was completed on Nvivo® software. Iterative analysis process was utilized and themes were identified and collated. Results Our findings reveal four thematic areas: Illness interpretation, the role of social relationship on illness recognition and response, medical pluralism and healthcare access. Participants reported some illnesses are caused by supernatural powers and some by biological factors, and that the illness etiology would determine the health-seeking pathway. It was common to seek consensus from respected community members on the diagnosis and therefore presumed cause and necessary treatment for a child's illness. Medical pluralism was commonly practiced and caregivers would alternate between biomedicine and traditional medicine. Accessibility of healthcare may determine the health seeking pathway. Caregivers unable to afford biomedical care may choose traditional medicine as a cheaper alternative. Conclusion Health seeking behavior was driven by illness interpretation, financial cost associated with healthcare and advice from extended family and community. These findings enrich the perspectives of health education programs to develop health messages that address factors that hinder prompt health care seeking.
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Affiliation(s)
- Sarah Ngere
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sammy Khagayi
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Peter Otieno
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Kennedy Ochola
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Kelvin Akoth
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Aggrey Igunza
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Benard Ochieng
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | | | - Victor Akelo
- U.S. Centers for Disease Control and Prevention, Kisumu, Kenya
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Pallati A, Singh A, Ranjan P, Rawat N, Sarkar S, Kaloiya G, Baitha U, Upadhyay AD, Prakash B, Jadon RS. Exploring the Link Between Somatic and Psychiatric Symptoms in Patients With Medically Unexplained Physical Symptoms: A Cross-Sectional Survey From North India. Cureus 2024; 16:e65984. [PMID: 39221380 PMCID: PMC11366069 DOI: 10.7759/cureus.65984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The association between somatic symptoms and psychiatric co-morbidities remains unexplored among patients with medically unexplained physical symptoms (MUPS) in Asian populations. This study aims to bridge this gap by investigating psychiatric morbidities and their determinants among patients presenting with MUPS in an Indian setup. METHODOLOGY This cross-sectional study, conducted in the outpatient department (OPD) of a tertiary care hospital in India, assessed 200 patients diagnosed with MUPS. Assessment tools, such as the Somatic Symptom Scale (SSS-8), Presumptive Stressful Life Event Scale (PSLES), and Depression, Anxiety, and Stress Scale (DASS), were administered to collect data. RESULTS The study examined patients (mean age 36.51±9.82 years), predominantly comprising females (67.5%), presenting with MUPS. Common presenting symptoms were general (96.3%), musculoskeletal pain (91.7%), and gastrointestinal symptoms reported by 81.7%. Medium somatic symptom severity (57%) was more prevalent in females. Prevalent psychiatric co-morbid conditions included depression (mild: 22.0%, moderate: 26.5%), moderate anxiety (41.5%), and moderate stress (26%). Strong associations were observed between the SSS-8 score and depression (χ²(6, N = 200) = 49.26, p < 0.001), anxiety (χ²(8, N = 200) = 37.90, p < 0.001), stress (χ²(6, N = 200) = 44.45, p < 0.001), and the experience of stressful life events (χ²(3, N = 200) = 6.5, p < 0.05). CONCLUSION The study indicates an intertwined association between MUPS and psychiatric disorders. Individuals with MUPS commonly experience heightened anxiety and depression, emphasizing the complex interplay between somatic symptoms and emotional well-being. Consideration of environmental and social factors may be crucial for a comprehensive understanding.
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Affiliation(s)
- Abhivandana Pallati
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Amandeep Singh
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Piyush Ranjan
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Nandini Rawat
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Siddharth Sarkar
- Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Gaurishanker Kaloiya
- Clinical Psychology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Upendra Baitha
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Ashish D Upadhyay
- Biostatistics, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Bindu Prakash
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Ranveer S Jadon
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Omondi Aduda DS, Agot K, Ohaga S, Aoko A, Onyango J, Toroitich-Ruto C, Kambona C, Odoyo-June E. Facility characteristics preferred by older men seeking medical male circumcision services in Kenya: qualitative findings from the 'Tasco' study (May 2014-June 2016). BMC Public Health 2024; 24:1718. [PMID: 38937707 PMCID: PMC11210051 DOI: 10.1186/s12889-024-19234-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Abstract
Primary healthcare facilities are central to the implementation of voluntary medical male circumcision (VMMC) as points of access to integrated health services in line with the Kenya AIDS Strategic Framework II (2020/21-2024/25). Knowledge of factors that explain men's uptake of VMMC and sexual health services at these facilities and preferences of where to get the services remain poorly understood. Using qualitative methodologies, we examined factors that determined facility choice for VMMC services and reasons for preferring the facility among men aged 25-39 years who previously underwent VMMC. The current study draws from focus group discussion interviews with circumcised men and their partners conducted as part of a randomized controlled trial to assess impact of two demand creation interventions in western Kenya. This involved 12 focus group discussions (FGD) with 6-10 participants each. Six FGDs were conducted with circumcised men, and 6 with their sex partners. Thematic issues relevant to a predetermined framework were identified. The themes were organized as follows: service availability, accessibility, affordability, appropriateness and, acceptability. Facility location, physical layout, organization of patient flow, infrastructure, and service provider skills were the outstanding factors affecting the choice of VMMC service outlets by men aged 25-39 years. Additionally, preferences were influenced by individual's disposition, attitudes, knowledge of VMMC services and tacit balance between their own recognized health needs versus desire to conform to social-cultural norms. Facility choice and individual preference are intricate issues, simultaneously involving multiple but largely intra-personal and facility-level factors. The intrapersonal dimensions elicited may also reflect differential responses to strategic communications and demand creation messages with promotion and prevention frames.
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Affiliation(s)
- Dickens S Omondi Aduda
- Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya.
- Impact Research and Development Organization, Kisumu, Kenya.
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Spala Ohaga
- Impact Research and Development Organization, Kisumu, Kenya
| | - Appolonia Aoko
- Division of Global HIV & TB, Division of Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jacob Onyango
- Impact Research and Development Organization, Kisumu, Kenya
| | - Cathy Toroitich-Ruto
- Division of Global HIV & TB, Division of Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Caroline Kambona
- Division of Global HIV & TB, Division of Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Elijah Odoyo-June
- Division of Global HIV & TB, Division of Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
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Fischer R, Bailey Y, Shankar M, Safaeinili N, Karl JA, Daly A, Johnson FN, Winter T, Arahanga-Doyle H, Fox R, Abubakar A, Zulman DM. Cultural challenges for adapting behavioral intervention frameworks: A critical examination from a cultural psychology perspective. Clin Psychol Rev 2024; 110:102425. [PMID: 38614022 DOI: 10.1016/j.cpr.2024.102425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/14/2024] [Accepted: 04/04/2024] [Indexed: 04/15/2024]
Abstract
We introduce the bias and equivalence framework to highlight how concepts, methods, and tools from cultural psychology can contribute to successful cultural adaptation and implementation of behavioral interventions. To situate our contribution, we provide a review of recent cultural adaptation research and existing frameworks. We identified 68 different frameworks that have been cited when reporting cultural adaptations and highlight three major adaptation dimensions that can be used to differentiate adaptations. Regarding effectiveness, we found an average effect size of zr = 0.24 (95%CI 0.20, 0.29) in 24 meta-analyses published since 2014, but also substantive differences across domains and unclear effects of the extent of cultural adaptations. To advance cultural adaptation efforts, we outline a framework that integrates key steps from previous cultural adaptation frameworks and highlight how cultural bias and equivalence considerations in conjunction with community engagement help a) in the diagnosis of behavioral or psychological problems, b) identification of possible interventions, c) the selection of specific mechanisms of behavior change, d) the specification and documentation of dose effects and thresholds for diagnosis, e) entry and exit points within intervention programs, and f) cost-benefit-sustainability discussions. We provide guiding questions that may help researchers when adapting interventions to novel cultural contexts.
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Affiliation(s)
- Ronald Fischer
- Institute D'Or for Research and Education, Sao Paulo, Brazil; School of Psychology, Victoria University of Wellington, New Zealand.
| | | | - Megha Shankar
- Division of General Internal Medicine, Department of Medicine, University of California San Diego, USA
| | - Nadia Safaeinili
- Division of Primary Care and Population Health, Stanford School of Medicine, USA
| | - Johannes A Karl
- School of Psychology, Dublin City University, Dublin, Ireland; School of Psychology, Victoria University of Wellington, New Zealand
| | - Adam Daly
- School of Psychology, Dublin City University, Dublin, Ireland
| | | | - Taylor Winter
- School of Mathematics and Statistics, University of Canterbury, New Zealand
| | | | - Ririwai Fox
- School of Psychology, University of Waikato, Tauranga, New Zealand
| | - Amina Abubakar
- Aga Khan University, Nairobi, Kenya & Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Donna Michelle Zulman
- Division of Primary Care and Population Health at Stanford University & Center for Innovation to Implementation (Ci2i) at VA Palo Alto, USA
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Engeda EH, Aldersey HM, Davison CM, Gelaye KA, Fayed N. Perceptions and behaviors of healthcare providers towards rehabilitation support to children with severe malaria-related disability in Ethiopia: A qualitative descriptive study using the Theoretical Domains Framework. PLoS One 2024; 19:e0298769. [PMID: 38696368 PMCID: PMC11065226 DOI: 10.1371/journal.pone.0298769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 01/31/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Severe malaria often results in childhood disability. The prevalence of disability related to severe malaria is significant and is estimated to affect up to 53% of severe malaria survivors. In contrast, information is sparse about how healthcare providers in Africa think about or provide rehabilitation support in acute and post-acute phases respectively. Understanding the perceptions and behaviors of healthcare providers treating malaria could help inform malaria-related disability research, policy, and practice, aimed at the providers themselves. This study explored the perceptions and behaviors of healthcare providers towards rehabilitation for children with severe malaria-related disability. The Theoretical Domains Framework was used to describe the findings relative to wider literature on health provider behavior change. METHODS A qualitative descriptive approach was used to interview thirteen healthcare providers recruited purposively based on their clinical professions, roles, and settings. Data were analyzed using directed content analysis. We decided on the most prominent theoretical domains considering the frequency of specific perceptions and behaviors across the participants, the frequency of perceptions and behaviors in each domain, and evidence of strong perceptions and behaviors. RESULTS Nine out of fourteen theoretical domains were identified. These domains were: Beliefs about consequences, environmental context and resources, goals, knowledge, skills, optimism, reinforcement, social influences, and social or professional role and identity. Healthcare providers' beliefs about their roles in screening for disability or referring to rehabilitation were less positive. CONCLUSIONS The findings of this study suggest the need for interventions to support healthcare providers in acute phases (prevention and control of severe malaria) and post-acute phases (disability screening, referral, and rehabilitation care). Recommended interventions should focus on developing clinical guidelines, training clinicians, addressing institutional factors, and modifying external social influences such as socio-cultural factors.
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Affiliation(s)
- Eshetu Haileselassie Engeda
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Heather M. Aldersey
- Queen’s University School of Rehabilitation Therapy, Kingston, Ontario, Canada
| | - Colleen M. Davison
- Department of Public Health Sciences, Queen’s University Kingston, Kingston, Ontario, Canada
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nora Fayed
- Queen’s University School of Rehabilitation Therapy, Kingston, Ontario, Canada
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Tarar HM, Azhar A, Ismail K, Oduoye MO, Asim O, Omer R. The influence of sociodemographic factors on parental health-seeking behavior for illnesses among the pediatric age group in Karachi: A cross-sectional study. Health Sci Rep 2024; 7:e2081. [PMID: 38779222 PMCID: PMC11109048 DOI: 10.1002/hsr2.2081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/13/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
Background Health-seeking behavior (HSB) is an individual's reaction to sickness, for which they seek medical attention, regardless of the form such care may take. Poor HSB is frequently associated with lower health outcomes and greater mortality and disease rates in a nation. Sociodemographic factors, including age, gender, family structure, occupation, ethnicity, and rates of literacy and poverty, can influence a person's HSB. This study would benefit Pakistani parents of the paediatric population to make more informed health choices for their children. Aim This study aims to determine the influence of sociodemographic factors on parental HSB for illnesses among the pediatric age group in Karachi. Materials and Methods A cross-sectional study was conducted in which 214 parents were interviewed about their choices for health-seeking healthcare for their pediatric children of the pediatric age group (birth-18 years), who were attending the pediatric OPD and wards at Dr. Ruth Pfau Civil Hospital, Karachi in May 2023. Only parents or guardians with sick children were included. Their sociodemographic characteristics and health-seeking choices were asked. Informed consent was obtained, and all data were recorded. SPSS version 25 was used for analysis. Results For the first choice, the majority of parents (82.7%) preferred to seek healthcare for their children from medical doctors, followed by spiritual healers (10.7%), traditional healers (5.6%), and homoeopathic doctors (0.9%). For the second choice, the highest percentage was for a doctor (76.2%), followed by a spiritual healer (18.7%), a homoeopathic doctor (3.3%), and a traditional healer (1.9%). A significant correlation was found between the first visit and the decision makers (p = 0.019), the father's education level of the father (p = 0.001), the mother's occupation of the mother (p = 0.019), and the mother's education level of the mother (p = 0.001). Conclusion Sociodemographic characteristics greatly influence parents' HSBs of parents for their children. Despite having low-paying jobs and being uneducated, most people choose to refer to a doctor for their child due to awareness.
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Affiliation(s)
| | - Ayesha Azhar
- Department of Medicine and SurgeryDow Medical CollegeKarachiPakistan
| | - Kiran Ismail
- Department of Medicine and SurgeryDow Medical CollegeKarachiPakistan
| | - Malik Olatunde Oduoye
- Department of ResearchThe Medical Research CircleGomaGisenyiDemocratic Republic of the Congo
| | - Omama Asim
- Department of Medicine and SurgeryDow Medical CollegeKarachiPakistan
| | - Rida Omer
- Department of ChemistryKaachi UniversityKarachiPakistan
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Jabeen S, Zakar R, Zakar MZ, Fischer F. Experiences of family caregivers in dealing with cases of advanced breast cancer: a qualitative study of the sociocultural context in Punjab, Pakistan. BMC Public Health 2024; 24:1030. [PMID: 38609905 PMCID: PMC11015732 DOI: 10.1186/s12889-024-18404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Patients with advanced breast cancer require consistent help and support from family caregivers. These caregivers often endure financial burdens and psychological stress, with their experiences significantly influenced by sociocultural factors. This study aims to explore the experiences of family caregivers of advanced breast cancer patients in Punjab province, Pakistan. METHODS Data was collected through in-depth interviews with fifteen family caregivers of advanced breast cancer patients in three major cities of Punjab, Pakistan. Caregivers, who had been in close contact with the patient for the last two years, were purposively sampled from five major hospitals. The data was analyzed using thematic analysis. RESULTS The study revealed that the experiences of family caregivers are deeply rooted in the sociocultural context. Key themes identified include social responsibility and cultural reciprocity norms; limited awareness and mobility options for caregivers; financial responsibility and strain; impacts of beauty myths and shyness on caregiving attitudes and decisions; the stressful and emotional nature of caregiving; treatment perspectives influenced by social groups; challenges in consulting male physicians and associated stigma; the role of religious beliefs in caregiving; and stress management, with religion often being a coping mechanism. These factors can contribute to delayed treatment decisions for patients. CONCLUSIONS Family caregivers are crucial in facilitating timely treatment decisions for advanced breast cancer patients in the Pakistani context. To minimize treatment delays and alleviate caregiver stress, addressing sociocultural barriers in care-seeking is essential. A tailored approach, considering sociocultural and religious factors, is imperative for the management and early diagnosis of breast cancer, necessitating appropriate policymaking and implementation.
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Affiliation(s)
- Sadia Jabeen
- Department of Sociology, Virtual University of Pakistan, Lahore, Pakistan
| | - Rubeena Zakar
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | | | - Florian Fischer
- Institute of Public Health, Charité- Universitätsmedizin Berlin Institute of Public Health, Charitéplatz 1, 10117, Berlin, Germany.
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Muchangi JM, Mturi J, Mukasa H, Kithuki K, Kosgei SJ, Kanyangi LM, Moraro R, Nankanja M. Enablers and barriers to vaccine uptake and handwashing practices to prevent and control COVID-19 in Kenya, Uganda, and Tanzania: a systematic review. Front Public Health 2024; 12:1352787. [PMID: 38601496 PMCID: PMC11004251 DOI: 10.3389/fpubh.2024.1352787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
The global emergence of coronavirus disease 2019 (COVID-19) posed unprecedented challenges, jeopardizing decades of progress in healthcare systems, education, and poverty eradication. While proven interventions such as handwashing and mass vaccination offer effective means of curbing COVID-19 spread, their uptake remains low, potentially undermining future pandemic control efforts. This systematic review synthesized available evidence of the factors influencing vaccine uptake and handwashing practices in Kenya, Uganda, and Tanzania in the context of COVID-19 prevention and control. We conducted an extensive literature search across PubMed, Science Direct, and Google Scholar databases following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Out of 391 reviewed articles, 18 were eligible for inclusion. Some of the common barriers to handwashing in Kenya, Uganda, and Tanzania included lack of trust in the government's recommendations or messaging on the benefits of hand hygiene and lack of access to water, while some of the barriers to vaccine uptake included vaccine safety and efficacy concerns and inadequate awareness of vaccination sites and vaccine types. Enablers of handwashing practices encompassed hand hygiene programs and access to soap and water while those of COVID-19 vaccine uptake included improved access to vaccine knowledge and, socio-economic factors like a higher level of education. This review underscores the pivotal role of addressing these barriers while capitalizing on enablers to promote vaccination and handwashing practices. Stakeholders should employ awareness campaigns and community engagement, ensure vaccine and hygiene resources' accessibility, and leverage socio-economic incentives for effective COVID-19 prevention and control. Clinical trial registration: [https://clinicaltrials.gov/], identifier [CRD42023396303].
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Affiliation(s)
| | - James Mturi
- Amref Health Africa, Dar es Salaam, Tanzania
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McGuire MF, Ortega E, Patel R, Paz-Soldán VA, Riley-Powell AR. Seeking information and services associated with reproductive health among rural Peruvian young adults: exploratory qualitative research from Amazonas, Peru. Reprod Health 2024; 21:36. [PMID: 38475803 DOI: 10.1186/s12978-024-01769-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Sexual and reproductive health (SRH) literacy allows young adults to make informed decisions about health outcomes. In Peru, roughly one fifth of the population lives in rural areas, and little is known about where young adults in rural areas get their SRH information. The aim of this study was to identify what motivates and influences young adults to seek information and care related to SRH in three rural communities in the highlands of Northern Peru. METHODS Five gender-stratified focus group discussions with a total of 24 participants, and nine follow-up interviews were conducted to generate in-depth narrative data and triangulate data from the target group. Participants were women and men aged 18-24. The focus group discussions and interviews explored sources of reproductive health information, the role of informal social networks, barriers to care, and primary health concerns of the target population. RESULTS Main findings include: (1) The two greatest perceived SRH risks were unwanted pregnancy and abnormal discharge; (2) There appears to be limited concern about HIV or other sexually transmitted infections in the narratives; (3) There is a low quality of information concerning SRH, with discrepancies between the genders; (4) A broad spectrum of sources for SRH information were cited, including Internet, traditional healers, and specialized care; and varied by gender and life experience; (5) Having trust in the information source was the primary variable associated with uptake of services and/or access to information for both men and women. However, men reported more embarrassment around seeking services and information, whereas women faced more physical barriers. CONCLUSIONS There is a lack of SRH information among young adults in some communities in the northern highlands of Peru. Both schools and health centers were noted as being trusted and established information sources for all genders so could be a key resource to explore as a way to disseminate information.
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Affiliation(s)
- Molly F McGuire
- Department of Global Health Systems & Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | - Emma Ortega
- Department of Tropical Medicine and Infectious Disease, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Radha Patel
- Department of Medicine, University of Tennessee, Knoxville, TN, USA
| | - Valerie A Paz-Soldán
- Department of Tropical Medicine and Infectious Disease, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Amy R Riley-Powell
- Institute of Development Studies, University of Sussex, Brighton, BN1 9RE, UK
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Nche GC, Agbo UM, Okwueze MI. Church leader's Interpretation of COVID-19 in Nigeria: Science, Conspiracies, and Spiritualization. JOURNAL OF RELIGION AND HEALTH 2024; 63:741-764. [PMID: 37964055 DOI: 10.1007/s10943-023-01947-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
The need for governments across the globe to collaborate with religious leaders in the fight against COVID-19 has been emphasized by international organizations including the World Health Organization (WHO). However, there has not been much discernible scholarly effort to know what religious leaders think of COVID-19. The present study, therefore, explored the interpretations church leaders have about COVID-19 in Nigeria. Semi-structured interviews were conducted with eighteen leaders from Catholic, Anglican and Pentecostal churches in Nigeria. Using a thematic analytical approach, the study found that only few church leaders interpreted COVID-19 as a medical problem in line with science (33%). The rest interpreted the virus as a tool of conspiracies/political manoeuvrings (27%) and as a spiritual event (39%). The study discussed the implications of the findings for policy and research as well as how to address some of the harmful interpretations.
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Affiliation(s)
- George C Nche
- Department of Religion Studies, University of Johannesburg, Johannesburg, South Africa
| | - Uchechukwu M Agbo
- Department of Religion and Cultural Studies, University of Nigeria, Nsukka, Nigeria.
| | - Malachy I Okwueze
- Department of Religion and Cultural Studies, University of Nigeria, Nsukka, Nigeria
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Lyimo EJ, Msangi M, Zangira AJ, Msaki RV, Lekey A, Rwenyagira M, Mwiru R, Codjia P, Ezekiel M, Leyna GH, Masumo RM. Healthcare-seeking behaviours among mother's having under-five children with severe wasting in Dodoma and Mbeya regions of Tanzania-A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001943. [PMID: 38190374 PMCID: PMC10773934 DOI: 10.1371/journal.pgph.0001943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024]
Abstract
Maternal healthcare-seeking behaviour affects the health and well-being of under-five children. Drawing from the concepts of the health belief model, this study seeks to understand the determinants of health-seeking behaviours among mothers or caregivers of under-five-year-old children having severe wasting in Tanzania. A qualitative study employing the ethnography method conducted 32 semi-structured and narrative interviews with healthcare workers, community health workers, traditional healers, religious and village leaders, and mothers or caregivers of children who had acute malnutrition. The analysis of transcripts was done by qualitative content analysis. Further, the thematic analysis was carried out by assigning data into relevant codes to generate categories based on study objectives. Severe wasting among under-five-year-old children was not observed as a serious disease by the majority of mothers or caregivers. The study established that the health systems parameters such as the availability of the community health workers or healthcare providers and the availability of medicines and supplies to the health facility impact on mothers' or caregivers' healthcare-seeking behaviours. The findings also show that long distances to the health facility, behavioural parameters such as lack of awareness, negative perception of the management of severe wasting at the health facility, superstitious beliefs, women's workload, household food insecurity, and gender issues have a significant role in seeking healthcare. The results reaffirm how a programme on integrated management of severe wasting in Tanzania should encompass sociocultural factors that negatively influence mothers or caregivers of children with acute malnutrition. The programme should focus on engaging community structures including traditional healers, religious and village leaders to address prevailing local beliefs and sociocultural factors.
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Affiliation(s)
| | - Maria Msangi
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | | | - Rose V. Msaki
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Aika Lekey
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | | | - Ramadhan Mwiru
- The United Nations Children’s Fund (UNICEF) Tanzania, Dar es Salaam, Tanzania
| | - Patrick Codjia
- The United Nations Children’s Fund (UNICEF) Tanzania, Dar es Salaam, Tanzania
| | - Mangi Ezekiel
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Germana H. Leyna
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ray M. Masumo
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
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Mutiu Alani J, Olaoye DQ, Adesina Abass AS. Adoption and use of immunotherapy in breast cancer management in Africa: barriers and prospect - a narrative review. Ann Med Surg (Lond) 2023; 85:6041-6047. [PMID: 38098562 PMCID: PMC10718371 DOI: 10.1097/ms9.0000000000001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/04/2023] [Indexed: 12/17/2023] Open
Abstract
Breast cancer (BC) is the world's most frequently diagnosed cancer in women, with 7.8 million women diagnosed with BC in the past 5 years. BC has the highest incidence rate of all cancers in women worldwide (1.67 million), accounting for over 500 000 deaths annually. In Africa, BC accounts for 28% of all cancers and 20% of all cancer deaths in women. The African continent has recorded an alarming increase in incidence, with the highest mortality rate globally. Despite BC being a major health concern in Africa, there is limited access to adequate healthcare services to combat the growing need. Immunotherapy, a promising treatment approach that harnesses the immune system's power to fight cancer, has shown great potential in BC management. However, in the face of the growing body of evidence supporting its effectiveness, the adoption and use of immunotherapy in BC management in Africa remain limited. Hence, this review aimed to explore the barriers and prospects of immunotherapy adoption and use in BC management in Africa. A comprehensive search across various databases and sources using specific keywords related to immunotherapy and BC to achieve the study aim was conducted. The criteria for including data in the study were based on relevance and availability in English, with no publication year restrictions. The collected data underwent narrative analysis, supplemented by information from sources like country reports, newsletters, commentaries, policy briefs, and direct Google searches. By identifying the challenges and opportunities, this review provided insights into how healthcare providers, policymakers, and other stakeholders can work together to improve the availability and accessibility of immunotherapy to BC patients in Africa.
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Affiliation(s)
- Jimoh Mutiu Alani
- Radiation Oncology Department, College of Medicine
- Faculty of Pharmacy, University of Ibadan
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Kiburi SK, Jaguga F, Atwoli L. Health equity in substance use disorder treatment in Kenya. Drug Alcohol Depend 2023; 253:111005. [PMID: 37931329 DOI: 10.1016/j.drugalcdep.2023.111005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Affiliation(s)
| | - Florence Jaguga
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Lukoye Atwoli
- Medical College East Africa, and Brain and Mind Institute, The Aga Khan University, Nairobi, Kenya
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Huda M, Rabbani F, Shipton L, Aftab W, Khan KS, Marini MG. Listening to Caregivers: Narratives of Health Seeking for Children Under Five with Pneumonia and Diarrhea: Insights from the NIGRAAN Trial in Pakistan. J Multidiscip Healthc 2023; 16:3629-3640. [PMID: 38034877 PMCID: PMC10683648 DOI: 10.2147/jmdh.s417102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023] Open
Abstract
Background Understanding health-seeking behaviors of caregivers is important to reduce child mortality. Several factors influence decision-making related to childhood illnesses. Objective The objective of this study was to gather caretaker narratives to develop a comprehensive understanding of the context and process of caregiving at household level during all stages of an episode of diarrhea and pneumonia in children <5. Methods Using a narrative interview approach, stories from caregivers of children <5 were collected from a rural district in Sindh Pakistan. Eleven households with children <5 were randomly selected and purposive sampling was done to interview 20 caregivers. All data collection was conducted privately in participants' homes and informed consent taken. Manual content analysis was carried out by three independent researchers and emerging themes drawn. Results The role of joint family system is integral in making decisions and the child's paternal grandmother, is an important and trusted source of information regarding child sickness in the household. They often promote home remedies with considerable authority prior to formal consultation with the health care system. Caregivers were generally dissatisfied with doctors in the public sector who were perceived to be providing free consultation with a poor quality of care and long waiting time as compared to private doctors. Financial considerations and child support were favorably addressed in households with a joint family system. Conclusion The joint family system provides a strong support system, but also tends to reduce parental autonomy in decision-making and delay first contact with formal health providers. Prevalent home remedies, and authority of elders in the family influence management practices. Interventions for reducing improving child mortality should be cognizant of the context of decision-making and social influences at the household level.
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Affiliation(s)
- Maryam Huda
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
- Brain & Mind Institute, Aga Khan University, Karachi, Pakistan
| | - Leah Shipton
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Wafa Aftab
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Kausar S Khan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Maria Giulia Marini
- Research and Health Care Director, Fondazione ISTUD per la Cultura d’Impresa e di Gestione, Milan, Italy
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Tshuma N, Ngbede ED, Nyengerai T, Mtapuri O, Moyo S, Mphuthi DD, Nyasulu P. Understanding health outcome drivers among adherence club patients in clinics of Gauteng, South Africa: a structural equation modelling (SEM) approach. AIDS Res Ther 2023; 20:71. [PMID: 37798794 PMCID: PMC10557202 DOI: 10.1186/s12981-023-00565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND There has been growing interest in understanding the drivers of health outcomes, both in developed and developing countries. The drivers of health outcomes, on the other hand, are the factors that influence the likelihood of experiencing positive or negative health outcomes. Human Immunodeficiency Virus (HIV) continues to be a significant global public health challenge, with an estimated 38 million people living with the aim of this study was therefore to develop and empirically test a conceptual research model using SEM, aimed at explaining the magnitude of various factors influencing HIV and other health outcomes among patients attending Adherence Clubs. METHOD This was a cross sectional survey study design conducted in 16 health facilities in the City of Ekurhuleni in Gauteng Province, South Africa. A total of 730 adherence club patients were systematically sampled to participate in a closed ended questionnaire survey. The questionnaire was assessed by Cronbach's alpha coefficient for internal consistency. The proposed model was tested using structural equation modelling (AMOS software: ADC, Chicago, IL, USA). RESULTS A total of 730 adherence club members participated in the study. Of these, 425 (58.2%) were female and 305 (41.8%) were male. The overall results indicated a good reliability of all the scale involved in this study as Cronbach alphas ranged from 0.706 to 0.874, and composite reliability from 0.735 to 0.874. The structural model showed that the constructs health seeking behavior (β = 0.267, p = 0.000), health care services (β = 0.416, p = 0.000), stigma and discrimination (β = 0.135, p = 0.022) significantly predicted health outcomes and explained 45% of its variance. The construct healthcare service was the highest predictor of health outcomes among patients in adherence clubs. CONCLUSION Patient health seeking behaviour, healthcare services, stigma and discrimination were associated with perceived health outcomes. Since adherence clubs have been found to have a significant impact in improving patient outcomes and quality of life, there is a need to ensure replication of this model.
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Affiliation(s)
- Ndumiso Tshuma
- The Best Health Solutions, Johannesburg, Gauteng, South Africa.
- Texila American University and University of Central Nicaragua, Managua, Nicaragua.
| | - Elakpa Daniel Ngbede
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Tawanda Nyengerai
- The Best Health Solutions, Johannesburg, Gauteng, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Oliver Mtapuri
- The Best Health Solutions, Johannesburg, Gauteng, South Africa
- University of KwaZulu Natal, Durban, South Africa
| | - Sangiwe Moyo
- The Best Health Solutions, Johannesburg, Gauteng, South Africa
- Final Mile, Johannesburg, Gauteng, South Africa
| | - David D Mphuthi
- The Best Health Solutions, Johannesburg, Gauteng, South Africa
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Aremu SK. Knowledge and awareness of aetiological and risk factors as determinants of health-seeking pattern of parents of children with epistaxis in a tertiary health institution: A 7-year prospective study. Afr J Paediatr Surg 2023; 20:211-217. [PMID: 37470558 PMCID: PMC10450115 DOI: 10.4103/ajps.ajps_3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 01/22/2023] Open
Abstract
Aim This prospective study aimed to assess the knowledge and awareness of aetiological and risk factors as determinants of the health-seeking pattern of parents of children with epistaxis in a tertiary health institution. Materials and Methods This was a 7-year cross-sectional prospective study where copies of the questionnaire were distributed to consenting parents whose children presented to our institution with epistaxis between January 2015 and December 2021. A total of 570 parents were enrolled in the study in the research time period. Results Out of 570 patients, majority (39%) were aged between 11 and 15 years, followed by 35% aged between 6 and 10 years, 17% aged between 1 and 5 years and 11% aged between 16 and 18 years. Three hundred and eighty (66.67%) were male and 190 (33.33%) were female. Two hundred and ninety-five (51.75%) patients had primary education, followed by 189 (33.16%) patients with secondary education and 86 (15.09%) patients with preschool education. Three hundred and seventy-three (65.44%) patients had anterior bleeding and 107 (18.77%) patients had posterior bleeding while 90 (15.79%) patients had both anterior and posterior bleeding. The majority of the parents, 399 (70%), were aware about the epistaxis while 171 (30%) parents were unaware about the epistaxis. Conclusion A significant number of parents are unaware of the epistaxis and also unaware of the various aetiological and risk factors of the epistaxis and these issues need a more nuanced analysis in light of Africa's rich cultural diversity.
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Affiliation(s)
- Shuaib Kayode Aremu
- Department of ENT, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti, Nigeria
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von Gaudecker J, Andrade C, Baby P, Cassier-Woidasky AK, Cubria T, Hupperich LM, Mariano MEM, Mastamet G, Nydahl P, Olson DM, Sila F, Ramazanu S, Strayer A, Hirosue M, Rhudy L. Family Role in Care of Patients With Neurological Conditions: International Neuroscience Nursing Research Symposium Proceedings. J Neurosci Nurs 2023; Publish Ahead of Print:01376517-990000000-00044. [PMID: 37224222 DOI: 10.1097/jnn.0000000000000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
ABSTRACT BACKGROUND: Discussions during the 2022 International Neuroscience Nursing Research Symposium highlighted the impact of family in the care of neuroscience patients. This sparked conversations about the need for understanding global differences in family involvement in the care of patients with neurological conditions. METHODS: Neuroscience nurses from Germany, India, Japan, Kenya, Singapore, Saudi Arabia, the United States, and Vietnam collaborated to provide a short summary of family involvement in caring for patients with neurological conditions in their respective countries. RESULTS: Family roles for neuroscience patients vary across the globe. Caring for neuroscience patients can be challenging. Family involvement in treatment decisions and patient care can be affected by sociocultural beliefs and practices, economic factors, hospital policies, manifestation of the disease, and long-term care requirements. CONCLUSION: Understanding the geographic, cultural, and sociopolitical implications of family involvement in care is of benefit to neuroscience nurses.
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Sari NM, Devansyah S, Modjaningrat I, Suryawan N, Susanah S, Rakhmillah L, Wahyudi K, Kaspers GJL. Type of cancer and complementary and alternative medicine are determinant factors for the patient delay experienced by children with cancer: A study in West Java, Indonesia. Pediatr Blood Cancer 2023; 70:e30192. [PMID: 36636790 DOI: 10.1002/pbc.30192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 11/27/2022] [Accepted: 12/14/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Most pediatric cancer patients in developing countries present at an advanced stage due to delayed diagnosis, being an important barrier to effective care. The objective of this study was to evaluate the associated factor of patient delay and explore significant parental practice-associated risk factor to patient delay. METHODS This was a sequential mixed methodology, utilizing data from the Indonesian Pediatric Cancer Registry for clinical variables and completed interviews with parents using structured questionnaires to obtain their sociodemographic data. A binary logistic regression analysis model was fitted to identify factors associated with patient delay. Additional semi-structured interviews related to parental practice of using complementary and alternative medicine (CAM) were administered to 30 parents. Thematic framework analysis was performed on qualitative data to explore determinant factors of parental practice of using CAM. RESULTS We interviewed 356 parents with children with cancer. The median patient delay was 14 days (interquartile range [IQR]: 6-46.5 days). The most extended delay was in patients with malignant bone tumors (median 66, IQR: 14-126). In multivariable logistic regression analysis, solid cancer (odds ratio [OR] = 5.22, 95% confidence interval [CI]: 2.79-9.77, p < .001) and use of CAM (OR = 1.86, 95% CI: 1.13-3.08, p = .015) were associated with patient delay. Qualitative interviews highlighted key issues relative to determinant parental factors using CAM, including vague initial childhood cancer symptoms, parental health-seeking behavior, CAM availability and accessibility, also barriers of healthcare facilities. CONCLUSION Type of cancer and use of CAM are essential factors that cause patient delay. It should be addressed in the future childhood cancer awareness and childhood cancer diagnosis pathway.
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Affiliation(s)
- Nur Melani Sari
- Division of Hematology Oncology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital Bandung, Department of Child Health, Bandung, Indonesia
| | - Sultan Devansyah
- Universitas Padjadjaran, Faculty of Medicine, Bandung, Indonesia
| | | | - Nur Suryawan
- Division of Hematology Oncology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital Bandung, Department of Child Health, Bandung, Indonesia
| | - Susi Susanah
- Division of Hematology Oncology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin Hospital Bandung, Department of Child Health, Bandung, Indonesia
| | - Lulu Rakhmillah
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Kurnia Wahyudi
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Gertjan J L Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Exploring Knowledge about Fang Traditional Medicine: An Informal Health Seeking Behaviour for Medical or Cultural Afflictions in Equatorial Guinea. Healthcare (Basel) 2023; 11:healthcare11060808. [PMID: 36981465 PMCID: PMC10048063 DOI: 10.3390/healthcare11060808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
This study explores a range of informal health-seeking behaviors, including the use of Fang Traditional Medicine (FTM) for medical or cultural afflictions in Equatorial Guinea (EQ), the therapeutic methods used, the health problems handled, the learning process, traditional medicine user profiles and the social images of Fang Traditional Healers (FTHs). Ethnography was employed as a qualitative strategy using emic–etic approaches. Semi-structured interviews were conducted with 45 individuals, including 6 community leaders, 19 tribal elders, 7 healthcare professionals, 11 FTHs and 2 relatives of traditional healers in 5 districts of EQ. FTM offers a cure for malaria and treatments for reproductive health issues, bone fractures and cultural illnesses. Several methods used to learn FTM are based on empirical observation, and without the need for traditional schooling, unlike with Western medical professionals: for example, watching a family member, or the spirits or ancestors, can reveal healing knowledge. Materials from forests, including tree barks and plants, and rituals are used to keep Fang populations healthy; in addition, two rituals known as “osuiñ” and “etoak” (infusions of tree barks with the blood of sacrificed animals) are the most commonly used treatments. In addition, elders and women are the most active consumers of FTM. FTM plays a relevant role in curing medical and cultural afflictions in Fang communities. The informal health-seeking behavior among the Fang community is conditioned by the explanation model of illness.
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Ibrahim AZ. Food taboo and dietary habits among low-income people in Kedah, Malaysia. POTRAVINARSTVO 2023. [DOI: 10.5219/1793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Food beliefs and taboos about certain foods influence the use and consumption of food in the household. Today, especially in rural areas, some people believe certain foods affect health. This practice has resulted in the non-optimized intake of some food categories. As a result, it is not easy to diversify the types of food for daily diet. This study aims to investigate the beliefs and convictions of rural communities in Kedah regarding certain foods that may influence health. This study also identified the pattern of food intake among residents in rural areas of Kedah State following the belief that some foods can affect health. This study focuses on the rural areas of Kedah State, which include Kubang Pasu, Baling, Pendang, Alor Setar, and Kuala Muda districts. A total of 225 farmers in the rural areas of the selected districts were selected using stratified random sampling. The data were analyzed using SPSS 25 and food intake results. The results of the study show that low-income residents in rural areas of Kedah believe that some foods have an impact on health. A total of 37.11% believe that coffee, carbonated drinks, fresh milk, and low-fat milk cause headaches, stomach aches, heartburn, and nausea, followed by 18.66% who admit that spicy foods such as mutton, beef, and durian cause headaches, high blood pressure and skin problems. The impact of the food taboo has resulted in an overall food consumption rate below 29.9 in households of low-income residents in rural areas in Kedah State. The study's findings suggest that the Malaysian Ministry of Health should develop nutrition and health awareness programs and activities for the rural population. At the same time, there is a need for a comprehensive restructuring of the curriculum and syllabus by addressing the need for healthy eating as early as primary school so that nutrition and health awareness can be embedded in early childhood education.
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Ngere SH, Akelo V, Ondeng’e K, Ridzon R, Otieno P, Nyanjom M, Omore R, Barr BAT. Traditional Medicine Beliefs and Practices among Caregivers of Children under Five Years-The Child Health and Mortality Prevention Surveillance (CHAMPS), Western Kenya: A qualitative study. PLoS One 2022; 17:e0276735. [PMID: 36322582 PMCID: PMC9629611 DOI: 10.1371/journal.pone.0276735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/13/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Approximately 80% of the population residing in sub-Saharan Africa relies on Traditional Medicine (TM). However, literature on factors motivating the use of TM for children under the age of five in these settings is limited. Such information can guide policy formulation for integration of TM into mainstream health care services. This study aimed to describe the motivation on use of TM among caregivers of children residing in rural and urban communities in western Kenya. METHODS The socio-behavioral sciences (SBS) arm of the Child Health and Mortality Prevention Surveillance (CHAMPS) program in western Kenya, conducted a cross-sectional qualitative study in Manyatta-an urban informal settlement located in Kisumu town and Karemo-a rural setting in Siaya County. We performed 29 in-depth interviews, 5 focus group discussions and 11 semi-structured interviews with community representatives (n = 53), health workers (n = 17), and community leaders (n = 18). All the participants were purposively sampled. We performed thematic analysis using both inductive and deductive approaches. Data management was completed on Nvivo 11.0 software (QSR International, Melbourne, Australia). RESULTS Our findings reveal that some caregivers prefer TM to treat some childhood diseases. Use of TM was informed by illness beliefs about etiology of disease. We observed an appreciation from the study participants that malaria can effectively be treated by Conventional Medicine (CM) while TM was preferred to treat measles and diseases believed to be associated with supernatural etiology such as witchcraft, evil spirit or breaching cultural taboos. TM was also used in instances where CM failed to provide a diagnosis or when CM was 'slow'. TM in such cases was used as a last resort. CONCLUSION We observed varied beliefs that motivate caregivers' choice of TM use among children in western Kenya. It is therefore crucial to consider perceptions and socio-cultural beliefs about illnesses when formulating interventions that are geared towards child health.
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Affiliation(s)
- Sarah Hawi Ngere
- Kenya Medical Research Institute, Center for Global Health Research, (KEMRI-CGHR), Kisumu, Kenya
- * E-mail:
| | - Victor Akelo
- Centers for Disease Control and prevention (CDC), Nairobi, Kenya
| | - Ken Ondeng’e
- Kenya Medical Research Institute, Center for Global Health Research, (KEMRI-CGHR), Kisumu, Kenya
| | - Renee Ridzon
- Centers for Disease Control and prevention (CDC), Nairobi, Kenya
| | - Peter Otieno
- Kenya Medical Research Institute, Center for Global Health Research, (KEMRI-CGHR), Kisumu, Kenya
| | - Maryanne Nyanjom
- Kenya Medical Research Institute, Center for Global Health Research, (KEMRI-CGHR), Kisumu, Kenya
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research, (KEMRI-CGHR), Kisumu, Kenya
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Mutombo CS, Bakari SA, Ntabaza VN, Nachtergael A, Lumbu JBS, Duez P, Kahumba JB. Perceptions and use of traditional African medicine in Lubumbashi, Haut-Katanga province (DR Congo): A cross-sectional study. PLoS One 2022; 17:e0276325. [PMID: 36256659 PMCID: PMC9578634 DOI: 10.1371/journal.pone.0276325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
In the Democratic Republic of Congo, the desire of the Ministry of Health to integrate Traditional African Medicine into the Official Health System remains limited by the lack of reliable data on several aspects of this medicine. This study aims to determine the perceptions of the Lubumbashi population towards Traditional African Medicine and the contexts of recourse to these therapeutic modalities. We conducted semi-structured interviews of population samples in each of the 7 Lubumbashi municipalities, which were semi-randomly selected in proportions to each population size, from January to June 2017 and from February to July 2018. A total of 4278 people (average age, 32.1 ± 10.4 years; 36.5% of women) have been surveyed. Among them, 75.8% define "Traditional African Medicine" as "herbal-based treatments"; 79.4% have resorted to traditional medicine, for several pathologies and social problems. This medicine was preferred for efficiency, speed of healing and low cost, as well as the presence of the diseases against which it would be the only one used. Most, (52.1%) have started with Conventional Medicine, then resorted to Traditional African Medicine, 34.7% started directly with Traditional African Medicine, while 13.2% combined these two medicines. From those who have resorted to Traditional African Medicine (n = 3396), 55% declare no concern towards traditional medicine, while 42.5% fear looseness, overdose, intoxication, and lack of hygiene; from those who have not resorted to Traditional African Medicine (n = 882), 78% are fearful of fear looseness, witchcraft, and fetishism. Traditional African Medicine remains an important health care resource for the Lubumbashi people. It is essential that decision-makers consider the importance of this health sector for the population, but also the reported fears and hindrances, and work towards the regulation, sanitization, and control of this medicine to ensure its safe use.
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Affiliation(s)
- Cedrick S Mutombo
- Laboratory of Pharmacognosy, Department of Pharmacology, Faculty of Pharmaceutical Sciences, Université de Lubumbashi, Lubumbashi, DR Congo
- Unit of Therapeutic Chemistry and Pharmacognosy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium
| | - Salvius A Bakari
- Laboratory of Pharmacognosy, Department of Pharmacology, Faculty of Pharmaceutical Sciences, Université de Lubumbashi, Lubumbashi, DR Congo
| | - Vianney N Ntabaza
- Laboratory of Pharmacognosy, Department of Pharmacology, Faculty of Pharmaceutical Sciences, Université de Lubumbashi, Lubumbashi, DR Congo
| | - Amandine Nachtergael
- Unit of Therapeutic Chemistry and Pharmacognosy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium
| | - Jean-Baptiste S Lumbu
- Service de Chimie Organique, Département de Chimie, Faculté des Sciences, Université de Lubumbashi, Lubumbashi, DR Congo
| | - Pierre Duez
- Unit of Therapeutic Chemistry and Pharmacognosy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium
| | - Joh B Kahumba
- Laboratory of Pharmacognosy, Department of Pharmacology, Faculty of Pharmaceutical Sciences, Université de Lubumbashi, Lubumbashi, DR Congo
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Amissah-Arthur MB, Gyaban-Mensah A, Boima V, Yorke E, Dey D, Ganu V, Mate-Kole C. Health-seeking behaviour, referral patterns and associated factors among patients with autoimmune rheumatic diseases in Ghana: A cross-sectional mixed method study. PLoS One 2022; 17:e0271892. [PMID: 36094929 PMCID: PMC9467363 DOI: 10.1371/journal.pone.0271892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background Challenges exist in the diagnosis and management of autoimmune rheumatic diseases in low and middle income countries due to factors, such as poverty and under-resourced healthcare infrastructure. Furthermore, other contributory factors such as societal, cultural and religious practices influence health seeking behaviour which has a bearing on access and delivery of healthcare. Objectives To examine the health seeking behaviour and referral patterns of Ghanaian patients with autoimmune rheumatic diseases and assess the associated factors that influence these. Method A cross-sectional study using an explanatory sequential mixed method design was carried out in a Rheumatology clinic at a national referral centre. 110 participants were purposively recruited for the quantitative phase. The qualitative phase comprised 10 participants for in-depth interviews and 10 participants for a focus group discussion. Analysis using descriptive statistics, t-tests and logistic regression models were performed. Transcripts generated from the interviews and focused group discussion were analysed using thematic analysis. Results Median duration from onset of symptoms until seeking help was 1 week (IQR = 12); from seeking help until obtaining a final diagnosis was 12 months (IQR = 33). Multiple factors determined the choice of first facility visited, X2 (12, N = 107) = 32.29, p = .001. Only twenty-one participants (19.6%) had knowledge of their disease prior to diagnosis. Education predicted prior knowledge [OR = 2.6 (95% CI = .66–10.12), p < .021]. Unemployed participants had increased odds of seeking help after a month compared to those who were employed [Odds ratio = 2.60 (95% CI = 1.14–5.90), p = .02]. Knowledge of autoimmune rheumatic diseases was low with multiple causative factors such as biomedical, environmental and spiritual causes determining where patients accessed care. Forty (36.4%) participants utilised complementary and alternative treatment options. Conclusion We observed that knowledge about autoimmune rheumatic diseases among Ghanaian patients was low. Patients sought help from numerous medical facilities, traditional healers and prayer camps often contributing to a delay in diagnosis for most patients. This was influenced by individual perceptions, cultural beliefs and socioeconomic status. Active awareness and educational programmes for the public and healthcare workers are required, as well as strategic planning to integrate the biomedical and traditional care services to enable earlier presentation, accurate diagnosis and better clinical outcomes for the patients.
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Affiliation(s)
- Maame-Boatemaa Amissah-Arthur
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail:
| | | | - Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ernest Yorke
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Dzifa Dey
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Vincent Ganu
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Charles Mate-Kole
- Department of Psychiatry, Korle Bu Teaching Hospital, Accra, Ghana
- Center for Ageing Studies, College of Humanities, University of Ghana, Legon, Ghana
- Department of Psychology, College of Humanities, University of Ghana, Legon, Ghana
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Akter S. Factors influencing health service utilization among mothers for under-five children: A cross-sectional study in Khulna district of Bangladesh. PLoS One 2022; 17:e0274449. [PMID: 36095009 PMCID: PMC9467315 DOI: 10.1371/journal.pone.0274449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
Although Bangladesh has made significant progress in reducing child mortality, proper utilization of health services for under-five children among mothers remains one of the major challenges. Hence, this study was designed to investigate the factors influencing health service utilization among mothers for under-five children in the Khulna district of Bangladesh. Administering a semi-structured interview schedule, data were collected from 364 randomly selected mothers from the study area between June and August 2021. At first, Pearson’s Chi-square test was conducted to measure the association between outcome and predictor variables. Multivariable logistic regression model was used to identify the factors associated with utilization of health services. Overall, about 59 percent of the mother received health services from unqualified doctors during their children’s illness and the rest of them (41.5%) seek care from the qualified doctors. Results of regression analysis revealed that long duration of illness (AOR = 2.338; CI: 1.175–4.649; p = 0.015), the severity of illness (AOR = 6.402; CI: 3.275–12.513; p<0.001), and higher cost of treatment (AOR = 7.371; CI: 3.297–16.480; p<0.001) were the significant predictors of utilization of health services from the qualified doctors for under-five children. Thus, the study suggests that to reduce under-five child mortality by ensuring proper utilization of health services, it is necessary to raise awareness among mothers, improve transport facilities, establish need-based health care centers, and lower treatment costs.
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Affiliation(s)
- Shahinur Akter
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
- * E-mail:
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Applying an authentic partnership approach to facilitate optimal health of Aboriginal children. Prim Health Care Res Dev 2022; 23:e47. [PMID: 35968994 PMCID: PMC9381162 DOI: 10.1017/s1463423622000329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The aim of this development paper is to inform the ongoing implementation of the partnership approach with Aboriginal families in Australia. As almost all Community Health Nurses employed by the Health Department of Western Australia, Country Health Service are non-Aboriginal, there are a number of factors that may, potentially, limit their capacity to work effectively with the primary caregivers of Aboriginal children. Historically, much that has been written about the health and development of Aboriginal people in Australia has been negative and derogatory with wide criticism for their non-participation with health services and healthy lifestyle activities. Not only has this “deficit discourse” approach proved to be unhelpful in terms of improving the health and well-being of Aboriginal people but also there is mounting evidence that it has been detrimental to mental and physical health and capacity to achieve autonomy in all aspects of life. In response to the voices of Aboriginal people, the partnership approach to care has been promoted for use by Community Health Nurses in Western Australia. However, the implementation of the approach is not always genuinely strength based, and it does not always focus on mutual goal setting within authentic partnership relationships. The partnership approach has the potential to improve the lives of Aboriginal people if it is implemented with appropriate cultural sensitivity, shared responsibility, dignity and respect.
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Kariuki-Barasa I, Adam MB. Living on the Edge of Possibility. Crit Care Clin 2022; 38:853-863. [DOI: 10.1016/j.ccc.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bitta M, Thungana Y, Kim HH, Denckla CA, Ametaj A, Yared M, Kwagala C, Ongeri L, Stroud RE, Kwobah E, Koenen KC, Kariuki S, Zingela Z, Akena D, Newton C, Atwoli L, Teferra S, Stein DJ, Gelaye B. Cross-country variations in the reporting of psychotic symptoms among sub-Saharan African adults: A psychometric evaluation of the Psychosis Screening Questionnaire. J Affect Disord 2022; 304:85-92. [PMID: 35183621 PMCID: PMC9036658 DOI: 10.1016/j.jad.2022.02.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Self-reporting of psychotic symptoms varies significantly between cultures and ethnic groups. Yet, limited validated screening instruments are available to capture such differences in the African continent. METHODOLOGY Among 9,059 individuals participating as controls in a multi-country case-control study of the genetic causes of psychosis, we evaluated the psychometric properties of the Psychosis Screening Questionnaire (PSQ). We applied multi-group confirmatory factor analysis and item response theory to assess item parameters. RESULTS The overall positive endorsement of at least one item assessing psychotic symptoms on the PSQ was 9.7%, with variability among countries (Uganda 13.7%, South Africa 11%, Kenya 10.2%, and Ethiopia 2.8%). A unidimensional model demonstrated good fit for the PSQ (root mean square error of approximation = 0.009; comparative fit index = 0.997; and Tucker-Lewis Index = 0.995). Hypomania had the weakest association with single latent factor (standardized factor loading 0.62). Sequential multi-group confirmatory factor analysis demonstrated that PSQ items were measured in equivalent ways across the four countries. PSQ items gave more information at higher levels of psychosis, with hypomania giving the least discriminating information. LIMITATIONS Participants were recruited from general medical facilities, so findings may not be generalizable to the general population. CONCLUSION The PSQ demonstrated a unidimensional factor structure in these samples. Items were measured equivalently across all study settings, suggesting that differences in prevalence of psychotic symptoms between countries were less likely to represent measurement artifact. The PSQ is more reliable in screening for psychosis in individuals with higher degrees of psychotic experiences-hypomania excluded-and might decrease the false-positive rate from mild nonspecific psychotic experiences.
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Affiliation(s)
- Mary Bitta
- Clinical Research-Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Yanga Thungana
- Department of Psychiatry, Walter Sisulu University, Mthatha, South Africa
| | - Hannah H Kim
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Christy A Denckla
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Amantia Ametaj
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Mahlet Yared
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Claire Kwagala
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Linnet Ongeri
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Rocky E Stroud
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Edith Kwobah
- Department of Mental Health, Moi teaching and Referral Hospital, Eldoret, Kenya
| | - Karestan C Koenen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Symon Kariuki
- Clinical Research-Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Zukiswa Zingela
- Department of Psychiatry, Walter Sisulu University, Mthatha, South Africa
| | - Dickens Akena
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Charles Newton
- Clinical Research-Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Lukoye Atwoli
- Department of Mental Health, Moi teaching and Referral Hospital, Eldoret, Kenya; Medical College East Africa, The Aga Khan University, Nairobi, Kenya
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Bizu Gelaye
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA; The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Dutta GK, Sarker BK, Ahmed HU, Bhattacharyya DS, Rahman MM, Majumder R, Biswas TK. Mental healthcare-seeking behavior during the perinatal period among women in rural Bangladesh. BMC Health Serv Res 2022; 22:310. [PMID: 35255914 PMCID: PMC8900444 DOI: 10.1186/s12913-022-07678-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Mental health conditions are of rising concern due to their increased contribution to the global burden of disease. Mental health issues are inextricably linked with other socio-cultural and health dimensions, especially in the rural areas in developing countries. The complex relationship between mental health issues and socio-cultural settings may largely toll upon healthcare-seeking behavior. So, it urges to document the current status of mental healthcare-seeking behavior during the perinatal period among rural women in Bangladesh to develop a context-specific intervention in the future. METHODS This study was carried out in one sub-district in Bangladesh from April 2017 to June 2018. We conducted 21 In-depth Interviews (IDIs) and seven Focus Group Discussions (FGDs) with different groups of purposively selected participants. After collecting the recorded interview and making the verbatim transcription, the data were coded through Atlasti 5.7.a. Data were analyzed thematically to interpret the findings. RESULTS Two-thirds of the total respondents did not seek mental healthcare during the perinatal period at the community level. They also did not know about the mental health service provider or the facility to get set these services. Only one respondent out of twenty-one sought maternal mental healthcare from a gynecologist from a private hospital. Socio-cultural factors such as social stigma, traditional beliefs and practices, social and religious taboos, and social capital negatively influence healthcare-seeking behaviors. Besides, the community-level service providers were not found to be adequately trained and did not have proper guidelines regarding its management. CONCLUSION The findings provide evidence that there is an urgent need to increase the awareness for service users and formulate a guideline for the community-level service provider to manage maternal mental problems during the perinatal period of women in rural Bangladesh.
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Affiliation(s)
- Goutam Kumar Dutta
- icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | | | | | | | - Md Musfikur Rahman
- icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Ratna Majumder
- Maternal and Child Health Training Institute, 1205, Dhaka, Bangladesh
| | - Taposh Kumar Biswas
- icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
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Takeyama N, Muzembo BA, Jahan Y, Moriyama M. Health-Seeking Behaviors in Mozambique: A Mini-Study of Ethnonursing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042462. [PMID: 35206649 PMCID: PMC8872320 DOI: 10.3390/ijerph19042462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 02/01/2023]
Abstract
In settings where traditional medicine is a crucial part of the healthcare system, providing culturally competent healthcare services is vital to improving patient satisfaction and health outcomes. Therefore, this study sought to gain insight into how cultural beliefs influence health-seeking behaviors (HSBs) among Mozambicans. Participant observation and in-depth interviews (IDIs) were undertaken using the ethnonursing method to investigate beliefs and views that Mozambicans (living in Pemba City) often take into account to meet their health needs. Data were analyzed in accordance with Leininger’s ethnonursing guidelines. Twenty-seven IDIs were carried out with 12 informants from the Makonde and Makuwa tribes. The choice of health service was influenced by perceptions of health and illness through a spiritual lens, belief in supernatural forces, dissatisfaction with and dislike of the public medical system on grounds of having received poor-quality treatment, perceived poor communication skills of health professionals, and trust in the indigenous medical system. This study confirmed the need for health professionals to carefully take cultural influences into consideration when providing care for their patients. We recommend an educational intervention that emphasizes communication skills training for healthcare workers to ensure successful physician/nurse–patient relationships.
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Affiliation(s)
- Naoko Takeyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (N.T.); (Y.J.)
| | - Basilua Andre Muzembo
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan;
| | - Yasmin Jahan
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (N.T.); (Y.J.)
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (N.T.); (Y.J.)
- Correspondence: ; Tel.: +81-82-257-5365
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Ng TC, Teo CH, Toh JY, Dunn AG, Ng CJ, Ang TF, Abdullah A, Syed A, Lim HM, Yin K, Liew CS. Factors influencing healthcare seeking in patients with dengue: systematic review. Trop Med Int Health 2021; 27:13-27. [PMID: 34655508 DOI: 10.1111/tmi.13695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Delays in seeking healthcare for dengue are associated with poor health outcomes. Despite this, the factors influencing such delays remain unclear, rendering interventions to improve healthcare seeking for dengue ineffective. This systematic review aimed to synthesise the factors influencing healthcare seeking of patients with dengue and form a comprehensive framework. METHODS This review included both qualitative and quantitative studies. Studies were obtained by searching five databases, contacting field experts and performing backward reference searches. The best-fit meta-synthesis approach was used during data synthesis, where extracted data were fitted into the social-ecological model. Sub-analyses were conducted to identify the commonly reported factors and their level of statistical significance. RESULTS Twenty studies were selected for meta-synthesis. Eighteen factors influencing healthcare seeking in dengue were identified and categorised under four domains: individual (11 factors), interpersonal (one factor), organisational (four factors) and community (two factors). The most reported factors were knowledge of dengue, access to healthcare, quality of health service and resource availability. Overall, more barriers to dengue health seeking than facilitators were found. History of dengue infection and having knowledge of dengue were found to be ambiguous as they both facilitated and hindered dengue healthcare seeking. Contrary to common belief, women were less likely to seek help for dengue than men. CONCLUSIONS The factors affecting dengue healthcare-seeking behaviour are diverse, can be ambiguous and are found across multiple social-ecological levels. Understanding these complexities is essential for the development of effective interventions to improve dengue healthcare-seeking behaviour.
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Affiliation(s)
- Tze Chang Ng
- Department of Computer System & Technology, Faculty of Computer Science & Information Technology, Universiti Malaya, Malaysia
| | - Chin Hai Teo
- University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Jia Yong Toh
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Chirk Jenn Ng
- University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Tan Fong Ang
- Department of Computer System & Technology, Faculty of Computer Science & Information Technology, Universiti Malaya, Malaysia
| | - Adina Abdullah
- University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Ayeshah Syed
- Department of English Language, Faculty of Languages & Linguistics, Universiti Malaya, Malaysia
| | - Hooi Min Lim
- University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Kathleen Yin
- Centre of Health Informatics, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Chee Sun Liew
- Department of Computer System & Technology, Faculty of Computer Science & Information Technology, Universiti Malaya, Malaysia.,University of Malaya eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia
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Jeong J, Ahun MN, Bliznashka L, Velthausz D, Donco R, Yousafzai AK. Barriers and facilitators to father involvement in early child health services: A qualitative study in rural Mozambique. Soc Sci Med 2021; 287:114363. [PMID: 34500322 DOI: 10.1016/j.socscimed.2021.114363] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Engaging men and increasing their involvement as partners and parents can improve child health and development. Despite the increasing global evidence and advocacy around father involvement and caregiving, there remain few father-inclusive interventions for promoting early child health, especially within primary health systems in low- and middle-income countries. In this study, we explored community perspectives regarding fathers' roles in early child health services during the first three years of life to identify the barriers and facilitators to father involvement in Monapo District in northern, rural Mozambique. A qualitative sub-study was embedded within a qualitative intervention implementation evaluation conducted in October-November 2020. In-depth interviews were conducted with 36 caregivers, 15 health facility providers, 12 community health providers, 4 government officials, and 7 non-governmental partner organizations. Data were analyzed using inductive thematic content analysis. Results revealed that fathers were generally uninvolved in early child healthcare services. Primary barriers to fathers' involvement included the absence of fathers in many households; opportunity costs associated with fathers' accompanying children to health facilities; long waiting times at facilities; negative health provider attitudes towards fathers; and patriarchal gender norms. Respondents also highlighted facilitators of father involvement, which included fathers' broader engagement with their child at home; fathers' desires to support their partners; parental awareness about the importance of father involvement in child healthcare; and community outreach and sensitization campaigns targeting fathers directly. Our study highlights opportunities for enhancing the focus, design, and delivery of child health services so that they are more inclusive and responsive to fathers. Future research should assess the feasibility, acceptability, and effectiveness of father-focused child health interventions on caregiving and early child health and development outcomes. These strategies should holistically address not only individual and household factors, but also broader structural and sociocultural determinants at the health system and community levels.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Marilyn N Ahun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Université de Montréal School of Public Health, Montréal, QC, Canada
| | - Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Choi CEE, Yee MYF, Tan LYL, Phan P. A qualitative study of dermatology patients and providers to understand discordant perceptions of symptom burden and disease severity. J DERMATOL TREAT 2021; 33:2344-2351. [PMID: 34314298 DOI: 10.1080/09546634.2021.1961996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients often present with symptoms that are disproportionate to the observed disease state, and grade disease severity differently from healthcare providers (HPs). This discordant symptom burden and severity grading (DSG) results in poorer patient care. Current research on DSG is limited, relying on structured models that are theoretically incomplete. OBJECTIVE To fully understand the factors driving DSG. METHODS Qualitative study of dermatology patients and HPs. Interview data were analyzed using grounded theory to derive a model of the causes of DSG. RESULTS Eighteen patients and 12 HPs were interviewed. Results reflect a tendency for patients to grade their conditions more severely than HPs. Factors driving DSG are related to emotional and cognitive disparities in the constructs used to grade severity, varying consequences of disease due to differing resilience and coping methods, socio-psychological factors influencing how patients report their symptoms, and the context of the consult. CONCLUSION A better understanding of DSG is required for achieving mutual understanding and patient-centered collaborative care. It is easy to label a patient with high symptom burden as having a low threshold for discomfort, or for a patient to presume that the doctor is unempathetic. This study suggests the causes of DSG are nuanced and multifactorial.
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Affiliation(s)
- C E Ellie Choi
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - M Y Fiona Yee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Phillip Phan
- Johns Hopkins Carey Business School, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
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Sogbossi ES, Houekpetodji D, Kpadonou TG, Bleyenheuft Y. Mothers' perception of cerebral palsy in a low-income country of West Africa: a cross-sectional study. Disabil Rehabil 2021; 44:4767-4774. [PMID: 33993806 DOI: 10.1080/09638288.2021.1919765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Investigating mothers' perceptions of Cerebral Palsy (CP) and the impact of caregiving on family life in Benin, a west-African low to middle-income country (LMIC). METHODS In this cross-sectional study we interviewed at their homes 88 mothers of children with CP about their perception of the cause of CP and stigmatization issues. Additionally, they completed the Impact on Family Scale and the Family Support Scale questionnaires. Multinomial and ordinal regressions analyses were used (p < 0.05). RESULTS Most mothers (78%) referred to non-biomedical causes of CP (God's will or curse). Caregivers with a limited education level were more likely to report non-biomedical beliefs. Only 28% reported having received from physicians an explanation of the causes of CP. Around 38% endorsed neighbors considered their children as cursed, which is a source of stigmatization. Mothers perceived a high impact of caregiving on their family life that correlated with non-biomedical beliefs, low education level, and the severity of CP. CONCLUSION There is a need in Benin, and probably in West-African LMICs generally, to shift to a family-centered care system and to inform the public about the root causes of CP to improve social integration of children with CP and decrease the negative impact on their families.Implication for rehabilitationMothers with a limited education level are more likely to report non-biomedical causes of CP in this LMIC;mothers' level of education and non-biomedical beliefs of causes of CP are associated to a high impact of caregiving on family life in this LMIC;mothers of children with CP in this LMIC do not perceive health-workers helpful.
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Affiliation(s)
- Emmanuel Segnon Sogbossi
- Motor Skill Learning and Intensive Neurorehabilitation Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Faculty of Health Sciences, School of Physical Therapy, University of Abomey-Calavi, Cotonou, Benin
| | - Damienne Houekpetodji
- Faculty of Health Sciences, School of Physical Therapy, University of Abomey-Calavi, Cotonou, Benin
| | - Toussaint G Kpadonou
- Faculty of Health Sciences, School of Physical Therapy, University of Abomey-Calavi, Cotonou, Benin.,Clinique Universitaire de Médecine Physique et Réadaptation du Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA (CNHU-HKM) de Cotonou, Cotonou, Benin
| | - Yannick Bleyenheuft
- Motor Skill Learning and Intensive Neurorehabilitation Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
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Aziato L, Pwavra JBP, Paarima Y, Konlan KD. The Nurse or Midwife at the Crossroads of Caring for Patients With Suicidal and Rigid Religious Ideations in Africa. Front Psychol 2021; 12:549766. [PMID: 33986704 PMCID: PMC8110727 DOI: 10.3389/fpsyg.2021.549766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Nurses and midwives are the majority of healthcare professionals globally, including Africa, and they provide care at all levels of the health system including community levels. Nurses and midwives contribute to the care of patients with rigid or dogmatic religious beliefs or those with suicidal ideations. This review paper discusses acute and chronic diseases that have suicidal tendencies such as terminal cancer, diseases with excruciating pain, physical disability, stroke, end-stage renal failure, and diabetics who are amputated. It was reiterated that nurses and midwives taking care of these patients should be alert and observant to identify their suicidal tendencies. The paper also discusses religious or spiritual inclinations that negatively affect healthcare access and adherence, especially to biomedical or western medicine. It was emphasized that some religious beliefs do not allow their followers to employ biomedical treatment and nurses and midwives should not impose their faith on patients and their families. The paper ends with a discussion on the specific roles of nurses and midwives in the care of patients with suicidal ideations such as assessment, counseling, administering medication, observation, social interaction, ensuring safety measures, and providing an enabling environment for the family to part of the care and for the observation of religious coping strategies. Nurses and midwives should enhance their knowledge and skills on suicide and increase public education on suicide prevention and identification of those at risk.
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Affiliation(s)
- Lydia Aziato
- School of Nursing and Midwifery, University of Ghana, Accra, Ghana
| | - Joyce B P Pwavra
- Department of Maternal and Child Health, School of Nursing and Midwifery, University of Ghana, Accra, Ghana
| | - Yennuten Paarima
- Department of Research, Education, and Administration, School of Nursing and Midwifery, University of Ghana, Accra, Ghana
| | - Kennedy Dodam Konlan
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Accra, Ghana
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Kebaya LMN, Wamalwa D, Kariuki N, Admani B, Ayieko P, Nduati R. Efficacy of Mobile phone use on adherence to Nevirapine prophylaxis and retention in care among the HIV-exposed infants in prevention of mother to child transmission of HIV: a randomized controlled trial. BMC Pediatr 2021; 21:186. [PMID: 33879118 PMCID: PMC8056659 DOI: 10.1186/s12887-021-02660-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV is a major contributor to infant mortality. A significant gap remains between the uptake of infant and maternal antiretroviral regimens and only a minority of HIV-exposed infants receives prophylaxis and safe infant feeding. Losses to follow-up of HIV-exposed infants are associated with shortcomings of facility-based PMTCT models with weak community support of linkages. Use of mobile phones offers an opportunity for improving care and promoting retention assessed by timely attendance of scheduled appointments for the mother-baby pairs and achievement of an HIV-free generation. The objective of this study was to compare self-reported adherence to infant Nevirapine (NVP) prophylaxis and retention in care assessed by timely attendance of scheduled appointments over 10 weeks in HIV exposed infants randomized to 2-weekly mobile phone calls (intervention) versus no phone calls (control). METHODS In this open label randomized controlled study, one hundred and fifty HIV infected women drawn from 3 health facilities in Western Kenya and their infants were randomly assigned to receive either phone-based reminders on PMTCT messages or standard health care messages (no calls) within 24 h of delivery. Women in the intervention arm continued to receive fortnightly phone calls. At 6- and 10-weeks following randomization we collected data on infant adherence to Nevirapine, mode of infant feeding, early HIV testing and retention in care in both study arms. All analyses were intention to treat. RESULTS At 6 weeks follow-up, 90.7% (n = 68) of participants receiving phone calls reported adherence to infant NVP prophylaxis, compared with 72% (n = 54) of participants in the control group (p = 0.005). Participants in the intervention arm were also significantly more likely to remain in care than participants in the control group [78.7% (n = 59) vs. 58.7% (n = 44), p = 0.009 at 6 weeks and 69.3% (n = 52) vs. 37.3% (n = 28), p < 0.001 at 10 weeks]. CONCLUSIONS These results suggest that phone calls are potentially an important tool to improve adherence to infant NVP prophylaxis and retention in care for HIV-exposed infants. TRIAL REGISTRATION PACTR202007654729602. Registered 6 June 2018 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3449.
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Affiliation(s)
- Lilian M N Kebaya
- Department of Paediatrics. Division of Neonatal-Perinatal Medicine, Western University, London, Ontario, Canada.
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
| | - Dalton Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Nyambura Kariuki
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Bashir Admani
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Philip Ayieko
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Nduati
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Widayanti AW, Green JA, Heydon S, Norris P. Health-Seeking Behavior of People in Indonesia: A Narrative Review. J Epidemiol Glob Health 2021; 10:6-15. [PMID: 32175705 PMCID: PMC7310809 DOI: 10.2991/jegh.k.200102.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/21/2019] [Indexed: 11/01/2022] Open
Abstract
This review aims to locate existing studies on health-seeking behavior of people in Indonesia, identify gaps, and highlight important findings. Articles were retrieved from Medline, Scopus, Web of Science, Academic Search Complete (via Ebsco), and ProQuest with a number of key words and various combinations. Articles from Indonesian journals were also searched for with Google Scholar. A total of 56 articles from peer-reviewed journal databases and 19 articles from Indonesian journals were reviewed. Quantitative designs were applied more frequently than qualitative, and mixed methods designs were used in some studies. The majority gathered retrospective information about people's behaviors. Communicable diseases and maternity care were the most frequently studied conditions, in contrast to noncommunicable diseases. In terms of geographical distribution, most research was conducted on Java island, with very few in outside Java. Important findings are a model of Indonesian care-seeking pathways, an understanding of determinants of people's care choices, and the role of sociocultural beliefs. The findings from this narrative review provide insight to what and how Indonesians make decisions to manage their illness and why. This makes an important contribution to understanding the problem of underutilization of medical services despite the government's extensive efforts to improve accessibility.
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Affiliation(s)
- Anna Wahyuni Widayanti
- School of Pharmacy, University of Otago, Dunedin, New Zealand.,Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - James A Green
- School of Pharmacy, University of Otago, Dunedin, New Zealand.,School of Allied Health and Physical Activity for Health, Health Research Institute (HRI), University of Limerick, Limerick, Ireland
| | - Susan Heydon
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Pauline Norris
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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Ezeugwu CR, Ojedokun O. Masculine norms and mental health of African men: what can psychology do? Heliyon 2020; 6:e05650. [PMID: 33336092 PMCID: PMC7734219 DOI: 10.1016/j.heliyon.2020.e05650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/25/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022] Open
Abstract
In Africa, internalisation of masculine norms among men has been reported to make them more susceptible to mental health problems. In this chapter, social construction and role theories are used to explore the relationships between masculine norms and mental health among men in Africa. The authors argued that due to traditional and institutionalised beliefs, men engage in restrictive emotionality through defence mechanisms by denying their mental health challenges and status. Hence, an inclusive model of remedy was suggested that targets men's traditional beliefs as a way of aiding help-seeking behaviour among them to make them less susceptible to mental health problems.
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Affiliation(s)
- Chika Remigious Ezeugwu
- Department of Psychology & Education, Faculty of Education, University of Cambridge, United Kingdom
| | - Oluyinka Ojedokun
- Department of Pure & Applied Psychology, Faculty of Social & Management Sciences, Adekunle Ajasin University, Akungba-Akoko, Ondo State, Nigeria
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Odwe G, Ndwiga C, Okondo C, Sripad P, Abuya T, Warren CE. Exploring communities' perceptions of the etiology of illnesses in newborns and young infants 0-59 days old in 4 counties in Kenya. PLoS One 2020; 15:e0240852. [PMID: 33201913 PMCID: PMC7671537 DOI: 10.1371/journal.pone.0240852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/04/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Understanding communities' beliefs about the causes of illnesses in sick young infants (SYIs) is key to strengthening interventions and improving newborn health outcomes. This study explored communities' perception of the etiology of illnesses in SYIs 0-59 days old in four counties in Kenya. METHODS We used an exploratory qualitative study design. Data were collected between August and September 2018 and involved 23 in-depth interviews with female caregivers aged 15-24years; 25 focus group discussions with female caregivers aged 15-18 years, 19-24 years and 25-45 years; and 7 focus group discussions with fathers aged 18-34 years and 35 or more years. Participants were purposely sampled, only those with SYIs 0-59 days old were eligible to participate. Data were analyzed using inductive thematic analysis framework approach. RESULTS Female caregivers and fathers attributed illnesses in SYIs 0-59 days old to natural (biomedical) and supernatural causes which sometimes co-existed. There were commonalities in perceived natural causes of illness in SYIs across sites, age groups and gender. Perceived natural causes of illness in SYIs include unfavorable environmental and hygiene conditions, poor maternal and child nutrition, and healthcare practices. Perceived supernatural causes of illness in SYIs such as 'evil eyes' were common across the four counties while others were geographically unique such as the belief that owls cause illnesses. CONCLUSION Communities' understanding of the etiology of illnesses in SYIs in the study settings overlapped between natural and supernatural causes. There is need for child health programmes to take into consideration communities' beliefs and practices regarding disease and health to improve newborn health outcomes.
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Affiliation(s)
| | | | | | - Pooja Sripad
- Population Council, Washington, DC, United States of America
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Ng'ambi W, Mangal T, Phillips A, Colbourn T, Mfutso-Bengo J, Revill P, Hallett TB. Factors associated with healthcare seeking behaviour for children in Malawi: 2016. Trop Med Int Health 2020; 25:1486-1495. [PMID: 32981174 DOI: 10.1111/tmi.13499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To characterise health seeking behaviour (HSB) and determine its predictors amongst children in Malawi in 2016. METHODS We used the 2016 Malawi Integrated Household Survey data set. The outcome of interest was HSB, defined as seeking care at a health facility amongst people who reported one or more of a list of possible symptoms given on the questionnaire in the past two weeks. We fitted a multivariate logistic regression model of HSB using a forward step-wise selection method, with age, sex and symptoms entered as a priori variables. RESULTS Of 5350 children, 1666 (32%) had symptoms in the past two weeks. Of the 1666, 1008 (61%) sought care at health facility. The children aged 5-14 years were less likely to be taken to health facilities for health care than those aged 0-4 years. Having fever vs. not having fever and having a skin problem vs. not having skin problem were associated with increased likelihood of HSB. Having a headache vs. not having a headache was associated with lower likelihood of accessing care at health facilities (AOR = 0.50, 95% CI: 0.26-0.96, P = 0.04). Children from urban areas were more likely to be taken to health facilities for health care (AOR = 1.81, 95% CI: 1.17-2.85, P = 0.008), as were children from households with a high wealth status (AOR = 1.86, 95% CI: 1.25-2.78, P = 0.02). CONCLUSION There is a need to understand and address individual, socio-economic and geographical barriers to health seeking to increase access and use of health care and fast-track progress towards Universal Health Coverage.
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Affiliation(s)
- Wingston Ng'ambi
- College of Medicine, Health Economics and Policy Unit, University of Malawi, Lilongwe, Malawi
| | | | | | | | - Joseph Mfutso-Bengo
- College of Medicine, Health Economics and Policy Unit, University of Malawi, Lilongwe, Malawi
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Funk T, Källander K, Abebe A, Alfvén T, Alvesson HM. 'I also take part in caring for the sick child': a qualitative study on fathers' roles and responsibilities in seeking care for children in Southwest Ethiopia. BMJ Open 2020; 10:e038932. [PMID: 32819953 PMCID: PMC7440706 DOI: 10.1136/bmjopen-2020-038932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Fathers play an important role in household decision-making processes and child health development. Nevertheless, they are under-represented in child health research, especially in low-income settings. Little is known about what roles fathers play in the care-seeking processes or how they interact with the health system when their child is sick. This study aimed to understand Ethiopian fathers' roles and responsibilities in caring for their children when they are or become ill. DESIGN Qualitative study using semistructured interviews with fathers. SETTING This study was conducted in three rural districts of the Southern Nations, Nationalities and People's Region of Ethiopia. PARTICIPANTS Twenty-four fathers who had at least one child between 2 and 59 months who visited a health extension worker with fever. RESULTS The overarching theme of this study was 'changing perceptions of paternal responsibilities during children's ill health'. It constituted three subthemes, namely, 'fathers' burden of earning money for care', 'fatherhood entails advocating children's healthcare needs' and 'investing in children's health can benefit the family in the future'. Fathers described that they were the ones mainly responsible for the financial arrangement of care and that this financial responsibility can involve stress when resources are scarce. Fathers knew what health services were available and accessible to them and were involved in different ways in the care seeking of the child. Changes in the importance ascribed to child health were expressed by fathers who described being more alert to children's ill-health. CONCLUSION Fathers play various roles in the care-seeking process during children's illness episodes. This included, for instance, arranging resources to seek care, (co)-deciding where to seek care as well as accompanying the child to the health facility. The inability to organise necessary resources for care can lead to involuntary delays in care seeking for the child. This demonstrates the importance of including fathers in future interventions on maternal and child health.
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Affiliation(s)
- Tjede Funk
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Hooft A, Nabukalu D, Mwanga-Amumpaire J, Gardiner MA, Sundararajan R. Factors Motivating Traditional Healer versus Biomedical Facility Use for Treatment of Pediatric Febrile Illness: Results from a Qualitative Study in Southwestern Uganda. Am J Trop Med Hyg 2020; 103:501-507. [PMID: 32458776 PMCID: PMC7356444 DOI: 10.4269/ajtmh.19-0897] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/26/2020] [Indexed: 12/17/2022] Open
Abstract
Febrile illnesses, such as malaria and pneumonia, are among the most common causes of mortality in children younger than 5 years in Uganda outside of the neonatal period. Their impact could be mitigated through earlier diagnosis and treatment at biomedical facilities; however, it is estimated that a large percentage of Ugandans (70-80%) seek traditional healers for their first line of medical care. This study sought to characterize individual and structural influences on health care-seeking behaviors for febrile children. Minimally structured, qualitative interviews were conducted for 34 caregivers of children presenting to biomedical and traditional healer sites, respectively. We identified six themes that shape the pathway of care for febrile children: 1) peer recommendations, 2) trust in biomedicine, 3) trust in traditional medicine, 4) mistrust in providers and therapies, 5) economic resources and access to health care, and 6) perceptions of child health. Biomedical providers are preferred by those who value laboratory testing and formal medical training, whereas traditional healer preference is heavily influenced by convenience, peer recommendations, and firm beliefs in traditional causes of illness. However, most caregivers concurrently use both biomedical and traditional therapies for their child during the same illness cycle. The biomedical system is often considered as a backup when traditional healing "fails." Initiatives seeking to encourage earlier presentation to biomedical facilities must consider the individual and structural forces that motivate seeking traditional healers. Educational programs and cooperation with traditional healers may increase biomedical referrals and decrease time to appropriate care and treatment for vulnerable/susceptible children.
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Affiliation(s)
- Anneka Hooft
- Department of Pediatrics, Rady Children’s Hospital San Diego, University of California, San Diego, San Diego, California
| | - Doreen Nabukalu
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Juliet Mwanga-Amumpaire
- Department of Paediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Michael A. Gardiner
- Department of Pediatrics, Rady Children’s Hospital San Diego, University of California, San Diego, San Diego, California
| | - Radhika Sundararajan
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York
- Center for Global Health, Weill Cornell Medicine, New York, New York
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Mochache V, Wanje G, Nyagah L, Lakhani A, El-Busaidy H, Temmerman M, Gichangi P. Religious, socio-cultural norms and gender stereotypes influence uptake and utilization of maternal health services among the Digo community in Kwale, Kenya: a qualitative study. Reprod Health 2020; 17:71. [PMID: 32448327 PMCID: PMC7245746 DOI: 10.1186/s12978-020-00919-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background Maternal health outcomes in resource-limited settings are typically influenced by supply-side factors affecting the provision of quality health services. The extent to which demand-side factors contribute to this influence is unclear. We aimed to explore how individual and community-wide factors influenced uptake and utilization of maternal health services among the Digo community residing in Kwale County of coastal Kenya. Methods Between March and December 2015, we conducted 5 focus group discussions (FGDs) and 15 in-depth interviews (IDIs) with members of the Digo community predominant in Kwale county, Kenya. Respondents were sampled purposively and included female (pregnant and postpartum) as well as male adult community members. A thematic content analytic approach was used. Results There were a total of 47 FGD respondents, including 15 (32%) females with a median (interquartile, IQR) age of 38 (27–55) years and 6 (3–8) children. Majority (40%) reported attaining secondary-level education. All IDI respondents were female with a median (IQR) age of 27 (24–35) years and 4 (2–5) children. Majority (80%) had attained primary-level education. We found that religious and socio-cultural norms as well as gender stereotypes were important influences on the uptake and utilization of maternal health services, including facility-based delivery and contraception. Key amongst this was the unspoken deference to the counsel of a prominent matriarchal figure in the decision-making process. Conclusions Among the Digo community of coastal Kenya, a unique social-cultural context comprising of a religious and gendered value belief system influences women’s reproductive health and rights. These findings highlight the important role of demand-side factors in influencing maternal health outcomes. In addition to addressing supply-side factors, programs in such settings should aim to address factors that leverage inherent social capital to drive demand for maternal health services ensuring that they are not only effective, but also responsive to the local context.
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Affiliation(s)
- Vernon Mochache
- International Centre for Reproductive Health, P.O. Box 91109-80103, Mombasa, Kenya. .,University of Ghent, Ghent, Belgium.
| | - George Wanje
- Department of Medical Microbiology, University of Nairobi, Mombasa Field Site, P.O Box 91276-80103, Mombasa, Kenya
| | - Lucy Nyagah
- Community Health Department, Aga Khan University, P.O Box 83013-80100, Mombasa, Kenya
| | - Amyn Lakhani
- Community Health Department, Aga Khan University, P.O Box 83013-80100, Mombasa, Kenya
| | - Hajara El-Busaidy
- Department of Health, County Government of Kwale, P.O Box 6-80403, Kwale, Kenya
| | - Marleen Temmerman
- International Centre for Reproductive Health, P.O. Box 91109-80103, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,Community Health Department, Aga Khan University, P.O Box 83013-80100, Mombasa, Kenya.,Aga Khan University Hospital, 3rd Parklands Avenue, Limuru Road, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health, P.O. Box 91109-80103, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,Technical University of Mombasa, P.O Box 90420-80100, Mombasa, Kenya
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Ao M. Health outcome measures and determinants of using indigenous medicine in a pluralistic healthcare in Nagaland, Northeast India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Adjei CA, Stutterheim SE, Naab F, Ruiter RAC. Barriers to chronic Hepatitis B treatment and care in Ghana: A qualitative study with people with Hepatitis B and healthcare providers. PLoS One 2019; 14:e0225830. [PMID: 31794577 PMCID: PMC6890212 DOI: 10.1371/journal.pone.0225830] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hepatitis B viral (HBV) infection remains an important public health concern particularly in Africa. Between 1990 and 2013, Hepatitis B mortality increased by 63%. In recent times, effective antiviral agents against HBV such as Nucleos(t)ide analogs (NAs) are available. These drugs are capable of suppressing HBV replication, preventing progression of chronic Hepatitis B to cirrhosis, and reducing the risk of hepatocellular carcinoma and liver-related death. Notwithstanding, these treatments are underused despite their effectiveness in managing Hepatitis B. This study sought to explore barriers to treatment and care for people with Hepatitis B (PWHB) in Ghana, paying particular attention to beliefs about aetiology that can act as a barrier to care for PWHB. METHODS We used an exploratory qualitative design with a purposive sampling technique. Face-to-face interviews were conducted for 18 persons with Hepatitis B (PWHB) and 15 healthcare providers (HCP; physicians, nurses, and midwives). In addition, four focus group discussions (FGD) with a composition of eight HCPs in each group were done. Participants were recruited from one tertiary and one regional hospital in Ghana. Data were processed using QSR Nvivo version 10.0 and analysed using the procedure of inductive thematic analysis. Participants were recruited from one tertiary and one regional hospital in Ghana. RESULTS Three main cultural beliefs regarding the aetiology of chronic Hepatitis B that act as barriers to care and treatment were identified. These were: (1) the belief that chronic Hepatitis B is a punishment from the gods to those who touch dead bodies without permission from their landlords, (2) the belief that bewitchment contributes to chronic Hepatitis B, and (3) the belief that chronic Hepatitis B is caused by spiritual poison. Furthermore, individual level barriers were identified. These were the absence of chronic Hepatitis B signs and symptoms, perceived efficacy of traditional herbal medicine, and PWHB's perception that formal care does not meet their expectations. Health system-related barriers included high cost of hospital-based care and inadequate Hepatitis B education for patients from HCPs. CONCLUSION Given that high cost of hospital based care was considered an important barrier to engagement in care for PWHB, we recommend including the required Hepatitis B laboratory investigations such as viral load, and the recommended treatment in the National Health Insurance Scheme (NHIS). Also, we recommend increasing health care providers and PWHB Hepatitis B knowledge and capacity in a culturally sensitive fashion, discuss with patients (1) myths about aetiology and the lack of efficacy of traditional herbal medicines, and (2) patients' expectations of care and the need to monitor even in the absence of symptoms.
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Affiliation(s)
- Charles Ampong Adjei
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands
- School of Nursing and Midwifery University of Ghana, Accra, Ghana
- * E-mail:
| | - Sarah E. Stutterheim
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands
| | - Florence Naab
- School of Nursing and Midwifery University of Ghana, Accra, Ghana
| | - Robert A. C. Ruiter
- Department of Work and Social Psychology Maastricht University, Maastricht, The Netherlands
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Mazzi M, Bajunirwe F, Aheebwe E, Nuwamanya S, Bagenda FN. Proximity to a community health worker is associated with utilization of malaria treatment services in the community among under-five children: a cross-sectional study in rural Uganda. Int Health 2019; 11:143-149. [PMID: 30265330 DOI: 10.1093/inthealth/ihy069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 06/24/2018] [Accepted: 08/20/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In rural areas of sub-Saharan Africa, health facilities are difficult to access for prompt treatment of malaria. Community health workers (CHWs) have been trained and equipped to treat malaria. Utilization of their service has not been adequately evaluated. The aim of this study was to determine the level of utilization of CHWs, and whether distance and other factors influence the utilization. METHODS The authors conducted a cross-sectional study among households with a child below 5 y of age and interviewed caregivers in Sheema district, rural western Uganda. Logistic regression was used to calculate adjusted ORs (aOR) for factors associated with use of CHW services. RESULTS Among 547 households, 64% (338/528) reported using CHWs as the first point of consultation for their febrile children. Factors associated with the use of CHWs services were lower asset index (aOR=1.9, p=0.02), mother being the decision maker for site of first consultation (aOR=1.9, p=0.01), distance to nearest CHW of <3 km (aOR=2.1, p=0.03) compared to >3 km, and trust for CHWs services (aOR=7.8, p<0.001). CONCLUSION Proximal location to a CHW is associated with use of CHW services. Programs should ensure that CHW are well located to enable easy access.
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Affiliation(s)
- Micheal Mazzi
- Mbarara University of Science and Technology, Department of Community Health, Mbarara, Uganda.,Lakka Infectious Disease Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Francis Bajunirwe
- Mbarara University of Science and Technology, Department of Community Health, Mbarara, Uganda
| | - Emmanuel Aheebwe
- Mbarara University of Science and Technology, Department of Community Health, Mbarara, Uganda
| | - Simpson Nuwamanya
- Mbarara University of Science and Technology, Department of Community Health, Mbarara, Uganda
| | - Fred N Bagenda
- Mbarara University of Science and Technology, Department of Community Health, Mbarara, Uganda
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Rono MMed HK, Macleod D, Bastawrous A, Wanjala E, Gichangi M, Burton MJ. Utilization of Secondary Eye Care Services in Western Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3371. [PMID: 31547252 PMCID: PMC6766006 DOI: 10.3390/ijerph16183371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/05/2019] [Accepted: 09/07/2019] [Indexed: 12/29/2022]
Abstract
Background: Eye care provision is currently insufficient to meet the population's eye health needs in Kenya. Many people remain unnecessarily visually impaired or at risk of becoming so due to treatable or preventable conditions. A lack of access and awareness of services are key barriers, in large part due to their being too few eye care providers in the health system for this unmet need. Methods: A hospital-based, retrospective analysis of patients who attended Kitale eye unit, Trans Nzoia County, Kenya from 1st January 2013 to 31st December 2015. Age and sex standardized hospital attendance rates by residence, age group, and sex were calculated for Trans Nzoia county and each subcounty. The changing trends in attendance rates were estimated by calculating the difference between base year and last year. Incidence rate ratios for attendance for each age-group, sex, and residence were estimated using a multivariable regression model. Results: 20,695 patients from the county were seen in Kitale Eye Unit in 2013, 2014 and 2015. In that period, 8.3% had either uncorrected refractive error, cataracts or glaucoma, the priority VISION2020 diseases, and 61.0% had allergic or other conjunctivitis or normal eyes, which could potentially be managed at primary eye care. During the study period, overall average annual attendance rate increased from 609 to 792 per 100, 000 population, incidence rate ratio (IRR) 1.30 (95% confidence interval (CI) 1.26-1.35). Attendance rates increased more in females than males (34.7% vs. 25.1%, respectively), IRR 1.07 (1.04-1.10). Attendance rates increased with increasing age, (highest among the elderly compared to the young). We found that in extreme age groups (>75 years and <15years) females were less likely to attend than males and there was reduced utilization from those based furthest from the hospital. Conclusion: Specialist eye services are heavily utilized by people with conditions that could be managed at the primary health care level. Barriers to accessing eye services were distance and gender, especially among the most vulnerable groups (young and the elderly). Integration of primary and secondary eye care services could lower barriers to essential eye care services to the population whilst lowering pressure on the limited specialist services by ensuring more appropriate utilization.
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Affiliation(s)
- Hillary K Rono MMed
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
- Kitale County and Referral Hospital, Box 98, Kitale 30200, Kenya.
| | - David Macleod
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Andrew Bastawrous
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
- The Peek Vision Foundation, London EC2Y 9DT, UK.
| | - Emmanuel Wanjala
- Kitale County and Referral Hospital, Box 98, Kitale 30200, Kenya.
| | - Michael Gichangi
- Ophthalmic Services Unit, Ministry of Heath, Box 30016, Nairobi 00100, Kenya.
| | - Matthew J Burton
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
- Moorfields Eye Hospital NHS Trust, London EC1V 2PD, UK.
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Abegaz NT, Berhe H, Gebretekle GB. Mothers/caregivers healthcare seeking behavior towards childhood illness in selected health centers in Addis Ababa, Ethiopia: a facility-based cross-sectional study. BMC Pediatr 2019; 19:220. [PMID: 31269920 PMCID: PMC6607537 DOI: 10.1186/s12887-019-1588-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background Seeking healthcare in children is unique since parents decide upon the type and frequency of healthcare services accessed. Mothers/caregivers lower healthcare seeking behavior is one of the major reason for increased morbidity and mortality from childhood illness in developing countries. Hence, this study aimed to assess healthcare seeking behavior of mothers/caregivers towards childhood illnesses in selected health centers of Addis Ababa, Ethiopia. Methods A facility-based cross-sectional survey was conducted on 422 sampled mothers/caregivers of children age 0–59 months, from April 18 to May 11, 2016. Ten health centers were selected using simple random sampling technique and proportionate number of participants were included from each health centers. A pre-tested, semi-structured questionnaire was used to collect data. Data were analyzed using SPSS version 20.0. Descriptive statistics was used to summarize socio-demographic characteristics and multivariable logistic regression was employed to identify factors associated with of healthcare seeking behavior. Result In case of illnesses, 26.5% of mothers/caregivers sought healthcare for their children. Among the common childhood illnesses, acute respiratory tract infection and diarrhea accounted for 47.6 and 31%, respectively. Mothers/caregivers healthcare seeking behavior towards common childhood illnesses were influenced by child’s age (AOR = 1.78, 95% CI:1.02, 3.13), education of mothers/caregivers (AOR = 4.24, 95% CI:1.32, 13.63), family size (AOR = 3.83, 95% CI:1.06, 13.78), perception of severity of illnesses (AOR = 2.00, 95% CI:1.05, 3.84), previous experience of similar illnesses (AOR = 3.67, 95% CI:1.36, 9.86) and previous history of under-five child death (AOR = 13.31, 95% CI:5.13, 34.53). Conclusions The common under-five childhood illnesses were acute respiratory tract infection and diarrhea. The study also revealed that there was a delay in seeking healthcare and this was significantly associated with age of the child; mothers/caregivers level of education; family size; perception of illness severity; previous experience of similar illnesses and under-five child death. Electronic supplementary material The online version of this article (10.1186/s12887-019-1588-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Gebremedhin Beedemariam Gebretekle
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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49
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Household relationships and healthcare seeking behaviour for common childhood illnesses in sub-Saharan Africa: a cross-national mixed effects analysis. BMC Health Serv Res 2019; 19:308. [PMID: 31088474 PMCID: PMC6518738 DOI: 10.1186/s12913-019-4142-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background Intra-household dynamics play crucial roles in utilisation of healthcare services for children. We investigated the influence of household relationships on healthcare seeking behaviour for common childhood illnesses in four sub-Sahara African regions. Methods Data on 247,061 under-five children were extracted from recent Demographic and Health Surveys conducted between 2012 and 2016 in 25 countries. Data were combined and analysed per sub-region. Dependent variables (DVs) were uptake of health facility care for diarrhea and Acute Respiratory Tract Infection (ARI) symptoms. The main independent variable (IV) was household relationship which was represented by maternal marital profile (marital status, family type and number of marriages) and maternal relationship to household head. Mixed effects logit models were fitted to assess independent relationship between the IVs and DVs with adjustment for relevant demographic and socio-economic characteristics at 5% significance level. Results The percentage of children who received care for diarrhea and ARI symptoms from health facilities across sub-regions was: Western Africa (WA) 42.4, 44.1%; Central Africa (CA) 32.6, 33.9%; Eastern Africa (EA) 41.5, 48.7% and Southern Africa (SA) 58.9, 62.7%. Maternal marital profile was not associated with healthcare seeking behaviour for diarrhea and ARI symptoms in any of the sub-regions. Children whose mothers were daughter/daughter-in-law to household head were significantly less likely to be taken to health facility for diarrhea treatment in Eastern Africa (AOR = 0.81, CI: 0.51–0.95). Having a mother who is the head of household was significantly associated with higher odds of facility care for ARI symptoms for children from Western (AOR = 1.20, CI: 1.02–1.43) and Southern Africa (AOR = 1.49, CI: 1.20–1.85). Conclusion The type of relationship between mother of under-fives and head of households affect health seeking behaviour for treatment of diarrhea and ARI symptoms in Eastern, Western and Southern Africa. Countries in these regions need to adapt best practices for promoting healthcare utilisation for children such that household relationship does not constitute barriers. Electronic supplementary material The online version of this article (10.1186/s12913-019-4142-x) contains supplementary material, which is available to authorized users.
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50
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Adhikari B, Phommasone K, Pongvongsa T, Koummarasy P, Soundala X, Henriques G, Sirithiranont P, Parker DM, von Seidlein L, White NJ, Day NPJ, Dondorp AM, Newton PN, Cheah PY, Pell C, Mayxay M. Treatment-seeking behaviour for febrile illnesses and its implications for malaria control and elimination in Savannakhet Province, Lao PDR (Laos): a mixed method study. BMC Health Serv Res 2019; 19:252. [PMID: 31018855 PMCID: PMC6480816 DOI: 10.1186/s12913-019-4070-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 04/08/2019] [Indexed: 02/06/2023] Open
Abstract
Background How people respond to febrile illness is critical to malaria prevention, control, and ultimately elimination. This article explores factors affecting treatment-seeking behaviour for febrile illnesses in a remote area of Lao PDR. Methods Household heads or their representatives (n = 281) were interviewed using a structured questionnaire. A total of twelve focus group discussions (FGDs) each with eight to ten participants were conducted in four villages. In addition, observations were recorded as field notes (n = 130) and were used to collect information on the local context, including the treatment seeking behaviour and the health services. Results Almost three-quarters (201/281) of respondents reported fever in past two months. Most (92%, 185/201) sought treatment of which 80% (149/185) sought treatment at a health centre. Geographic proximity to a health centre (AOR = 6.5; CI = 1.74–24.25; for those < 3.5 km versus those > 3.6 km) and previous experience of attending a health centre (AOR = 4.7; CI = 1.2–19.1) were strong predictors of visiting a health centre for febrile symptoms. During FGDs, respondents described seeking treatment from traditional healers and at health centre for mild to moderate illnesses. Respondents also explained how if symptoms, including fever, were severe or persisted after receiving treatment elsewhere, they sought assistance at health centres. Access to local health centres/hospitals was often constrained by a lack of transportation and an ability to meet the direct and indirect costs of a visit. Conclusion In Nong District, a rural area bordering Vietnam, people seek care from health centres offering allopathic medicine and from spiritual healers. Decisions about where and when to attend health care depended on their economic status, mobility (distance to the health centre, road conditions, availability of transport), symptoms severity and illness recognition. Current and future malaria control/elimination programmes could benefit from greater collaboration with the locally accessible sources of treatments, such as health volunteers and traditional healers.
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Affiliation(s)
- Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,Kellogg College, University of Oxford, Oxford, UK.
| | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | | | - Palingnaphone Koummarasy
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Xayaphone Soundala
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Gisela Henriques
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Pasathorn Sirithiranont
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Daniel M Parker
- Department of Population Health and Disease Prevention, University of California, Irvine, California, USA
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Paul N Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Phaik Yeong Cheah
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christopher Pell
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Mayfong Mayxay
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos.,Institute of Research and Educational Development, University of Health Sciences, Vientiane, Laos
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