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Background: Malaria is a major public health issue in Guinea and care-seeking behaviour is dominated by self-medication and delayed access to appropriate care. However early and appropriate care-seeking are essential to control and reduce complicate forms and mortality, particularly for the most vulnerable. This study was conducted to analyse the diagnostic pathway, and the factors associated with early and appropriate care-seeking for malaria patients in the Republic of Guinea. Methods: A cross-sectional study was carried out between December 2022 to March 2023 in nine health districts within health facilities and at community level. The study population was confirmed malaria patients with RDT or microscopy. Kroeger's conceptual framework was used to design the questionnaire. Conventional recourse was defined as using a healthcare facility or community services, early and appropriate care-seeking was defined as within 24 h of symptom onset in a conventional recourse, and care pathway as the sequence of recourses followed by each patient. Sankey alluvial plots were used to represent patients' diagnostic pathways, and logistic regression to identify factors associated with early and appropriate care-seeking. Results: A total of 3300 malaria patients were studied, of which 1632 (49.45%) were female and 1132 (34.30%) were under 5 years of age, with a median age of 23 months. At the time of the survey, 1337 (40.52%), 1423 (43.12%), and 437 (13.85%) of patients were respectively in their first, second and third recourse. A total of 2002 (60.67%) patients had sought care from a conventional recourse as a first line. Of all patients, 1757 (53.25%) had sought care within 24 h, while 28.55% had sought early and appropriate care. In the initial stages of treatment, self-medication was the most common approach, used by 1214 (37.30%). Patients from the health districts of Boffa (Lower Guinea, coastal region) OR = 0.48 95% CI 0.33–0.70, Dabola (Upper Guinea, savanna region) OR = 0.43 95% CI 0.30–0.63 and Labe (Middle Guinea, mountain region) OR = 0.63 CI 95% 0.43–0.91 (p < 0.05) were more likely to delay appropriate care-seeking, when compared to those in Dixinn, (Conakry). However, the under 5-year-old group OR = 1.55 95% CI 1.30–1.85 (p < 0.001) and the availability of a stable monthly household income OR = 4.98 95% CI 3.03, 8.27 (p < 0.001) were positively associated with early and appropriate care seeking. Conclusion: A low rate of early and appropriate care-seeking was observed. Patients sought care through multiple means, often resulting in a delay in adequate management. The results show the need to deploy strategies adapted to the needs of communities. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) have a central role to play on reduction of polypharmacy and deprescribing. This study aimed to assess beliefs and attitudes towards deprescribing in patients, aged 65 years or older in primary care, and to identify factors associated with deprescribing and their willingness to stop medication. Methods: A questionnaire study was performed between 23 May and 29 July 2022 on patients aged 65 years or older attending a GP's surgery in a French area. We used the French version of the revised Patients' Attitudes Towards Deprescribing self-report questionnaire (rPATD), which measures four subscales ("Burden", "Appropriateness", "Concerns about stopping" and, "Involvement"), patients' willingness to stop one of their regular medicines, and patients' satisfaction with their current medicines. Results: The study enrolled 200 patients. Median age was 76 years old (IQR 71–81), 55% were women, and 42.5% took 5 or more medications per day. Although most patients (92.5%) were satisfied with their current medicines, 35% were reluctant to stop medications they had been taking for a long time, and 89.5% were willing to stop medication if asked to by their GP. Patients aged less than 75 years old reported more concerns about stopping. Women and patients with higher educational attainment showed significantly higher involvement in medication management. Conclusions: The majority of older adults were willing to stop one or more of their regular medicines if asked to do so by their GP. GPs should address deprescribing into their current practice. [ABSTRACT FROM AUTHOR]

Objectives: The objective is to describe the informative value and the added value of a qualitative multiphase methodology in order to investigate the conceptions of children aged 6–11 on the determinants of health and cancer.Method: This article provides an analysis of the “Determ'Ados” research protocol, a qualitative study in human and social sciences, carried out with children aged 6–11 years. This protocol, organized in three phases, addresses in the first global health with the tool “e.Photoexpression©,” in the second questions and knowledge around the topic of cancer with the tool “QC” and in the third cancer again with the “Photonarration” tool. The methodology of this innovative, open and exploratory research protocol aims to collect data relating to the experiences, declared practices and knowledge specific to each child who express themselves through photography and storytelling.Results: The analysis of the Déterm'Ados methodology reveals a density and richness of results among all the children interviewed, even among the youngest: 1,498 productions (4 productions per child) were made by 381 children resulting in a wealth of data available thanks to the multiphase protocol. This massive qualitative survey brings complementarity as the collection phases progress and guarantees continuity in the discourse of each child which allows them to deepen their conceptions and to know how they create or not meaning between the determinants of health and cancer.Perspectives: The density and quality of the proposals collected from the children reinforce the validity and rigor of the Determ'Ados methodology. Multiphase is the innovative aspect of the tools used. The e.Photoexpression© and the Photonarration are complementary and inseparable to bring out concepts on health and cancer. These research results, transferable into interventions and current practices, present prevention officers to act more effectively, closer to the conceptions and needs of children.