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Background: Tungiasis, an ectoparasitic disease caused by sand fleas, causes suffering to millions of people in the tropics. Although the Kenyan National Policy Guidelines list tungiasis treatments as including disinfectants, flea repellents, and botanical oil, the insufficient knowledge and financial constraints of affected communities have led to neglect and inappropriate self-treatment. Current reports show insignificant progress on educational activities at the community level. Therefore, we investigated community residents' treatment-seeking behaviour concerning tungiasis, using an endemic area of Kenya as the research setting. Methods: A cross-sectional mixed-methods design was employed. Quantitative data were collected from the participants—410 adults who had experienced tungiasis—using a questionnaire, while qualitative data were collected from 20 older adults to 10 medical staffs using semi-structured individual interviews. The study was conducted in two sub-counties of Homa Bay County, Kenya. Results: Factors significantly correlated with using non-guideline-listed treatments for tungiasis were 'not knowing the causse of tungiasis', 'not seeking treatment from healthcare facilities and traditional healers', and 'wait and see to prevent infection in non-affected members'. The interviews with the older adults revealed 19 self-treatment options for tungiasis, and 40% of the participants opted for self-removal using sharp objects. Only two of these treatments were listed in the guidelines. The most frequently mentioned reason for using a self-treatment option was 'Someone else's idea'. The most frequently mentioned reason for choosing the best self-treatment option was 'Effectiveness'. Interviews with medical staff revealed 11 treatment options; only five of these treatments are listed in the guidelines. The most frequently mentioned reason for selecting/using the treatment was 'Supply situation'. Conclusions: Residents' socioeconomic factors, cultural factors, and access to appropriate treatment, as well as knowledge of medical staff were significant factors that influenced the residents' tungiasis treatment-seeking behaviours. This study provides feasibility and baseline data to establish an effective, safe, and sustainable treatment for tungiasis. [ABSTRACT FROM AUTHOR]

Abstract Background Tungiasis, an ectoparasitic disease caused by sand fleas, causes suffering to millions of people in the tropics. Although the Kenyan National Policy Guidelines list tungiasis treatments as including disinfectants, flea repellents, and botanical oil, the insufficient knowledge and financial constraints of affected communities have led to neglect and inappropriate self-treatment. Current reports show insignificant progress on educational activities at the community level. Therefore, we investigated community residents’ treatment-seeking behaviour concerning tungiasis, using an endemic area of Kenya as the research setting. Methods A cross-sectional mixed-methods design was employed. Quantitative data were collected from the participants—410 adults who had experienced tungiasis—using a questionnaire, while qualitative data were collected from 20 older adults to 10 medical staffs using semi-structured individual interviews. The study was conducted in two sub-counties of Homa Bay County, Kenya. Results Factors significantly correlated with using non-guideline-listed treatments for tungiasis were ‘not knowing the causse of tungiasis’, ‘not seeking treatment from healthcare facilities and traditional healers’, and ‘wait and see to prevent infection in non-affected members’. The interviews with the older adults revealed 19 self-treatment options for tungiasis, and 40% of the participants opted for self-removal using sharp objects. Only two of these treatments were listed in the guidelines. The most frequently mentioned reason for using a self-treatment option was ‘Someone else’s idea’. The most frequently mentioned reason for choosing the best self-treatment option was ‘Effectiveness’. Interviews with medical staff revealed 11 treatment options; only five of these treatments are listed in the guidelines. The most frequently mentioned reason for selecting/using the treatment was ‘Supply situation’. Conclusions Residents’ socioeconomic factors, cultural factors, and access to appropriate treatment, as well as knowledge of medical staff were significant factors that influenced the residents’ tungiasis treatment-seeking behaviours. This study provides feasibility and baseline data to establish an effective, safe, and sustainable treatment for tungiasis.

Background: Acute diarrhoeal diseases (ADD) account for a large number of preventable deaths in India, especially in children less than five years who are more at risk than adults with respect to the degree of dehydration and complications. (1) To measure the incidence of ADD among children under 5 years; (2) Determine risk factors associated among children; (3) Study treatment-seeking behaviour of their mothers. Community-based, prospective, longitudinal study conducted in an urban area of Goa. Material and Methods: 250 children enrolled in the study with their mothers by stratified random sampling technique, conducted house-to-house visits every three months and mothers were interviewed with pre-tested semi-structured questionnaire. The duration of study was one year from January to December 2018. Data entered using EpiData Entry Client®, Analysed using SPSS® software version 22. Student’s t-tests and Chi-square tests were used. Results: The incidence of ADD was 0.124 episodes/child/year. Significant association was noted between ADD in children and certain socio-demographic factors like child’s sex, birth order, birth weight, immunization status, malnutrition, mother’s age group, mother’s education, and mothers’ hygiene practices. Conclusions: Efforts should be made to educate all mothers about the seeking timely treatment, awareness about home-based management and their types, awareness of ORS, zinc, importance of hygienic practices like hand washing for mother and child.

Background: Acute diarrhoeal diseases (ADD) account for a large number of preventable deaths in India, especially in children less than five years who are more at risk than adults with respect to the degree of dehydration and complications. (1) To measure the incidence of ADD among children under 5 years; (2) Determine risk factors associated among children; (3) Study treatment-seeking behaviour of their mothers. Community-based, prospective, longitudinal study conducted in an urban area of Goa. Material and Methods: 250 children enrolled in the study with their mothers by stratified random sampling technique, conducted house-to-house visits every three months and mothers were interviewed with pre-tested semi-structured questionnaire. The duration of study was one year from January to December 2018. Data entered using EpiData Entry Client®, Analysed using SPSS® software version 22. Student's t-tests and Chi-square tests were used. Results: The incidence of ADD was 0.124 episodes/child/year. Significant association was noted between ADD in children and certain socio-demographic factors like child's sex, birth order, birth weight, immunization status, malnutrition, mother's age group, mother's education, and mothers' hygiene practices. Conclusions: Efforts should be made to educate all mothers about the seeking timely treatment, awareness about home-based management and their types, awareness of ORS, zinc, importance of hygienic practices like hand washing for mother and child. [ABSTRACT FROM AUTHOR]

HIV is a major health issue globally. Though highly effective antiretroviral therapy has improved the life expectancy, people living with HIV (PLHIV) suffer from many physical and psychological issues. The present study assessed perceived health status, quality of life (QOL) and treatment-seeking behaviour among PLHIV. The study was carried out among 75 PLHIV attending ART clinic of a tertiary care centre of North India. Convenience sampling technique was used. Ethical approval for the study was obtained from the Institute Ethics Committee. Participants were asked to rate their current state of health as perceived by them on a five-point scale ranging from poor to excellent. QOL was assessed by using WHOQOL-BREF (Hindi version). Treatment-seeking behaviour was assessed by a structured questionnaire developed by researchers. A total of 45.3% (n = 34) rated it as fair, 22.7% (n = 17) rated it as good 13.3% (n = 10) rated it as poor, 10.7% (n = 8) rated it as excellent and 8% (n = 6) rated it as very good. QOL score was highest in physical health domain with a mean ± S.D. of 12.3 ± 4.1 (median 13) and lowest in the social relationships domain with a mean of 8.6 ± 2.9 (median = 8) (p =.001). Most common reason of going for HIV testing was being symptomatic (n = 21) followed by spouse testing positive for HIV (n = 19). HIV impacts QOL of the PLHIV and treatment-seeking behaviour varies among the patients. There is a need to develop a multilevel approach involving all the stakeholders including patient, family and society. [ABSTRACT FROM AUTHOR]

Abstract Background Appropriate malaria treatment-seeking behaviour (TSB) is critical for timely detecting malaria, prompt treatment, and prevention of onward transmission of the disease in a community. This study aimed to compare treatment-seeking behaviours between malaria patients and non-malaria febrile patients, and to analyse the factors associated with appropriate TSB along the China-Myanmar border. Methods A cross-sectional study was carried out to investigate the appropriate TSB of microscopy-confirmed malaria patients versus non-malaria febrile (NMF) patients. An unconditional logistic regression analysis (LRA) was used to identify factors associated with appropriate TSB. Results Among 223 malaria patients and 446 NMF patients, 129 (57.8%) of the malaria patients versus 163 (36.5%) of the NMF patients firstly sought treatment in health facilities without laboratory testing for malaria (P

Background: Appropriate malaria treatment-seeking behaviour (TSB) is critical for timely detecting malaria, prompt treatment, and prevention of onward transmission of the disease in a community. This study aimed to compare treatment-seeking behaviours between malaria patients and non-malaria febrile patients, and to analyse the factors associated with appropriate TSB along the China-Myanmar border. Methods: A cross-sectional study was carried out to investigate the appropriate TSB of microscopy-confirmed malaria patients versus non-malaria febrile (NMF) patients. An unconditional logistic regression analysis (LRA) was used to identify factors associated with appropriate TSB. Results: Among 223 malaria patients and 446 NMF patients, 129 (57.8%) of the malaria patients versus 163 (36.5%) of the NMF patients firstly sought treatment in health facilities without laboratory testing for malaria (P < 0.0001). A total of 85(38.1%) of the malaria patients versus 278 (62.3%) of the NMF patients had appropriate TSB, namely, seeking treatment in health facilities with laboratory testing for malaria within 48 h (P < 0.0001). Multivariate LRA identified that the malaria patients with Chinese nationality had less appropriate TSB compared to those with other nationalities (adjusted odds ratio [AOR]: 0.21, 95% confidence interval CI 0.07–0.68, P = 0.0097), and malaria patients residing in urban areas had more appropriate TSB compared to those living in rural areas (AOR: 2.16, 95%CI 1.06–4.39, P = 0.0337). Conclusions: TSB was not appropriate in malaria patients. Chinese citizenship and rural residence were two independent factors associated with inappropriate malaria TSB. It is urgently necessary to improve appropriate malaria TSB through effective campaigns of information, education, and communication for malaria control in Myanmar and preventing reestablishment of malaria transmission in Yunnan, China. [ABSTRACT FROM AUTHOR]

Abstract Background Recreational use of anabolic-androgenic steroids (AAS) is a public health concern world-wide associated with a range of physical and psychological side effects. Still, people who use AAS tend to be reluctant to seek treatment. This study aims to explore use characteristics, treatment-seeking behaviour, side effects and associated health concerns among men with AAS use. Methods The study includes cross-sectional self-report data from 90 men with a current or previous use of AAS exceeding 12 months, where 41 (45.6%) had sought treatment at least once during their lifetime, and 49 (54.4%) had not. Health service engagement was examined with descriptive statistics on reasons for contacting health services, transparency about AAS use, satisfaction with health services and reasons for not seeking treatment. Furthermore, experienced side effects and health concerns were compared between the treatment seeking and the non-treatment seeking group, using two-sample t-tests and Chi2 or Fisher exact tests for numerical and categorical variables, respectively. Results All 90 AAS-using men reported side effects from AAS use. Treatment seekers were significantly younger, experienced more side effects including gynecomastia, excessive sweating, fatigue, depression and anxiety, and expressed more concern for testosterone deficiency. Preventive health check-up was the most common reason for seeking treatment (n = 22, 53.7%), and 38 men (93%) were transparent about AAS use during consultations with health professionals. The main reported reasons for not seeking healthcare services were that the experienced side effects were not considered to be of treatment demanding nature (n = 39, 79.6%) and the belief that healthcare providers had scarce knowledge about AAS use and its health impacts (n = 12, 24.5%). Conclusions Reluctance to seek treatment among people who use AAS, despite having associated side effects and health concerns, may contribute to continued health risks. It is important to fill the knowledge gap on how to reach and treat this new patient group, and policy makers and treatment providers need to be educated on how to meet their treatment needs.

ABSTRACT Introduction: Motivation and the role of parents are essential in educating children on maintaining their oral health. The low parental knowledge in seeking oral health treatment will increase the prevalence of children’s oral disease. This study aimed to analyse the differences in the motivation for seeking oral health treatment among parents of kindergarten students in two kindergarten. Methods: The research was analytic with a cross-sectional technique, conducted on 109 parents taken as respondents, consisting of 54 parents of Bunda Asuh Nanda Kindergarten students and 55 parents of Mekar Arum Kindergarten students. Data collection was carried out with an online Google form questionnaire. Results: The mean intrinsic motivation range of Bunda Asuh Nanda Kindergarten and Mekar Arum Kindergarten parents was 45 to 65, while the extrinsic motivation range was 51 to 59, and the combined motivation range was 47 to 63. The Mann-Whitney test result showed a significant difference in the intrinsic and combined motivation, with a p-value of 0.0008 and 0.0073, respectively, while the extrinsic motivation showed no difference (p-value=0.2313). Conclusions: The motivation for seeking oral health treatment in parents of kindergarten students showed differences in intrinsic and combined motivation, while no difference is found in extrinsic motivation. Most of the parents in both kindergartens have rather good motivation in seeking oral health treatment for their children. Keywords: children; oral health; motivation; parents; treatment-seeking behaviour

Abstract Background The utilization and impact of the healthcare services depend on the perceived quality, appropriateness, ease of availability, and cost of the services. This study aimed to understand the community's perception of the quality of healthcare services delivered as part of the Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh, India. Methods The study used qualitative techniques to analyze the community perceptions that emerged from the participants’ narratives during the Focus Group Discussions (FGDs) and in-depth Interviews with Key Informants (IKIs) on the promptness and quality of healthcare service delivery, the behaviour of MEDP staff, Information, Education and Communication, and Behavioural Change Communication activities, coordination with community members and other health personnel, and capacity building of healthcare workers and the community. Results 36 FGDs and 63 IKIs with 419 respondents were conducted in nine blocks of district Mandla. Overall, 97% to 100% of beneficiaries associated MEDP with regularity and prompt service delivery, availability of diagnostics and drugs, friendly behaviour, good coordination, and community mobilization to enhance treatment-seeking behaviour. Conclusions The study's findings highlighted the importance of building and maintaining the community's participation and promoting the demand for optimal utilization of healthcare services inside the village to promptly achieve the malaria elimination goal.

Background: Recreational use of anabolic-androgenic steroids (AAS) is a public health concern world-wide associated with a range of physical and psychological side effects. Still, people who use AAS tend to be reluctant to seek treatment. This study aims to explore use characteristics, treatment-seeking behaviour, side effects and associated health concerns among men with AAS use. Methods: The study includes cross-sectional self-report data from 90 men with a current or previous use of AAS exceeding 12 months, where 41 (45.6%) had sought treatment at least once during their lifetime, and 49 (54.4%) had not. Health service engagement was examined with descriptive statistics on reasons for contacting health services, transparency about AAS use, satisfaction with health services and reasons for not seeking treatment. Furthermore, experienced side effects and health concerns were compared between the treatment seeking and the non-treatment seeking group, using two-sample t-tests and Chi2 or Fisher exact tests for numerical and categorical variables, respectively. Results: All 90 AAS-using men reported side effects from AAS use. Treatment seekers were significantly younger, experienced more side effects including gynecomastia, excessive sweating, fatigue, depression and anxiety, and expressed more concern for testosterone deficiency. Preventive health check-up was the most common reason for seeking treatment (n = 22, 53.7%), and 38 men (93%) were transparent about AAS use during consultations with health professionals. The main reported reasons for not seeking healthcare services were that the experienced side effects were not considered to be of treatment demanding nature (n = 39, 79.6%) and the belief that healthcare providers had scarce knowledge about AAS use and its health impacts (n = 12, 24.5%). Conclusions: Reluctance to seek treatment among people who use AAS, despite having associated side effects and health concerns, may contribute to continued health risks. It is important to fill the knowledge gap on how to reach and treat this new patient group, and policy makers and treatment providers need to be educated on how to meet their treatment needs. [ABSTRACT FROM AUTHOR]

Abstract Background Usage of mosquito bed nets and the practice of other prevention methods are essential for the prevention of malaria in endemic areas. Proper community knowledge about malaria and prompt treatment-seeking behaviour for early diagnosis and treatment are crucial for eliminating the disease. This study aimed to assess the awareness, treatment-seeking behaviour, and prevention practices towards malaria in Abu Ushar, Gezira State, Sudan. Methods A community-based, cross-sectional study was conducted in March 2021, including 310 households in Abu Ushar, Aljazeera, Sudan. Data were collected through face-to-face interviews with head of the household using an interviewer-administered questionnaire. Data were entered and analysed using R software. Results A total of 310 households were enrolled in this study. Sixty per cent had children under the age of 5 years. The majority of these households (94.8%) had a history of malaria in the past 12 months. Overall, awareness of malaria was good; 197 (63.5%) households had bed nets in their houses; 75.8% of total households identified fever with shivering as a symptom of malaria. Regarding treatment-seeking behaviour, 77.9% seek treatment from the nearby primary health centre, and 60% seek treatment within the first day. Only 45.3% stated that everyone in the household sleeps under bed nets. Conclusion High awareness about malaria and preventive measures was found among participants in households. Most households had previous infections with malaria. Therefore, an interventional programme should be established in this area to reduce this high rate of malaria.

Background: The utilization and impact of the healthcare services depend on the perceived quality, appropriateness, ease of availability, and cost of the services. This study aimed to understand the community's perception of the quality of healthcare services delivered as part of the Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh, India. Methods: The study used qualitative techniques to analyze the community perceptions that emerged from the participants' narratives during the Focus Group Discussions (FGDs) and in-depth Interviews with Key Informants (IKIs) on the promptness and quality of healthcare service delivery, the behaviour of MEDP staff, Information, Education and Communication, and Behavioural Change Communication activities, coordination with community members and other health personnel, and capacity building of healthcare workers and the community. Results: 36 FGDs and 63 IKIs with 419 respondents were conducted in nine blocks of district Mandla. Overall, 97% to 100% of beneficiaries associated MEDP with regularity and prompt service delivery, availability of diagnostics and drugs, friendly behaviour, good coordination, and community mobilization to enhance treatment-seeking behaviour. Conclusions: The study's findings highlighted the importance of building and maintaining the community's participation and promoting the demand for optimal utilization of healthcare services inside the village to promptly achieve the malaria elimination goal. [ABSTRACT FROM AUTHOR]

Background: Usage of mosquito bed nets and the practice of other prevention methods are essential for the prevention of malaria in endemic areas. Proper community knowledge about malaria and prompt treatment-seeking behaviour for early diagnosis and treatment are crucial for eliminating the disease. This study aimed to assess the awareness, treatment-seeking behaviour, and prevention practices towards malaria in Abu Ushar, Gezira State, Sudan. Methods: A community-based, cross-sectional study was conducted in March 2021, including 310 households in Abu Ushar, Aljazeera, Sudan. Data were collected through face-to-face interviews with head of the household using an interviewer-administered questionnaire. Data were entered and analysed using R software. Results: A total of 310 households were enrolled in this study. Sixty per cent had children under the age of 5 years. The majority of these households (94.8%) had a history of malaria in the past 12 months. Overall, awareness of malaria was good; 197 (63.5%) households had bed nets in their houses; 75.8% of total households identified fever with shivering as a symptom of malaria. Regarding treatment-seeking behaviour, 77.9% seek treatment from the nearby primary health centre, and 60% seek treatment within the first day. Only 45.3% stated that everyone in the household sleeps under bed nets. Conclusion: High awareness about malaria and preventive measures was found among participants in households. Most households had previous infections with malaria. Therefore, an interventional programme should be established in this area to reduce this high rate of malaria. [ABSTRACT FROM AUTHOR]

This paper examines the effect of national health insurance on the choice of healthcare facility among diabetic and hypertensive patients in Ghana. The data for this paper came from a secondary source, and the conditional mixed processing approach was utilised to investigate the influence of health insurance status on healthcare facility choice among diabetic and hypertension patients. The study reveals that when compared with uninsured individuals suffering from hypertension/diabetes, insured individuals are more likely to attend formal healthcare facilities and herbal clinics/hospitals and less likely to attend traditional/spiritual healing centres instead of chemical shop/self-care. This work addresses the problem of unobserved heterogeneity (selection bias) by employing the conditional mixed processing approach to account for the potential that health insurance is endogenous to the choice of healthcare facility, which if not accounted for might lead to biased estimates. [ABSTRACT FROM AUTHOR]

Background We aimed to investigate the association between institution trust and public responses to the coronavirus disease 2019 (COVID-19) outbreak. Methods An Internet-based, cross-sectional survey was administered on 29 January 2020. A total of 4393 adults ≥18 y of age and residing or working in the province of Hubei, central China were included in the study. Results The majority of the participants expressed a great degree of trust in the information and preventive instructions provided by the central government compared with the local government. Being under quarantine (adjusted odds ratio [OR] 2.35 [95% confidence interval {CI} 1.80 to 3.08]) and having a high institutional trust score (OR 2.23 [95% CI 1.96 to 2.53]) were both strong and significant determinants of higher preventive practices scores. The majority of study participants (n=3640 [85.7%]) reported that they would seek hospital treatment if they suspected themselves to have been infected with COVID-19. Few of the participants from Wuhan (n=475 [16.6%]) and those participants who were under quarantine (n=550 [13.8%]) expressed an unwillingness to seek hospital treatment. Conclusions Institutional trust is an important factor influencing adequate preventive behaviour and seeking formal medical care during an outbreak. [ABSTRACT FROM AUTHOR]

This study describes the illness narratives that inform treatment-seeking behaviours for acute abdominal conditions in Cambodia, and thereby explores factors impeding the timely delivery of surgical intervention. Semi-structured qualitative interviews were undertaken with patients who had undergone abdominal surgery at Siem Reap Provincial Hospital between 2011 and 2014. Interviews collected basic demographic information and also patient narratives based on Groleau's McGill Illness Narrative Interview (MINI). Interviews were contemporaneously translated from Khmer to English and recorded for transcription. A content analysis of interview transcripts based on narrative enquiry was undertaken. Ninety-seven patients participated in the study and five themes emerged from the data. These were: Explanatory models about the causes of abdominal pain and effects of surgery; Pre-surgery stoicism and illness management; Fear of poor outcomes and death; Burden of treatment costs and anticipated recovery time; and, Enhancing community trust in surgery. Our findings add the patient voice to the limited evidence about access to surgery, and socio-cultural and financial barriers affecting treatment-seeking behaviours in Cambodia. By understanding the collective narratives surrounding experiences of abdominal surgery, efforts to improve surgical services in Cambodia may be better informed of the reasons patients delay treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Myanmar has a high burden of malaria with two-third of the population at risk of malaria. One of the basic elements of the Roll Back Malaria Initiative to fight against malaria is early diagnosis and treatment within 24 h of fever. Public awareness about malaria is a key factor in malaria prevention and control and in improving treatment-seeking behaviour. Methods A large community-based survey was carried out in 27 townships of malaria endemic regions in Myanmar in 2015 which reported on the knowledge, behaviour and practices around malaria in the general population. We used the data already collected in this survey to assess (i) general public awareness of malaria and (ii) treatment-seeking behaviour and associated factors among persons with acute undifferentiated fever. Results A total of 6597 respondents from 6625 households were interviewed (response rate of 99.5%). About 85% of the respondents were aware that mosquito bite was the mode of transmission of malaria and 90% mentioned that malaria was preventable. However, only 16% of the respondents knew about anti-malaria drug resistance. There were certain misconceptions about the transmission of malaria such as dirty water, same blood group, sharing shelter, sleeping/eating together and poor hygiene. Health facility staff were the most common source of information about malaria (80%). Nearly one-fourth (23%) of the respondents with fever resorted to self-medication. Around 28% of the respondents with fever underwent blood testing, less than half of whom (44%) were tested within 24 h. Elderly age group, females, those with poor knowledge about malaria and those residing in non-Regional Artemisinin Resistance Initiative townships were associated with poor treatment-seeking behaviour in case of fever. Conclusion Although there is fair knowledge on mosquito bite as a mode of transmission and prevention of malaria, there are some misconceptions about transmission of malaria. Those having poor knowledge about malaria have poor treatment-seeking behaviour. A considerable number of respondents seek care from informal care providers and seek care late. Thus, there is a need to promote awareness about the role of early diagnosis and appropriate treatment and address misconceptions about transmission of malaria.

Abstract Background Seeking treatment in formal healthcare for uncomplicated infections is vital to combating disease in low- and middle-income countries (LMICs). Healthcare treatment-seeking behaviour varies within and between communities and is modified by socio-economic, demographic, and physical factors. As a result, it remains a challenge to quantify healthcare treatment-seeking behaviour using a metric that is comparable across communities. Here, we present an application for transforming individual categorical responses (actions related to fever) to a continuous probabilistic estimate of fever treatment for one country in Sub-Saharan Africa (SSA). Methods Using nationally representative household survey data from the 2013 Demographic and Health Survey (DHS) in Namibia, individual-level responses (n = 1138) were linked to theoretical estimates of travel time to the nearest public or private health facility. Bayesian Item Response Theory (IRT) models were fitted via Markov Chain Monte Carlo (MCMC) simulation to estimate parameters related to fever treatment and estimate probability of treatment for children under five years. Different models were implemented to evaluate computational needs and the effect of including predictor variables such as rurality. The mean treatment rates were then estimated at regional level. Results Modelling results suggested probability of fever treatment was highest in regions with relatively high incidence of malaria historically. The minimum predicted threshold probability of seeking treatment was 0.3 (model 1: 0.340; 95% CI 0.155–0.597), suggesting that even in populations at large distances from facilities, there was still a 30% chance of an individual seeking treatment for fever. The agreement between correctly predicted probability of treatment at individual level based on a subset of data (n = 247) was high (AUC = 0.978), with a sensitivity of 96.7% and a specificity of 75.3%. Conclusion We have shown how individual responses in national surveys can be transformed to probabilistic measures comparable at population level. Our analysis of household survey data on fever suggested a 30% baseline threshold for fever treatment in Namibia. However, this threshold level is likely to vary by country or endemicity. Although our focus was on fever treatment, the methodology outlined can be extended to multiple health seeking behaviours captured in routine national survey data and to other infectious diseases.

The poor often experience illness and the treatment costs are high and even catastrophic for the poor. This paper reports the extent of illness, treatment‐seeking behaviour and out of pocket healthcare expenditures and the determinants of treatment‐seeking behaviour and healthcare expenditures among the urban poor living in Delhi. A total of 2,998 households participated in the study. Socio‐demographic details, illness experiences (episodic illness in the past 3 months, hospitalisation in the past 1 year and any chronic illness), treatment seeking and healthcare expenditures were collected for all household members through a pretested, interviewer‐administered questionnaire. Logistic regressions were carried out for factors associated with treatment‐seeking choices. Multiple linear regressions were carried for factors associated with out of pocket expenditures (OOPE). Of the total 15,218 household members (of the 2,998 households), 4,052 (26.6%) experienced episodic illness (mainly fever, respiratory illnesses, food‐ and waterborne diseases and eye infections) in the past 3 months, 230 (1.5%) were hospitalised and 976 (6.4%) have chronic illness (mainly hypertension, diabetes, arthritis and respiratory problems). Of the 2,998 households, 2,225 (74.2%) households reported at least one event of illness. Unqualified practitioners were the main source of care for episodic illnesses. Perceived seriousness of the illness, having Employees State Insurance Scheme (ESIS) benefit, higher educational status of the head of the household, higher monthly household incomes, belonging other backward castes and settled‐migrant status led to seeking formal care. Dengue was the main reason for hospitalisation. Government including ESIS hospitals were mainly utilised for hospitalisation. Healthcare expenditures were higher for private healthcare. Possession of mandatory health insurance was protective against OOPEs. OOPEs were more for the men/boys and for the young. Improving access to government healthcare services is important. Extending the ESIS to the unorganised workers including urban poor migrants should be considered so as to bring them under mandatory social protection. [ABSTRACT FROM AUTHOR]

Background: The standard case management for acute respiratory infections (ARI) initiated by the World Health Organization (WHO) seeks to reduce pneumonia mortality by encouraging appropriate maternal home-care practices and early treatment from a health-care provider. Objective: To determine the practices and treatment-seeking behaviour of mothers for symptoms and signs of childhood acute respiratory infections. Methods: A health facility-based, prospective cross-sectional study of 400 mothers with interviewer-administered structured questionnaires was conducted. Data were analyzed with descriptive statistics on SPSS (version 17.0), and results were expressed in means ± standard deviations, frequencies and proportions (percentages). Pearson's chi-square test was used to determine the effect of maternal socio-economic class on treatment-seeking behaviour for ARI symptoms. P value less than 0.05 was adopted as the level of statistical significance. Results: For cough, 124/400 (31.0%) mentioned allopathic treatment and self-advised drugs while 274/400 (68.5%) would prefer to seek immediate medical consult. For catarrh, 230/400 (57.5%) would administer home remedies as first line of treatment while 156/400 (38.5%) preferred to seek medical consult from the outset. A substantial majority would immediately consult a health personnel for ear-ache/ear discharge (380/400; 95.0%) and sore-throat (372/400; 85%). For signs of pneumonia, majority would prefer immediate medical consult for fast breathing (394/400; 98.5%), difficult breathing (376/400; 94.0%) and chest in-drawing (390/400; 97.0%). There was no statistically significant difference between the socio-economic classes of mothers would seek immediate medical consult for cough and cold and ear-ache/discharge and those who would not (p > 0.05), but a statistically significant difference was noted between the socio-economic classes of mothers who would seek and those who would not seek immediate medical consult for sore-throat (p

Background: Seeking treatment in formal healthcare for uncomplicated infections is vital to combating disease in low- and middle-income countries (LMICs). Healthcare treatment-seeking behaviour varies within and between communities and is modified by socio-economic, demographic, and physical factors. As a result, it remains a challenge to quantify healthcare treatment-seeking behaviour using a metric that is comparable across communities. Here, we present an application for transforming individual categorical responses (actions related to fever) to a continuous probabilistic estimate of fever treatment for one country in Sub-Saharan Africa (SSA).Methods: Using nationally representative household survey data from the 2013 Demographic and Health Survey (DHS) in Namibia, individual-level responses (n = 1138) were linked to theoretical estimates of travel time to the nearest public or private health facility. Bayesian Item Response Theory (IRT) models were fitted via Markov Chain Monte Carlo (MCMC) simulation to estimate parameters related to fever treatment and estimate probability of treatment for children under five years. Different models were implemented to evaluate computational needs and the effect of including predictor variables such as rurality. The mean treatment rates were then estimated at regional level.Results: Modelling results suggested probability of fever treatment was highest in regions with relatively high incidence of malaria historically. The minimum predicted threshold probability of seeking treatment was 0.3 (model 1: 0.340; 95% CI 0.155-0.597), suggesting that even in populations at large distances from facilities, there was still a 30% chance of an individual seeking treatment for fever. The agreement between correctly predicted probability of treatment at individual level based on a subset of data (n = 247) was high (AUC = 0.978), with a sensitivity of 96.7% and a specificity of 75.3%.Conclusion: We have shown how individual responses in national surveys can be transformed to probabilistic measures comparable at population level. Our analysis of household survey data on fever suggested a 30% baseline threshold for fever treatment in Namibia. However, this threshold level is likely to vary by country or endemicity. Although our focus was on fever treatment, the methodology outlined can be extended to multiple health seeking behaviours captured in routine national survey data and to other infectious diseases. [ABSTRACT FROM AUTHOR]

Background: Delayed or inappropriate treatment for sexually transmitted diseases (STDs) increases the risk of HIV acquisition and may cause other harmful outcomes. However, studies on STD treatment-seeking behaviour and correlated factors in men who have sex with men (MSM) are scarce. This information is crucial for the promotion of STD treatment-seeking behaviour and reduction of HIV transmission among Chinese MSM. Methods: During 2012-2013, a multicentre cross-sectional study was conducted in 7 Chinese cities. Participants completed an interview-questionnaire and gave venous blood samples, which were then tested for antibodies to HIV, syphilis, and herpes simplex virus-2 (HSV-2). MSM who tested positive for syphilis/HSV-2 or had obvious STD-related symptoms within the last 12 months were defined as suspected STD-infected MSM. Results: Of the 4 496 eligible MSM who completed this survey, 24.4% (1 096/4 496) were categorized as suspected STD-infected MSM. 35.7% (391/1 096) of these MSM with suspected STD infections sought STD treatment in clinics within the last 12 months. Among MSM who did not attend STD clinics for treatment, the prevalence of syphilis and HSV-2 was significantly higher; the HIV prevalence and incidence within this subpopulation reached as high as 14.5% and 12.2/100 person-years, respectively. Multivariate logistic regression analysis indicated that having 7-12 years of education (vs. ≤6 years; aOR, 2.5; 95%CI, 1.0-6.1), ≥13 years of education (vs. ≤6 years: aOR, 2.8; 95%CI, 1.2-7.0), monthly income >500 USD (vs. ≤500 USD: aOR, 1.5; 95%CI, 1.1-2.1), obvious STD-related symptoms within last 12 months (aOR, 5.3; 95%CI, 3.7-7.5), being HIV infected (aOR, 1.7; 95%CI, 1.1-2.6), currently syphilis infected (aOR, 0.6; 95%CI, 0.4-0.9) and HSV-2 infected (aOR, 0.6; 95%CI, 0.5-0.9) were independent correlates with seeking STD treatment in clinics among Chinese MSM. Conclusions: The high prevalence of STD infection coupled with a low proportion of individuals who exhibit appropriate treatment-seeking behaviour create a high risk of a growing HIV epidemic among Chinese MSM. Models that prioritize better screening for and education about STDs should be urgently implemented, especially among low-income MSM. [ABSTRACT FROM AUTHOR]

Background: Early diagnosis and prompt treatment are the basic elements of malaria control. The mother′s perceptions about the cause of the fever, duration of sickness, accessibility and the anticipated cost of treatment, frequent use of traditional medicine, and judgement of the severity of the fever are the most important determinants for effective treatment of fever in children. Subjects and Methods : This cross-sectional study was conducted in Kassala city, in Eastern Sudan to investigate the caregivers′ care-seeking behaviour related to fever among children < 5 years. Data was collected by trained social workers using a structured questionnaire and was analysed by means of SPSS. Results: Three-hundred fifty housewives were interviewed. The majority (85.7%) had had at least basic education and 244 (69.7%) were full-time housewives. A total of 237 (67.7%) mothers were found to have adequate knowledge about malaria. Malaria was perceived by only 143 (40.9%) of the respondents as a cause of low grade fever and this percentage was almost doubled in the case of high fever. There were similar findings with respect to the selection of treatment sources and the use of antimalarial drugs. High fever urged 319 (91.1%) to seek advice from health workers and 281 (80.3%) to take drugs other than chloroquine. Conclusion: The intensity of fever (low/ high) governed the respondent′s perceived causes of fever, decision about available treatment options and the type of antimalarial drugs they used. Health education programmes should focus on the importance of seeking early advice, compliance with prescribed treatment and awareness and handling of danger signs before presenting at health facility.

Background: Malaria is one of the main health problems in the sub-Saharan Africa accounting for approximately 198 million morbidity and close to 600,000 mortality cases. Households incur out-of-pocket expenditure for treatment and lose income as a result of not being able to work or care for family members. The main objective of this survey was to assess the economic cost of treating malaria and/or fever with the new ACT to households in the Kintampo districts of Ghana where a health and demographic surveillance systems (KHDSS) are set up to document population dynamics. Methods: The study was a cross-sectional survey conducted from October 2009 to July 2011 using community members' accessed using KHDSS population in the Kintampo area. An estimated sample size of 4226 was randomly selected from the active members of the KHDSS. A structured questionnaire was administered to the selected populates who reported of fever within the last 2 weeks prior to the visit. Data was collected on treatment-seeking behaviour, direct and indirect costs of malaria from the patient perspective. Results: Of the 4226 households selected, 947 households with 1222 household members had fever out of which 92 % sought treatment outside home; 55 % of these were females. 31.6 % of these patients sought care from chemical shops. A mean amount of GHS 4.2 (US$2.76) and GHS 18.0 (US$11.84) were incurred by households as direct and indirect cost respectively. On average a household incurred a total cost of GHS 22.2 (US$14.61) per patient per episode. Total economic cost was lowest for those in the highest quintile and highest for those in the middle quintile. Conclusion: The total cost of treating fever/malaria episode is relatively high in the study area considering the poverty levels in Ghana. The NHIS has positively influenced health-seeking behaviours and reduced the financial burden of seeking care for those that are insured. [ABSTRACT FROM AUTHOR]

Background: A community-based malaria intervention was introduced through fixed and mobile clinics in rural Myanmar. This study attempted to identify treatment-seeking behaviour of caregivers for children under five and the determinants of appropriate treatment-seeking behaviour in mobile clinic villages (MV) and non-mobile clinic villages (NMV) in malaria-endemic rural areas in Myanmar. Methods: A cross-sectional study was conducted in 23 MV and 25 NMV in Ingapu Township, Myanmar. Appropriate treatment-seeking behaviour was operationally defined as seeking treatment from trained personnel or at a health facility within 24 hours after the onset of fever. Multiple logistic regression analyses were conducted to identify the determinants of appropriate treatment-seeking behaviour. Results: Among the 597 participants in both types of villages, 166 (35.3%) caregivers sought appropriate treatment. No significant difference in appropriate treatment-seeking behaviour was found between the two types of villages (adjusted odds ratio (AOR), 0.80; 95% confidence interval (CI), 0.51-1.24). Determinants of behaviour include proximity to public health facilities (AOR, 5.86; 95% CI, 3.43-10.02), knowledge of malaria (AOR, 1.90; 95% CI, 1.14-3.17), malaria prevention behaviour (AOR, 1.76; 95% CI, 1.13-2.76), treatment at home (AOR, 0.26; 95% CI, 0.15-0.45), and treatment and transportation costs (AOR, 0.52; 95% CI, 0.33-0.83). Conclusions: Caregivers' treatment-seeking behaviour was poor for fever cases among children under age five, and did not differ significantly between MV and NMV. It is necessary to educate caregivers, particularly for early treatment seeking and appropriate use of health care options for fever, and catering to their medical needs. These findings can help promote awareness and prevention, and improve the quality of interventions at the community level. [ABSTRACT FROM AUTHOR]

Background A community-based malaria intervention was introduced through fixed and mobile clinics in rural Myanmar. This study attempted to identify treatment-seeking behaviour of caregivers for children under five and the determinants of appropriate treatment-seeking behaviour in mobile clinic villages (MV) and non-mobile clinic villages (NMV) in malaria-endemic rural areas in Myanmar. Methods A cross-sectional study was conducted in 23 MV and 25 NMV in Ingapu Township, Myanmar. Appropriate treatment-seeking behaviour was operationally defined as seeking treatment from trained personnel or at a health facility within 24 hours after the onset of fever. Multiple logistic regression analyses were conducted to identify the determinants of appropriate treatment-seeking behaviour. Results Among the 597 participants in both types of villages, 166 (35.3%) caregivers sought appropriate treatment. No significant difference in appropriate treatment-seeking behaviour was found between the two types of villages (adjusted odds ratio (AOR), 0.80; 95% confidence interval (CI), 0.51-1.24). Determinants of behaviour include proximity to public health facilities (AOR, 5.86; 95% CI, 3.43-10.02), knowledge of malaria (AOR, 1.90; 95% CI, 1.14-3.17), malaria prevention behaviour (AOR, 1.76; 95% CI, 1.13-2.76), treatment at home (AOR, 0.26; 95% CI, 0.15-0.45), and treatment and transportation costs (AOR, 0.52; 95% CI, 0.33-0.83). Conclusions Caregivers' baseline treatment-seeking behaviour was poor for fever cases among children under age five, and did not differ significantly between MV and NMV. It is necessary to educate caregivers, particularly for early treatment seeking and appropriate use of health care options for fever, and catering to their medical needs. These findings can help promote awareness and prevention, and improve the quality of interventions at the community level. [ABSTRACT FROM AUTHOR]

Background: Community-based health insurance has been associated with increased hospitalisation in low-income settings, but with limited analysis of the illnesses for which claims are submitted. A review of claims submitted to VimoSEWA, an inpatient insurance scheme in Gujarat, India, found that fever, diarrhoea and hysterectomy, the latter at a mean age of 37 years, were the leading reasons for claims by adult women. We compared the morbidity, outpatient treatment-seeking and hospitalisation patterns of VimoSEWA-insured women with uninsured women. Methods: We utilised data from a cross-sectional survey of 1,934 insured and uninsured women in Gujarat, India. Multivariable logistic regression identified predictors of insurance coverage and the association of insurance with hospitalisation. Self-reported data on morbidity, outpatient care and hospitalisation were compared between insured and uninsured women. Results: Age, marital status and occupation of adult women were associated with insurance status. Reported recent morbidity, type of illness and outpatient treatment were similar among insured and uninsured women. Multivariable analysis revealed strong evidence of a higher odds of hospitalisation amongst the insured (OR = 2.7; 95% ci. 1.6, 4.7). The leading reason for hospitalisation for uninsured and insured women was hysterectomy, at a similar mean age of 36, followed by common ailments such as fever and diarrhoea. Insured women appeared to have a higher probability of being hospitalised than uninsured women for all causes, rather than specifically for fever, diarrhoea or hysterectomy. Length of stay was similar while choice of hospital differed between insured and uninsured women. Conclusions: Despite similar reported morbidity patterns and initial treatment-seeking behaviour, VimoSEWA members were more likely to be hospitalised. The data did not provide strong evidence that inpatient hospitalisation replaced outpatient treatment for common illnesses or that insurance was the primary inducement for hysterectomy in the population. Rather, it appears that VimoSEWA members behaved differently in deciding if, and where, to be hospitalised for any condition. Further research is required to explore this decision-making process and roles, if any, played by adverse selection and moral hazard. Lastly, these hospitalisation patterns raise concerns regarding population health needs and access to quality preventive and outpatient services. [ABSTRACT FROM AUTHOR]

A small-scale research/intervention project that aimed to develop and test an integrated package of communication campaign on health awareness among women belonging to the marginalized community was implemented in an underdeveloped setting of West Bengal, India during 2010–11. A quasi-experimental research design, with cross-sectional surveys conducted in six intervention and control villages at the baseline and endline, was used to evaluate the outcome of intervention among 1,196 respondents. This article examines the impact of behaviour change communication intervention on knowledge, reporting of illnesses and treatment-seeking of symptoms of general and gynaecological morbidity. Analyses included multiple, binary logistic and multinomial logistic regressions using a Difference-in-Difference estimator. Results of the evaluation suggest that the net effect of exposure to the intervention had a positive and significant impact on most of the indicators reflecting an increased level of awareness about signs and symptoms of general and reproductive complications. However, the net effect of exposure was mixed for the indicators of reporting of illnesses, pattern and sources of seeking treatment. The experience of implementing the project demonstrates that it is possible to improve women’s general and reproductive health awareness and practices which could have resulted in positive health outcomes in the long run. [ABSTRACT FROM PUBLISHER]

Background: In Southeast Asia, data on malaria treatment-seeking behaviours and related affecting factors are rare. The population of the Wa ethnic in Myanmar has difficulty in accessing formal health care. To understand malaria treatment-seeking behaviour and household-affecting factors of the Wa people, a cross-sectional study carried out in Shan Special Region II, Myanmar. Methods: The two methods, questionnaire-based household surveys to household heads and in-depth interviews to key informants, were carried out independently. The proportion of treatment-seeking patterns was calculated. Logistic regression was used to determine affecting factors of treatment-seeking. Qualitative data were analysed by using Text Analysis Markup System. Results: Overall, 87.5% of the febrile population sought treatment, but only 32.0% did so within 24 hours. The proportion accessing the retail sector (79.6%) was statistically significant higher (P<0.0001) than accessing the public sector (10.6%). Multivariable logistic regression analysis identified family income, distances from a health facility, family decision and patient characteristics being independently associated with delayed malaria treatment. Conclusion: Malaria treatment-seeking behaviour is not appropriate, and affecting factors include health service systems, social and cultural factors in Wa State of Myanmar. [ABSTRACT FROM AUTHOR]

Background: Appropriate case management of suspected malaria in Cambodia is critical given anti-malarial drug resistance in the region. Improving diagnosis and the use of recommended malarial treatments is a challenge in Cambodia where self-treatment and usage of drug cocktails is widespread, a notable difference from malaria treatment seeking in other countries. This qualitative study adds to the limited evidence base on Cambodian practices, aiming to understand the demand-side factors influencing treatment-seeking behaviour, including the types of home treatments, perceptions of cocktail medicines and reasons for diagnostic testing. The findings may help guide intervention design. Methods: The study used in-depth interviews (IDIs) (N = 16) and focus group discussions (FGDs) (N = 12) with Cambodian adults from malaria-endemic areas who had experienced malaria fever in the previous two weeks. Data were analysed using NVivo software.Results: Findings suggest that Cambodians initially treat suspected malaria at home with home remedies and traditional medicines. When seeking treatment outside the home, respondents frequently reported receiving a cocktail of medicines from trusted providers. Cocktails are perceived as less expensive and more effective than full-course, pre-packaged medicines. Barriers to diagnostic testing include a belief in the ability to self-diagnose based on symptoms, cost and reliance on providers to recommend a test. Factors that facilitate testing include recommendation by trusted providers and a belief that anti-malarial treatment for illnesses other than malaria can be harmful. Conclusions: Treatment-seeking behaviour for malaria in Cambodia is complex, driven by cultural norms, practicalities and episode-related factors. Effective malaria treatment programmes will benefit from interventions and communication materials that leverage these demand-side factors, promoting prompt visits to facilities for suspected malaria and challenging patients' misconceptions about the effectiveness of cocktails. Given the importance of the patient-provider interaction and the pivotal role that providers play in ensuring the delivery of appropriate malaria care, future research and interventions should also focus on the supply side factors influencing provider behaviour. [ABSTRACT FROM AUTHOR]

This paper examines the influence of social perceptions of medical specialists in the management of infertility and the extent to which they find infertility to be a social rather than a purely medical problem. Five doctors trained in the modern scientific (allopathic) system of medicine and having long experience of clinical practice, particularly in relation to infertility, were interviewed in-depth. The results uncover two factors associated with infertility: (i) it is a unique medical problem in which the 'patient' is a unit of two dissimilar individuals - the husband and the wife, and (ii) it now tends to be more and more a disease of lifestyle. Some suggestions emerge that could help in the overall management of infertility, complimenting rapid medical advances occurring in this field. These include education in reproductive health, a gender-neutral doctorpatient relationship, checking unfair competition and malpractices in rural areas, and advocacy for adoption [ABSTRACT FROM AUTHOR]

In Bangladesh, the formal public health system provides few services for common sexual and reproductive health problems such as white discharge, fistula, prolapse, menstrual problems, reproductive and urinary tract infections, and sexual problems. Recent research has found that poor women and men resort to informal providers for these problems instead. This paper draws on interviews with 303 providers and 312 women from two rural and one urban area of Bangladesh from July 2008 to January 2009. Both informal and formal markets played an important role in treating these problems, including for the poor, but the treatments were often unlikely to resolve the problems. Providers ranged from village doctors without formal training to qualified private practitioners. The health system is heavily marketised and boundaries between "public" and "private" are blurred. There exists a huge, neglected domain of sexual and reproductive health needs which are a source of silent suffering and for which there are no trained health staff providing treatment in government facilities. The complexity of this situation calls for engaged debate in Bangladesh on how to improve the quality of existing services, discourage or prevent obviously harmful practices, and develop financing mechanisms to enable women to access effective treatment, regardless of the source, for these neglected problems. Au Bangladesh, le système de santé officiel s'occupe peu des affections de santé génésique courantes, comme les pertes blanches, les fistules, les prolapsus, les problèmes menstruels, les infections de l'appareil génital et urinaire et les troubles sexuels. Des recherches récentes ont révélé que les femmes et les hommes pauvres s'adressent à des prestataires informels pour ces problèmes. L'article se fonde sur des entretiens avec 303 prestataires et 312 femmes de deux zones rurales et d'une zone urbaine du Bangladesh, de juillet 2008 à janvier 2009. Les marchés formels et informels jouaient tous deux un rôle important, notamment pour les pauvres, mais les traitements avaient peu de chances de résoudre ces problèmes. Les prestataires allaient de médecins villageois sans formation officielle à des praticiens privés qualifiés. Le système de santé est fortement influencé par les lois du marché et les frontières entre le « public » et le « privé » sont floues. Il existe un vaste domaine négligé de besoins de santé génésique qui sont une source de souffrances silencieuses et pour lesquels on ne dispose pas de personnel de santé formé à traiter les patientes dans les centres gouvernementaux. La complexité de la situation nécessite un débat engagé au Bangladesh pour trouver comment améliorer la qualité des services, décourager ou prévenir les pratiques manifestement dangereuses et créer des mécanismes de financement qui donneront accès aux femmes à un traitement efficace, quelle qu'en soit la source, de ces problèmes oubliés. En Bangladesh, el sistema oficial de salud pública ofrece pocos servicios para problemas comunes de salud sexual y reproductiva como secreción blanca, fistula, prolapso, problemas menstruales, infecciones del tracto reproductivo y de las vías urinarias y problemas sexuales. En recientes investigaciones se ha encontrado que las mujeres y los hombres pobres recurren a prestadores de servicios extraoficiales para resolver estos problemas. Este artículo se basa en entrevistas con 303 prestadores de servicios y 312 mujeres de dos zonas rurales y una urbana, en Bangladesh, desde julio de 2008 hasta enero de 2009. Ambos el mercado oficial y el extraoficial desempeñaron un papel importante para tratar estos problemas, incluso para gente pobre, pero a menudo resultó improbable resolver los problemas con sus tratamientos. Entre los prestadores de servicios figuraban desde médicos del pueblo sin formación académica hasta practicantes particulares calificados. El sistema de salud es muy comercializado y la línea divisoria entre los sectores "público" y "privado" es borrosa. Existe una enorme gama de necesidades desatendidas de salud sexual y reproductiva que son una fuente de sufrimiento silencioso y para las cuales no hay personal de salud capacitado ofreciendo tratamiento en unidades gubernamentales. Esta compleja situación en Bangladesh requiere un debate abierto sobre cómo mejorar la calidad de los servicios actuales, impedir o poner freno a las prácticas obviamente dañinas y crear mecanismos de financiamiento para que las mujeres tengan acceso a tratamientos eficaces, independientemente de la fuente, para estos problemas desatendidos. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study examines perceptions of infertility causes, treatment-seeking behaviour and factors associated with seeking medical care in an urban infertile population in Rwanda, as well as the response of health providers. [ABSTRACT FROM PUBLISHER]

Background. In Papua New Guinea (PNG) there continues to be considerable interest in developing a health system that incorporates both traditional and western medicine. A policy on traditional medicine has recently been endorsed. Simultaneously, there is limited information about the traditional beliefs and practices that influence treatment-seeking behaviour. Aim of the study. A case study among the Nasioi people of Bougainville was conducted to gather information that could help to inform the implementation of the National Policy on Traditional Medicine for PNG. Research objectives. The main objective of the case study was to describe how health knowledge and belief systems influence treatment-seeking behaviour, specifically in relation to the use of traditional and western health care systems. The study also sought to develop an explanatory model for decision-making responses to febrile illnesses and skin conditions. Methodology. By using a non-experimental, cross-sectional study design and focused ethnographic approach, a sample of 200 Nasioi community members were interviewed by Nasioi-speaking research assistants. Results. The study found that people in the sample group subscribe to both traditional and western medical paradigms. Western medical concepts have been assimilated but have not displaced traditional understanding of illness. There was congruence between beliefs about causes of illness, treatment-seeking responses to illness and stated or hypothetical preferences for traditional or western medicine. Data obtained in each of these domains reflect concepts of illness derived from both medical paradigms and demonstrate participants' confidence in the efficacy of both traditional and western medicine. Conclusions. It is proposed that a health system that incorporates traditional medicine may be better aligned with people's concepts of illness than the current system. Because it is more consistent with Nasioi concepts of illness, an incorporated health system may lead to more appropriate health service utilisation and, ultimately, to improvements in population health status. [ABSTRACT FROM AUTHOR]

The study highlights net effects of selected socio-economic, demographic and cultural factors on the prevalence and treatment-seeking behaviour for reproductive morbidity in India on the basis of self-reported reproductive health problems elicited from 84,862 currently married women aged 15-49 in the second National Family Health Survey, 1998-1999 (NFHS-2). Information was elicited on treatment sought, if any, from private or public health service providers from 34,034 women suffering from reproductive tract infections (RTIs). The study employed binary and multinomial logit regression techniques for respectively analysing prevalence and treatment-seeking behaviour. The prevalence of RTIs in India is quite high (40 per cent) and the treatment-seeking is extremely low (33 per cent). Usage of female sterilization and Intra-Uterine Device (IUD) significantly compounds the reproductive morbidity in India, possibly because of negligence in post-operative or post-insertion care. Women suffering from abdominal pain or intercourse-related complications have a higher likelihood of seeking treatment for RTIs. [ABSTRACT FROM AUTHOR]

In South Africa, in 2005–06, 100% of primary health care clinics in South Africa had health professionals trained to conduct Pap smears, yet the screening rate was only 1.3% and one in 26 women develop cervical cancer during their lifetime. Many women admitted to oncology wards are at such an advanced stage of disease that palliation is the only treatment option left. The purpose of this qualitative study in 2007, using semi-structured interviews with 15 women with advanced cervical cancer, was to understand the routes they followed from first signs and symptoms of disease to receiving treatment. The willingness of the women to be diagnosed was a positive finding of the study. The women did seek treatment, often more than once, and were not solely responsible for presenting late. The average number of months from first contact with a health care professional until diagnosis was 17.3, ranging from 11.8 months for urban participants to 28.4 months for rural participants, and three to seven months from diagnosis to referral for treatment. Lack of knowledge and awareness among health care professionals resulted in a low suspicion of cancer and misdiagnosis. A national cervical cancer strategy, including health education and re-training of health professionals, should be made a priority. En 2005–06, 100% des dispensaires de soins de santé primaires sud-africains disposaient de personnel formé aux frottis, pourtant le taux de dépistage n'était que de 1,3% et une femme sur 26 développe un cancer du col de l'utérus pendant sa vie. Beaucoup des femmes hospitalisées en oncologie sont à un stade si avancé de la maladie que des soins palliatifs sont la seule option. L'objet de cette étude qualitative, menée au cours d'entretiens semi-structurés avec 15 femmes présentant un cancer avancé du col de l'utérus, était de comprendre leur cheminement depuis les premiers signes de la maladie jusqu'au traitement. L'une des conclusions positives de l'étude est que les femmes souhaitaient être diagnostiquées. Elles avaient bien demandé un traitement, souvent à plusieurs reprises, et n'étaient pas seules responsables de leur présentation tardive. Le nombre de mois depuis le premier contact avec un soignant jusqu'au diagnostic était en moyenne de 17,3 (11,8 mois pour les participantes urbaines et 28,4 mois pour les rurales), et de trois à sept mois depuis le diagnostic jusqu'à l'aiguillage vers un traitement. Le manque de connaissances et la sensibilisation insuffisante des soignants ont abouti à une faible suspicion de cancer et à un diagnostic erroné. Une stratégie nationale en matière de cancer du col de l'utérus, avec notamment des programmes d'éducation sanitaire et de recyclage des professionnels de santé, devrait être prioritaire. En Sudáfrica, en 2005–06, el 100% de las clínicas de primer nivel de atención tenían profesionales de la salud capacitados para realizar la prueba de Papanicolaou, pero la tasa de tamizaje era sólo del 1.3% y una de cada 26 mujeres presenta cáncer cervical durante su vida. Muchas mujeres admitidas en los pisos de oncología presentan una etapa tan avanzada de enfermedad, que la paliación es la única opción de tratamiento posible. El propósito de este estudio cualitativo en 2007, que utilizó entrevistas semiestructuradas con 15 mujeres con cáncer cervical avanzado, era entender las rutas que siguieron desde los primeros signos y síntomas de enfermedad hasta el tratamiento recibido. La buena voluntad de las mujeres para ser diagnosticadas fue un resultado positivo del estudio. Las mujeres buscaron tratamiento, a menudo más de una vez, y no eran las únicas responsables de presentarse tarde. El número promedio de meses desde el primer contacto con un profesional de la salud hasta el diagnóstico fue de 17.3, variando desde 11.8 meses para las participantes urbanas hasta 28.4 meses para las rurales, y tres a siete meses desde el diagnóstico hasta la referencia para el tratamiento. La falta de conocimiento y conciencia entre los profesionales de la salud resultó en baja sospecha de cáncer y diagnóstico errado. Se debe dar prioridad a una estrategia nacional de cáncer cervical, que incluya educación sobre la salud y la re-capacitación de los profesionales de la salud. [ABSTRACT FROM AUTHOR]

Summary: Studies of factors affecting treatment-seeking behaviour for malaria have rarely considered the influence of gender roles and relations within the household. This study supported district-level government workers in the Volta Region of Ghana in conducting a situational analysis of gender inequities in relation to the malaria burden and access to healthcare services for malaria in one community in their district. Qualitative and participatory methods, such as focus group discussions, in-depth individual interviews and ranking exercises, were used. The study found that women who lacked either short- or long-term economic support from male relatives, or disagreed with their husbands or family elders about appropriate treatment-seeking, faced difficulties in accessing health care for children with malaria. This illustrates the significant influence of women''s access to resources and decision-making power on treatment-seeking behaviour for children with febrile illnesses, and the importance of approaching malaria management in the community or household from a gender perspective. [Copyright &y& Elsevier]

Abstract: Recent large-scale studies have revealed that approximately one third of the adult, community-dwelling women have some form of urinary incontinence (UI). Stress urinary symptoms are most prevalent, being apparent in 70%–88% of incontinent women, either as pure stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). SUI continues to remain a taboo, though, with only a minority of incontinent women consulting a doctor about their problem. Reasons for these low consultation rates include shame and embarrassment, lack of information about available treatment options, fear for surgery and the misconception that becoming incontinent is an inevitable consequence of age and/or giving birth. Yet, most SUI patients indicate that the condition has a negative impact on their well-being. However, even among those looking for help, treatment rates remain low. Hence, most SUI patients suffer in silence and try to cope with it themselves by using pads or panty liners, restricting fluid intake, avoiding social activities and limiting physical exercise. Recent developments of treatment options including a new pharmacological agent to alleviate SUI symptoms have good potential for treating these women, provided that awareness is raised in patients and physicians on the high prevalence, bothersomeness and treatment options of SUI. [Copyright &y& Elsevier]

The purpose of this study was to investigate illness experiences of patients after a first myocardial infarction (MI), focusing on life situation and the recovery process over time. Thirty patients were interviewed within the first 3 days of hospitalisation, and again 17 weeks after discharge. The interviews were tape-recorded verbatim and the transcriptions were analysed and categorised using qualitative content analysis. The main category was Uncertainty of the life situation that was combined with and articulated the superior theme in both interviews. Analyses revealed uncertainty focused on problems related to: treatment-seeking behaviour; existential threat; preventing another coronary and need for knowledge and support, which the patients considered important for their case and future life. The findings are fundamental for the health care when education and counselling are planned and challenge health care personnel to listen to MI-patients’ own experiences. [Copyright &y& Elsevier]

Objective: To describe the pattern of fever-associated morbidity, treatment-seeking behaviour for fever episodes, and cause-specific mortality in young children of a malaria-holoendemic area in rural Burkina Faso.Methods: In a longitudinal community-based intervention study, 709 representative children aged 6-31 months were followed daily over 6 months (including the main malaria transmission period) through village-based field staff.Results: Of 1848 disease episodes, 1640 (89%) were fever episodes, and of those, 894 (55%) were attributed to malaria (fever + > or =5000 parasites/microl). Eighty-five percent of fever episodes were treated, mainly with chloroquine and paracetamol, 69% of treatments took place in households, 16% in local health centres, 13% in villages, and 1% in hospitals. Treatment-seeking in a health centre or hospital was associated with accessibility and disease severity. Cerebral malaria and malnutrition-associated diarrhoea were the most frequently diagnosed causes of death. While most children with a post-mortem diagnosis of diarrhoea had not received any treatment, children who died of malaria had often received insufficient treatment. In particular, there was a lack of an appropriate second-line treatment at formal health services after chloroquine treatment had failed to resolve symptoms.Conclusions: These findings call for more effective prevention and treatment of malaria, malnutrition and diarrhoea in rural African communities, as well as for better supervision of existing malaria treatment guidelines in formal health services. [ABSTRACT FROM AUTHOR]

Community-based health insurance (CBHI) may be a mechanism for improving the quality of health care available to people outside the formal sector in developing countries. The purpose of this paper is to identify problems associated with the quality of hysterectomy care accessed by members of SEWA (Self-Employed Women's Association), an Indian CBHI scheme, and discuss mechanisms that would optimize quality of care. Data on hysterectomy care were collected through a review of 63 insurance claims and semi-structured interviews with 12 providers. Quality of hysterectomy care accessed by SEWA's members varied from potentially dangerous to excellent. Dangerous conditions included operating theatres without separate hand-washing facilities or proper lighting, the absence of qualified nursing staff, performing hysterectomy on demand, removing both ovaries without consulting or notifying the patient, and failing to send the excised organs for histopathology, even when signs were suggestive of disease. Women paid substantial amounts of money, even for poor and potentially dangerous care. In order to improve the quality of care for its members, a CBHI scheme can: (1) gather data on the costs and complications for each provider, and investigate where these are excessive; (2) use incentives to encourage providers to make efficient and equitable resource allocations; (3) contract with providers giving a high standard of care or who agree to certain conditions; and (4) inform and advise doctors and the insured about the costs and benefits of different interventions. In the case of SEWA, it is most feasible to identify a limited number of hospitals providing better quality care and contract directly with them. L'assurance maladie communautaire (AMC) peut améliorer la qualité des soins dans les pays en développement. Cet article identifie les problèmes associés à l'hystérectomie chez les membres de l'Association des travailleuses indépendantes (SEWA), un projet indien d'AMC, et examine les mécanismes qui optimiseraient la qualité des soins. Les données ont été recueillies en étudiant 63 demandes de remboursement et lors d'entretiens semi-structurés avec 12 prestataires. Les soins dispensés aux membres de la SEWA sont qualifiés de potentiellement dangereux à excellents. Parmi les situations dangereuses, des salles d'opération sans installations séparées pour se laver les mains ou sans éclairage suffisant, l'absence de personnel infirmier qualifié, des hystérectomies sur demande, l'ablation des deux ovaires sans consulter la patiente, et négliger d'envoyer les organes retirés pour histopathologie, même en présence de signes de maladie. Les femmes avaient payé de fortes sommes, même pour des soins médiocres et potentiellement dangereux. Afin d'améliorer les soins pour ses membres, un projet d'AMC peut: (1) recueillir pour chaque prestataire des renseignements sur les coûts et les complications, et déterminer où ils sont excessifs; (2) encourager les prestataires à allouer les ressources équitablement et efficacement; (3) passer des contrats avec des prestataires assurant un niveau élevé de soins ou qui acceptent certaines conditions; et (4) informer les médecins et les assurés des coûts et des avantages de différentes interventions. La SEWA peut identifier un nombre limité d'hôpitaux dispensant des soins de qualité et les prendre sous contrat. Este artı́culo identifica ciertos problemas relacionados con la calidad de la atención de histerectomı́a a que tenı́an acceso las socias de la Asociación de Trabajadoras Independientes (SEWA) – un plan de salud comunitario en la India. Después de revisar 63 solicitudes de reembolso, y entrevistar a 12 prestadores de servicios, se concluyó que la calidad de atención para esta intervención variaba desde potencialmente peligrosa hasta excelente. Entre las condiciones peligrosas se incluı́an la falta de iluminación apropiada en los quirófanos, y de instalaciones aparte para lavarse las manos; la ausencia de enfermeras calificadas; y la extirpación de ambos ovarios sin consultar ni notificar a la paciente. Además no siempre se sometı́an los órganos extirpados a exámenes histopatológicos, aun cuando presentaran signos de enfermedad. Las mujeres pagaron sumas altas, aun cuando la atención estuviera deficiente y potencialmente peligrosa. Para mejorar la calidad de atención que reciban sus socios, un seguro de salud comunitario puede (1) recolectar datos sobre los costos y complicaciones correspondientes a cada prestador de servicios, e investigar aquellos que sean excesivos; (2) ofrecer incentivos que animen a los prestadores de servicios a utilizar los recursos asignados eficiente y equitativamente; (3) contratar a los profesionales de la salud que ofrecen servicios de alta calidad o se comprometen a cumplir ciertas condiciones; (4) informar y orientar tanto a los médicos como a los asegurados acerca de los costos y beneficios de las distintas intervenciones. [ABSTRACT FROM AUTHOR]

Background: For the past 18 years, northern Sri Lanka has been affected by armed ethnic conflict. This has had a heavy impact on displacement of civilians, health delivery services, number of health professionals in the area and infrastructure. The north of Sri Lanka has a severe malaria burden, with less than 5% of the national population suffering 34% of reported cases. Health care providers investigated treatment-seeking behaviour and levels of treatment failure believed to be the result of lack of adherence to treatment.Methods: Pre- and post-treatment interviews with patients seeking treatment in the outpatient department (OPD) and focus groups.Results: A total of 271 persons completed interviews: 54.4% sought treatment within 2 days of the onset of symptoms, and 91.9% self-treated with drugs with prior to seeking treatment, mainly with paracetamol. Self-treatment was associated with delaying treatment (RR 3.55, CI 1.23-10.24, P=0.002). In post-treatment interviews, self-reported default was 26.1%. The main reasons for not taking the entire regimen were side-effects (57.6%) and disappearance of symptoms (16.7%). Focus groups indicated some lack of confidence in chloroquine treatment and prophylaxis, and scant enthusiasm for prevention methods.Conclusions: A number of factors contribute to a lack of access and a lower quality of care for malaria: lack of medical staff and facilities because of the fighting; lack of confidence in treatment, and perception of malaria as a routine illness. Prevention efforts need to take into account certain beliefs and practices to be successful. [ABSTRACT FROM AUTHOR]